Lip lipofilling – augmentation with your own fat. Photos, reviews and prices. How long does the result last?

Female beauty becomes a small key that can open the biggest doors. Every part of a woman's body makes a man feel interested in the whole feminine essence. An attractive appearance becomes an indestructible bridge to her inner wealth, and the alluring pomp and richness of her lips make her uniquely sensual in men’s eyes.

Lips are a guide to the sensual world of passion. Looking at the appetizing female lips, one imagines a red raspberry, just as ripe and fragrant. Someone managed to become lucky with natural talent, but there are cases when natural beauty requires intervention. Thanks to plastic surgery, thin and lacking volume lips that do not have an attractive shape will take on new shapes and be filled with vital freshness.

Injection procedures using various drugs are used mainly to add missing volume. Among them, there is an increase in lip volume through the introduction of one’s own fat, which is called lipofilling.

Photo of lip lipofilling

You can see photos of lip lipofilling on the website of the Abrielle plastic surgery clinic in the Photo Gallery section.

What is facial lipofilling

Fat grafting (fat grafting) is a procedure for transplanting fat cells from one area to another. This is a full-fledged plastic surgery, but without large incisions, which is usually performed in a standard operating room using anesthesia. And when I read on sites with similar topics that fat grafting is not an operation, I experience professional indignation. I instill in my patients a serious approach to this method of rejuvenation and urge them to follow all stages of preoperative preparation and the recovery period.

To carry out a transplant, fat is taken from the donor area (most often the abdomen), which is cleaned and processed in a special way. Obtaining “sterile” fat requires special skills and specialized equipment. High-quality preparation of biomaterial affects the survival rate of fat and the success of rejuvenation.

Then the resulting emulsion is injected with special cannulas into areas on the face.

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Contraindications for lipofilling of the labia majora

Blood diseases, including bleeding disorders.
Exacerbation of chronic diseases, liver, kidney and heart failure.
Sexual and other infections.
Pregnancy, regardless of duration.
Oncological processes in the body.
The presence of another filler in the labia majora - hyaluronic acid, fillers. You need to wait until they dissolve and leave the body.
Age less than 18 years - plastic surgery is done only after adulthood, as it can damage the development of the genital organs.
Feeling unwell, high temperature.
Menstruation, postpartum period, recent gynecological operations.

For a number of diseases of internal organs, as well as for metabolic disorders, for example, diabetes, surgery is performed only after consultation with the attending physician.

Photos "Before" and "After"

See more “Before” and “After” photos

TOP 7 main indications for surgery

Globally, the use of the patient’s own fat solves two problems: modeling facial contours and rejuvenation.

Chin augmentation and modeling
Increasing the volume of the cheekbones
Lip augmentation
Filling nasolabial folds
Lower eyelid correction
Correction of facial asymmetry
Scar correction

The age of the patient in this case does not matter. The condition of the tissue and objective indications for surgery are important to the specialist.

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Installation of implants

A rather rare and radical method of lip augmentation. It involves installing implants made of synthetic or natural materials under the skin of the lips. The operation takes about 30 minutes and can even be performed under local anesthesia.

Synthetic implants are made primarily from silicone. This is a hypoallergenic material that does not decompose in the body. The main disadvantage of the procedure is the excessive density of the upper lip, which can cause some discomfort. The result of the procedure is lifelong, but within a year the implant grows into the soft tissue, and the effect of lip augmentation is noticeably reduced.

Implants made from natural materials are made from your own tissue taken from the groin area. The patient is left with a small scar at the site of tissue collection, but this method guarantees 100% absence of implant rejection.

What you should know about your own fat

Let this paragraph be a fly in the ointment, but I consider it my duty to warn patients about the difficulties that fat rejuvenation poses. My approach is true.

Biodegradation (resorption) of transplanted fat. This is an absolutely normal recovery process. Some cells do not take root and seem to “go away”. Therefore, the patient may require re-correction.
Asymmetry. Consequence of tissue resorption. The volume decreases somewhat and there is a risk that this will not happen evenly. It can also be corrected by repeated correction.
Irregularities on the skin . This can be for two reasons: fibrosis (when adipose tissue is replaced by connective fibers) or the formation of fatty cysts (when a very large volume of biomaterial is introduced).
Fat migration . Fat moves and collects in compacted areas - oleogranulomas.

