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Fat transfer: Current use in practice
Abstract
The author has used fat transfer, including pearl fat grafts and fat injections, for almost 18 years in practice. Techniques for pearl fat grafting and fat injections are described. Pearls are limited to eyelids and small depressions. Fat injections can be used to augment various facial areas, including chin, cheekbones, nasolabial folds, lips, labiomandibular folds, glabella, forehead, and nose.
... Since its first reported description in 1893 by Neuber, autologous fat grafting (AFG) has undergone several advancements in both its procedural methodology and biological understanding. 1 For the majority of the early 1900s, fat grafting was primarily confined to treating specific facial deficits, including the malar region and chin. 1 By the 1980s, AFG was introduced to aesthetic surgery by a number of individuals such as Illouz, who utilized injectable fat grafting following liposuction, and Ellenbogen, who used it to treat facial atrophy wrinkles, nasolabial folds, and chin augmentation. [2][3][4][5][6] The basis for AFG was standardized by Coleman, who defined specific steps and equipment for harvesting, centrifugation, cleaning, and injecting microfat to the face. Additionally, Coleman and Grover outlined the basic effects of aging, including decreased skin elasticity, bone resorption and remodeling, tissue atrophy, and ptosis. ...
Background:
A standardized technique for facial fat grafting, injectable tissue replacement and regeneration (ITR2), incorporating new regenerative approaches, was developed to address anatomic volume losses in superficial and deep fat compartments as well as skin aging.
Objectives:
The aim of this study was to track the short- and long-term effects of facial fat grafting by ITR2 in the midfacial zone over 19 months.
Methods:
Twenty-nine females were analyzed for midfacial volume changes after autologous fat transfer with ITR2 with varying fat parcel sizes. Volumes were evaluated with an imaging system to calculate differences between a predefined, 3-dimensional midfacial zone measured preoperatively and after fat grafting.
Results:
Patient data were analyzed collectively and by age (<55 and >55 years). Collective analysis revealed a trend of initial volume loss during Months 1 to 7 followed by an increase during Months 8 to 19, averaging 56.6% postoperative gain, and ending at an average of 52.3% gain in volume by 14 to 19 months. A similar trend was observed for patients <55 years of age, with a 54.1% average postoperative gain and a greater final average of 75.2%. Conversely, patients >55 years of age revealed a linear decay from 60.6% to 29.5%. Multiple regression analysis revealed no statistically significant influence of weight change throughout the study.
Conclusions:
A dynamic change in facial volume was observed, with an initial decrease in facial volume followed by a rebound effect, by 19 months after treatment, of improved facial volume regardless of the amount of fat injected. Volume improvement was greater in patients <55 years old, whereas in patients >55 years old, volume gradually decreased. This study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment.
Level of evidence: 4:
... Ease of autogene fat tissue obtaining, lack of tissue compatibility, unlikeliness to lead antigenic or allergic reactions, donor sites adequacy and variety, low morbidity, rapid availability, large stem cell content and when needed plentiful is available make it preferable in the latest clinical trials. In addition to these advantages, when liposuction is performed, scar doesn't occur in the donor area, and long-term changes in volume and contours are ensured [3,5,[13][14][15][16]. The adventure of fat graft started with aesthetic purposes, with the concept of stem cell, has begun to have place in many areas of medicine in the daily practice. ...
Mesenchymal stem calls in adipose tissue and organs play role in
repair of minor injuries. Also, they turn into different cell types, inhibits
apoptosis and are stimulant for factors needed for regeneration. Although
they were shown to be beneficial for radiation related wound healing
and other regenerative applications, in clinical practice they haven’t had
routine use. Because irradiated tissue is accepted as ischemic, fat graft
survival in these areas may be expected to be less when compared to
healthy tissue. Prospective clinical studies observing fat graft survival
in patients receiving radiotherapy need to be explanatory.
... 4 With the advent of liposuction in 1980s, Coleman technique resulted in the increased survival of fat attributed to gentle extraction, handling, preparation and transfer with excellent long term results. 5 Fat grafting is done either alone or in combination with other rejuvenation procedure with advantage of being less invasive procedure with minimal complications. 6 The advantages of autologous fat grafting are easy availability, ease in harvest, the minimum risk of infection, and the short recovery period. ...