I publish this information not with the goal of “dissuading” from surgical intervention, but to understand the seriousness of the operation and a thorough approach to choosing a clinic and specialist! I repeat: rejuvenation with lipofilling is an operation with all the attendant nuances.

⇒ READ ALSO: How long does the effect of lipofilling last?

Temporal lifting, circular blepharoplasty, lipofilling of the forehead, cheekbones and nasolabial folds

Features of the procedure

Fat grafting is performed under sterile conditions under local anesthesia. The doctor uses a thin needle to remove the patient's own fat tissue. For better separation of adipose tissue, Klein's solution is injected, which contains adrenaline, lidocaine, and saline solution. The adipose tissue is freed from blood, anesthetic and other impurities using a filter and centrifuge. Then the autograft is inserted into the patient’s lips and their pre-agreed shape and size is formed.

Possible complications:

bleeding during the procedure;
strong pain;
swelling around the lips;
deformation and asymmetry;
hematomas;
infectious process at the injection site.

Facelift and fat grafting

This is the most common facial rejuvenation combination in my practice. Fat injection is the ideal completion of SMAS lifting. I understand that my work is 100% done when, after stretching the tissues, I create volumes of youth.

Three main goals that an aesthetic medicine specialist sets for himself:

Return soft tissues to the position characteristic of a youthful face
Excise excess stretched skin
Fill areas where volume is expected (cheekbones, temples, chin)

By facial rejuvenation by a surgeon, we are accustomed to understanding tissue tension. But this is only part of the process.

Circular blepharoplasty and lipofilling of the forehead, cheekbones, and temporal area

Why do I recommend fat grafting to almost all patients who decide to undergo a facelift?

Facial aging is expressed not only in atrophy and downward movement of tissue (which is what patients most often pay attention to, since these changes are most noticeable), but also in resorption of the bones of the skull.

Bone resorption is essentially resorption. Visually, the bones become smaller and flattened. The face becomes as if flat. Therefore, in areas where there is a decrease in volume due to bone resorption and soft tissue atrophy, it is important to inject your own fat.

These are the following areas on the face:

Cheekbones
Chin
In some cases whiskey

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Lipofilling of the buttocks

In buttock enlargement, lipofilling played almost a greater role than in breast enlargement. The fact is that the buttock implant leads to gradual atrophy of the muscle located above it and becomes visible. In addition, the volume of the buttocks decreases again due to a decrease in the volume of the muscle, which has atrophied under the pressure of the implant. Lipofilling, which allows you to increase the layer of subcutaneous fat above the implant and hide it, opens up the possibility of installing the implant under the fascia, which does not lead to thinning of the muscle and reduces postoperative pain.

Lipofilling eyelids

This technique rejuvenates the area around the eyes. It is used for both the upper and lower eyelids. In what cases is this procedure indicated:

lack of volume in the area of the upper or lower eyelids
eyelid asymmetry
Recession of the lower eyelids after blepharoplasty
pronounced nasolacrimal groove

As you age, fat thins out and moves downward. Because of this, the eyes seem constantly tired. The injected fat creates volumes characteristic of youth.

Lipofilling of the eyelids is most often combined with surgical blepharoplasty. The surgeon excises excess stretched skin and partially removes contouring hernias. After such manipulations, it becomes necessary to add volume to the area of the upper fixed eyelid and lower eyelid.

After removing hernias under the eyes, after some time, patients experience “recession” of the eyelid. For this purpose, a procedure can be performed to fill the lower eyelid with fat.

Correction of the nasolacrimal trough with fat gives excellent results! A pronounced furrow is a problem for many people, even young people under 30 years of age. Modern aesthetic medicine has in its arsenal several methods of working with this very delicate and complex area: injection of filler or injection of adipose tissue. Fat smoothes the contours and rejuvenates the eyelid.

I actively use the technique of rejuvenating the area around the eyes with the patient’s own fat and believe that in combination with classic blepharoplasty, this approach gives excellent results.

⇒ INFORMATION: Causes of wrinkles and ways to eliminate them

Lipofilling of lips

An alternative to the well-known method of lip augmentation using hyaluronic acid fillers.

Indications are the same as when using cosmetic preparations:

insufficient volume
asymmetry
age-related changes: wrinkles, loss of contours

Benefits of lip augmentation with fat

prolonged result. The fat is partially resorbed, but the engrafted cells remain forever. Therefore, we can talk about the lifelong effect of the procedure.
no allergies or rejections. Hyaluronic acid gel is a foreign body. The risk of an allergic reaction cannot be denied. Fat is absolutely biocompatible.

Technically, this procedure is more complicated than the usual contouring with hyaluronic acid. It is not advisable to carry out lip correction with fat independently. Within the framework of extended fat grafting (when several zones are corrected at once), this is appropriate and justified.

If you are on this page, then you are interested in learning more about cheiloplasty. Cheiloplasty is a general concept for all plastic surgeries on the lips. Dr. Guryanov performs all known operations to correct the shape and volume of the lips. You can be sure that you are in the hands of an excellent surgeon with extensive experience if you choose VIP STUDIO. Basically, people come to the doctor to solve problems that could be divided into 4 main groups:

INCREASE IN LIPS VOLUME.

Young girls often come to Dr. Guryanov with a request to make their lips plumper. In his studio, the doctor offers several options on how to solve this problem. And at the first consultation you will have an accurate idea of which method is right for you. However, before your first visit, it would be interesting to learn about methods that help achieve the desired lip volume.

Fillers.

Increasing the volume of the red border is the most common procedure. Most often, the volume of the upper lip is increased. To increase the volume of one or another part of the lips, injectable fillers are most often used. The most popular derivatives of hyaluronic acid (Resteline, Restylane, Surgiderm, etc.) are absorbed after 6-12 months. With their help, you can either enlarge the central or lateral parts of the lip, or emphasize the white ridge and edges of the philtrum. The latest technique is called Parisian lips. Parisian lips were developed and presented in Paris by Lauren Bacall for the spring of 1991 as a gentle, more natural look than the protruding full lips of high fashion models of the late 80s. This is a new style that emphasizes the border of the upper lip, mainly in its central part, called Cupid's bow (arch) so that the lip has a stylish, well-defined appearance. The Paris Lip technique gives you a more expressive appearance by outlining the natural shape of your lips along their border.

Parisian lips outline the border and recreate a natural contour even without lipstick. Not surprisingly, it is enthusiastically received by both 25-year-olds who want a modern, fashionable appearance, and 45-year-olds who restore the natural youthfulness of their lips.

Parisian lips are formed by precisely introducing fillers along the contour of the lip and emphasizing Cupid's Bow. Most often, fillers based on hyaluronic acid are used for this, which provide an effect of up to 1 year. Creating an even lip contour requires good medical skills. The outline may turn out to be intermittent, of uneven thickness or insufficient height; if it is filled too much, the outline may become blurry. This can be avoided by using AlloDerm® thread.

Fillers are very convenient as they give excellent results without any difficulties. It is quite quick, easy and convenient, without any lengthy rehabilitation periods, however, the fillers dissolve. And you will have to constantly add fillers to maintain the desired lip volume.

Lips can be enlarged using your own tissue. Your own fat (lipofilling) or strips of your own tissue (autografting) can be transplanted into your lips. The results are more stable in terms of resorption, however, the rehabilitation period is longer.

What to do if you don’t want to constantly inject fillers, transplant your own tissues and don’t want long-term rehabilitation, but the problem of increasing lip volume still particularly bothers you? Then there is one more option - lip implants.

Lip implants.

Permalip silicone lip implants are a safe and reliable solution to lifelong lip augmentation. More information about Permalip implants can be found on the page dedicated to Permalip. However, let's briefly talk about the advantages of this method:

3 different volumes - choose the one that suits your requirements.
without visible incisions on the lips - to install the implant you only need 2 punctures in the corners of the lips - which means no noticeable seams and long rehabilitation.
for life, safe, hypoallergenic - the material from which the implant is made does not interact with the human body in any way.
removal at any time - if suddenly you don’t like the volume (for example, you want to put a larger implant) or you change your mind - the implant can be removed at any time without any visible incisions on the lip.
Fillers can be used on top of the implant. If the resulting volume is still not enough, the implant is not a contraindication to the use of fillers.

Lip implants provide permanent lip augmentation. Permalip silicone lip implants are a safe and reliable solution to lifelong lip augmentation. The implant material is specially adapted for lips. The Permalip implant was registered by the FDA (USA) in 2004 and approved for medical use. The implant can be removed or replaced with another at any moment. The shape and material of the implant provide natural lip contour and movement.