Objective:
To compare the graft survival between fat harvested from abdomen and medial thigh for facial contour deformity.
Study design:
Randomised control trial (RCT) .
Place and duration of study:
Jinnah Burn and Reconstructive Surgery Center, Lahore, from October 2015 to April 2017.
Methodology:
Patients fulfilling the inclusion criteria were randomly divided into two groups. Fat was harvested from medial thigh in Group A and from abdomen in Group B. Outcome was measured in terms of fat survival by comparing mean fat at baseline, first and 12ᵗʰ week. Final fat survival thickness >6.00 mm at 12ᵗʰ week was considered as excellent. ANOVA was used for comparison of mean fat thickness (mm) between the groups, and Chi-square test for outcome and complications among groups with p-value <0.05 as statistical significance.
Results:
Mean age of subjects was 27 +7.44 (range 12 to 60) years. Mean final fat thickness in Group A was 6.030 +0.095 mm and in Group B was 4.989 +0.094 mm (p=0.001). Thirty patients (76.9%) in Group A and none in Group B showed excellent response (p=0.001).
Conclusion:
Outcome of graft survival with fat harvested from medial thigh was better as compared to that from abdominal fat.
... 7,8 As a result, it was not long before autologous fat transfer (AFT) or lipofilling found its way as a potentially superior facial filler with numerous studies reporting on the promising results besides minimal side effects. [9][10][11] Numerous reviews and articles describing the authors preferred method for facial AFT currently exist, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] but they generally lack a comprehensive study design. Furthermore, the abundance of anatomical facial zones further complicates pooling of data, with most authors describing its appliance to 1 or 2 facial regions. ...
| BACKGROUND |: Parallel to the steady decline in surgical aesthetic procedures to the face, dermal fillers seem to have gained a more prominent place in facial rejuvenation over the last couple of years. As a dermal, facial filler, autologous fat transfer (AFT) seems to have real potential because of the biocompatibility of adipose tissue besides being a procedure with few and primarily minor complications. This systematic review aims to evaluate the available evidence regarding the safety and effectiveness of AFT for facial rejuvenation.
| METHODS |: A systematic review after the Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analysis (PRISMA) statement was conducted. MEDLINE, Embase, and Cochrane Library were searched up to December 2016, with no language restrictions imposed. Case series, cohort studies, and randomized controlled trials (RCTs) reporting on relevant outcomes were included.
| RESULTS |: Eighteen clinical articles were included, reporting on 3,073 patients in total over a mean follow-up period of 13.9 months. Meta-analysis showed an overall complication rate of 6% (95% CI 3.0–14.0), with hematoma/ecchymosis (5%), fat necrosis/oil cysts (2%), and irregular fat distribution and scars (both 2%) being among the most reported. No major complications were reported, and the overall patient satisfaction rate was 81%.
| CONCLUSION |: Although the evidence in this systematic review is still limited and plagued by heterogeneity between studies, AFT seems to be a promising method in facial rejuvenation with fewer complications than other fillers and high patient satisfaction rates. Further large-cohort, preferably multicenter, RCTs should substantiate these results through quantifiable volumetric assessment tools and validated patient questionnaires, while adhering to predetermined nomenclature in terms of complications.
... At the end of the 1970s, Kesselring [4] and Illouz [5] suggested a new surgical technique: liposuction. Since 1980, several studies have highlighted different findings on transplantation of fat obtained by liposuction [6][7][8][9] and adipose cell vitality ranging from 30% to 70% [10,11,12]. ...
The aim of this study is to assess the success of core fat
graft in management of depressed scars. Forty patients presented
with subcutaneous defects due to depressed scars were
managed with core fat graft injection. The results were good
with significant improvement of personal satisfaction postinjection
in comparison to pre-injection state. The overall
mean percentage increase in personal satisfaction (64% out
of total score). Recipient site brusing and pigmentation were
the only complication in six out of forty patient.
Conclusion: Core fat grafting technique is simple and
effective in augmenting depressed scars. The technique is
simple, with short operative time & the cost is cheap.