To create an even and clear lip contour, especially in the USA, a special synthetic Gore-TEX® thread was successfully used. Gore-tex is used to emphasize the smooth contour of the lips and philtrum, as well as for thread lifting of the upper lip. The microporous structure of the thread allows tissues to grow into it. However, there is a tendency of the thread to mix, push out, and show through the skin. The biological collagen thread AlloDerm® turned out to be a successful alternative to Gortex. It is as easy to install as Gore-Tex, but within a few months it is replaced by its own collagen without loss of volume.

CHANGING THE SHAPE OF THE LIPS.

Fillers and implants will help increase the volume of the lips, namely their plumpness, but increasing the red border of the lips (especially often used for the upper lip) is achieved by other methods. A number of surgical procedures can change or correct the shape of the lips permanently. Most operations are based on changing the ratio of the skin and mucous membrane of the lips. In Dr. Guryanov's studio, any operations to increase the red border, such as Bullhorn or VY plastic, are performed.

VY lip surgery.

Stable lip augmentation is provided by VY lip surgery . The method is based on surgical expansion of the red border of the lips, while the stitches are hidden on the inside of the lip and are not visible. Stitches are removed after a week.

BULLHORN / Shortening of the upper lip.

Bullhorn is an operation that shortens the cutaneous part of the upper lip. In this case, there is an eversion and an increase in the red border, easier exposure of the incisors when smiling.

The plastic got its name bullhorn from the shape of the seam in the form of buffalo horns, which is hidden under the base of the nose. There are several varieties of this operation, when the suture does not cross the skin of the nasal septum or is hidden in the nose. In addition to shortening, it is possible to lift the upper lip in its central part towards the nose using a special thread.

AGE CHANGES:

Have you noticed that older ladies have practically no upper lips? They become very narrow and unexpressed. The length of the upper lip should be proportional primarily to the front teeth. With age, the lip becomes disproportionately long, completely covering the upper incisors, and the red border turns in and becomes visually smaller.

With age, not only the tone of the skin changes, wrinkles appear and smooth transitions on the face disappear, but also the lips, under the influence of time, become less plump, dull, framed by a network of wrinkles and lose their youthful freshness. However, plastic surgery comes to the rescue and will help you maintain your beautiful appearance. Especially when your surgeon is experienced and reliable. Age-related changes affect not only the lips, but the entire oral (perioral) area, including the chin. There are many reasons for this:

skin aging
tissue ptosis
change in the ratio between soft and hard tissues
loss of support of teeth and jaws
reduction in the height of the lower third of the face
reduction in soft tissue volume

A woman's age can be judged not only by her arms and neck... but also by her lips, and here is a list of 14 changes that occur with age in the perioral (near-oral) area

perioral wrinkles
smoothness of the filtrum
loss of definition and smoothness of the cupid's bow and lip edge
blurred border between skin and mucous membrane
increase in the length of the upper lip relative and absolute
convex upper lip profile
drooping corners of the lips
formation of marionette folds
change in mucous color, appearance of hemangiomas
sagging of the lower lip in the center, decreased tone
deepening of the labiomental groove
drooping chin
atrophy of the submucosal layer and reduction in lip volume
changes in muscle balance

Guryanov Andrey Stanislavovich has many years of experience and approaches solving such problems comprehensively. He always approaches each patient individually and offers solutions that suit a particular person. Age-related changes, as we see, have many causes, so perioral rejuvenation should include a whole list of procedures such as:

elimination of excess skin and tissue
restoration of the muscular aponeurotic frame of the lips and its balance
elimination of tissue ptosis
restoration of volume of lips and oral tissues.

Lifting the corners of the lips

The drooping of the corners of the lips can be true or apparent, due to the illusion created by skin folds. The drooping of the corners can be at rest or appear only during facial expressions. Asymmetry of the corners of the lips is common. Age-related drooping of the corners of the mouth cannot be eliminated with a conventional facelift and requires special techniques depending on the primary causes of the drooping.

One such technique to lift the corner of the mouth and smooth out marionette lines is surgical weakening of the depressor anguli oris (DAO) muscles. You can also get a similar effect by temporarily weakening DAO with a Botox injection.

Another operation, a corner lift, involves excision of small excess tissue in the corners of the lips (skin and muscles) and gives a more pronounced effect, especially on so-called “sour” mouths. This operation can be supplemented by the injection of fillers into marionette lines.

Fig. 16 Cornerlift - raising the corners of the lips. Before and 2 months after surgery.

FORCED OPERATIONS.

Removal of biopolymer gel.

Lip enlargement can be caused not only by excess filler, but also by pathological growth of lip tissue in response to the introduction of even a minimal amount of biopolymer gel. Excess of some fillers can be removed through punctures, while others (for example, hyaluronic acid) are easily dissolved by enzymes. Overgrown tissue is either removed, maintaining the shape of the lip, or conservative treatment is carried out. Patients often come to Dr. Guryanov with problems that arose after the introduction of the biopolymer. For a long time, Andrei Stanislavovich has been the best surgeon who helps patients with this problem. The doctor performs the operations very carefully and returns the lips to their natural appearance. In addition to lip augmentation, sometimes it is necessary to reduce them in case of congenital or acquired lip enlargement.

Gummy smile.

A smile in which the incisors are exposed from 1/3 of their length and no more than the edge of the gum is considered aesthetically attractive. Exposing the gums when smiling is called a gummy smile. It is due to the anatomical features of the structure of the perioral area. Algorithms for eliminating a gummy smile depend on the degree of its severity and anatomical features. Typically, measures such as reducing the depth of the vestibule of the upper lip, mobilizing the orbicularis labii muscle to reduce its mobility, and installing an implant to prevent the lip from sliding upward are used.

Elimination of a gummy smile with simultaneous surgical augmentation of the upper lip.

Dr. Guryanov is one of the outstanding surgeons of the present time, who is constantly improving his methods, and is a pioneer in the field of 3D modeling for plastic surgery purposes. More than 30 years of experience and a huge number of successfully completed operations.

If you decide to find an experienced, responsible surgeon, and decide to achieve a good result, sign up for an initial consultation with Dr. Guryanov and learn more about the methods that can be applied specifically in your case.

Lipofilling of nasolabial folds

Nasolabial folds are lines from the wings of the nose to the corners of the lips. Cosmetologists correct this area with fillers based on hyaluronic acid. Surgeons use the patient's own fat.

The essence of the procedure is to fill creases and level the level of the fold to the level of adjacent tissues.

Folds with overhanging tissue (cheeks) can be corrected using a combination of liposuction and fat grafting. At the first stage, the surgeon uses a special small cannula to suck out some of the fat in the cheek area, then cleans it and injects the fat emulsion into the fold.

Popular techniques

In cosmetology, there are methods of lip augmentation, both temporarily and permanently. Each method has its own contraindications and possible complications - there are no absolutely safe methods. But science does not stand still, and the procedure for lip augmentation is also improving. A huge number of women around the world decide to correct their lip shape and are satisfied with the result.

It is very important to contact only trusted specialists and carry out the procedure in a salon or clinic, and not at the specialists’ home. Some cosmetologists offer low prices and attractive promotional offers. However, high-quality implementation of the procedure is expensive - it is better to do it well once than to deal with the consequences for a long time.

Let's look at the most common lip augmentation methods used by cosmetologists.

Scar lipofilling

Scars after operations, post-traumatic ones can also be very successfully corrected by the injection of fat. A huge advantage of fat grafting of scars is the stimulation of deep skin regeneration. Fat cells not only fill the “minus tissue”, but also improve the color and texture of the damaged area.

⇒ READ ALSO: Rehabilitation after lipofilling

Preparation for lipofilling of the labia majora

During an examination by a gynecologist, a woman expresses wishes about how she would like her genitals to look after intimate plastic surgery. It is decided where the fat will come from to be transferred to the labia and how much fat tissue will need to be transferred.

After examination and consultation, the doctor prescribes tests:

General blood and urine tests that give an idea of the patient’s health status.
Swabs from the genital tract and urethra for STDs.
Smears from the surface of the cervix for oncocytology according to Papanicolaou - cancer and precancerous diseases.
Blood for HIV, syphilis and hepatitis.
Blood for clotting and duration of bleeding.

In some cases, the doctor may prescribe additional tests - ECG, pelvic ultrasound, and other blood tests.

The operation is carried out only if the tests are good. In other cases, it can be carried out only after correction of the identified violations.

On the day of surgery

My patients undergo full preparation for rejuvenation using fat grafting, that is, they undergo a health examination (list of tests).

Fat grafting can be performed either under general anesthesia or under intravenous sedation with local anesthesia.

Before the operation, the anesthesiologist-resuscitator must collect anamnesis and consult the patient.

After the procedure, the patient spends several hours in the clinic and goes home.

Rehabilitation

After fat transfer, patients do not experience any significant discomfort. The first few days of hematoma and swelling are normal during the recovery period.

Recommendations

for the first few months, do not sunbathe and protect your face from the sun
do not wash your face with very hot water for the first weeks
sauna and steam baths are prohibited for several months
do not use aggressive methods of cleansing the skin: peelings, scrubs, etc.
try to sleep on your back at first to reduce pressure on facial tissues
do not rub your face or allow mechanical impact on the skin

It is possible to evaluate the result 2-3 months after the operation!

Immediately about the cost of lip augmentation

The cost of lip augmentation consists of the cost of the drug and the services of a cosmetologist for its injection.

The most popular drug for lip augmentation is Juvederm Smile . The cost of introducing it into your lips from our cosmetologists is 13,000 rubles . Yes, in Moscow there are lower prices for this drug, but don’t rush to run away - we offer all primary patients a 15% discount - you can save 2000 rubles! But this drug has a catch - the volume of one syringe is only 0.55 ml. For some it’s enough, but for a full correction it’s not enough.

Therefore, we offer our patients a more acceptable option: a drug from the premium line of the manufacturer Merz - Belotero Intense , full 1 ml. This drug behaves better on the lips, the effect lasts longer, and the lips look very natural.

More than 70% of our patients chose Belotero Intense!

Want to save money?

Almost 80%* of all problems after lip augmentation occur due to the use of inexpensive fillers [* our experience, forums and review sites]. Almost all fillers with a cost below 7,000 are not officially approved for use in our country and are used by home-based cosmetologists and those working without a license. But you must have a choice.

We can offer you lip augmentation on a promotional basis or with inexpensive but registered drugs by appointment.

Enlarge your lips at a discount: leave your contacts to sign up!

Thank you!

We will definitely call you back and tell you everything about lip augmentation!
List of dangerous fillers and consequences of the procedure.

What lips look like after the procedure

The patient came to us twice for lip correction: on the first visit, 1 ml of Belotero Intense was injected, after 4 weeks an additional correction of 0.5 ml was performed. with Juvederm ultra smile. The result in the last photo above is 3 weeks after the last additional correction.

Useful tips/answers from cosmetologist Elena Anufrieva:

✅ If you are prone to herpes, I recommend taking a course of acyclovir 2-3 days before the procedure. Believe me, this is for your own beauty.

✅ Regarding alcohol: it is categorically unacceptable to drink on the eve of the procedure.

✅ I do not recommend thermal effects on lips that have undergone the procedure. For at least a week, protect your lips from hot food and drinks and do not visit baths and saunas.

Find out all the tips and life hacks.

How much does facial lipofilling cost?

You can find out the exact cost and agree on the date of the procedure during a face-to-face consultation with a plastic surgeon.

Facial rejuvenation	Price
SMAS lifting with lipofilling and liposuction of the face and neck	280 000
Temporal face lift	120 000
Mid-face lift	160 000
Lipofilling (1 zone, taking into account the fat sampling procedure)	15 000
Lipofilling of cheekbones	50 000
Lipofilling of lips	60 000
Chin lipofilling	50 000

How to prepare for the procedure

During a consultation with the doctor who will perform the manipulation, it is necessary to decide from which part of the body the adipocytes will be collected for lip correction.

A month before liposuction, it is necessary to avoid smoking, drinking alcoholic beverages, and taking medications that affect blood clotting (non-steroidal anti-inflammatory drugs, contraceptives, anticoagulants, antiplatelet agents). You also need to reduce physical activity to reduce blood flow to the face. Medical personnel should inform the patient about the procedure and possible complications.

To minimize the risk of complications, the patient needs to undergo a number of laboratory tests:

clinical analysis of blood, urine;
coagulography;
blood chemistry;
blood test for Wasserman reaction;
study for viral hepatitis.

An anesthesiologist and, if necessary, a therapist are also consulted.