... Figure 2 illustrates typical areas for fat grafting and average amounts grafted. 7 The fat was placed in stacked and cross-stacked "toothpick"-shaped layers with limited passes in order to minimize trauma. Local anesthetic with epinephrine was not infiltrated into these areas in order to preserve maximum adipocyte viability. ...
1 There has been no ideal option for patients who are unhappy with their facial shape but do not want to undergo complex surgeries or pay the high price of temporary injectable treatments. In this article, we describe the treatment of facial com-plaints such as the gaunt face, long face, bottom-heavy face, chubby face, midface retrusion, and asymmetric face, as well as the modification of racial and ethnic characteristics, through the use of minimally invasive methods. Fat grafting was used to accentuate the cheekbones in most patients complaining about their facial shape. For the long face, this technique increased the horizontal facial diameter. Lipoplasty combined with buccal lipectomy effectively decreased the fullness of the lower face and improved facial contour in the bottom-heavy face and chubby face. A skin-tightening face lift may also be necessary in patients with neck laxity. Fat grafting was used to fill in depressions or defects in the gaunt face and to treat midface retrusion and facial asymmetry. Added facial projection was obtained with nasal and chin implants. Photographs of representative patients treated for facial reshaping using the described techniques are presented. By using the minimally invasive techniques described, plastic surgeons can reshape a patient's face without the prolonged downtime or morbidities associated with more invasive procedures. (Aesthetic Surg J 2005;25:.) T hroughout the evolution of plastic surgery, facial reshaping has traditionally been accomplished with procedures that are complicated to perform and associated with long recovery periods and morbidi-ty. In some cases, complaints regarding facial shape were regarded as frivolous concerns. Facial shapes such as midface retrusion and a long face have traditionally been treated with maxillofacial osteotomies. 1-4 Patients with asymmetric faces have undergone treatment involving various flaps and max-illofacial rearrangement. 5,6 Although the recent populari-ty of injectables, such as Restylane, may encourage some surgeons to use these products to reshape the face, such corrections are temporary, and often several syringes are needed to fill in larger depressions. This paper deals with the use of minimally invasive techniques, such as fat grafting, silicone facial implants, lipoplasty, and buccal lipectomy, to reshape a patient's face. By using these and other techniques, patients now have options for facial reshaping that minimize down-time and morbidity. Treatment of the following facial shapes is described: the gaunt face, the long face, the bot-tom-heavy face, the chubby face, midface retrusion, and the asymmetric face.
... A lipoenxertia estruturada, ou lipoestrutura, termo cunhado por Coleman 8 , é um desses métodos, e talvez o mais popularizado pela forma didática com que foi apresentado e pela ampla divulgação no meio científico. Entretanto, outros autores demonstraram resultados igualmente satisfatórios com a enxertia de gordura [9][10][11] . Essencialmente, esse método baseia-se na obtenção da gordura sob baixa pressão negativa, na separação do tecido gorduroso viável de outros elementos por meio de centrifugação com baixa aceleração, e na reinjeção do tecido em pequenos glóbulos, de forma que permita a pega adequada do enxerto. ...
INTRODUÇÃO: A enxertia de gordura como preenchimento no rejuvenescimento e melhoria do contorno facial vem sendo usada por alguns autores e demonstra um potencial excelente como método de escolha para essa finalidade, uma vez que tem como premissa o princípio básico de corrigir as deformidades com o tecido mais semelhante possível. O objetivo deste trabalho foi avaliar clinicamente a eficiência da enxertia de gordura estruturada na redefinição do contorno facial. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes submetidos a lipoenxertia estruturada para a redefinição do contorno facial, entre 2002 e 2012. A seleção de pacientes incluiu correção de deformidades, assimetrias, harmonização do contorno e aumento da projeção óssea, mas excluiu o rejuvenescimento per se. A avaliação do resultado clínico foi realizada pelo paciente e pelo cirurgião, com auxílio de documentação fotográfica pré e pós-operatória. O resultado clínico foi classificado pelo paciente e cirurgião, empregando escala que variava de 1 a 3: (1) o objetivo não foi alcançado de forma alguma; (2) o objetivo foi alcançado parcialmente; ou (3) o objetivo foi alcançado totalmente. Foi realizado, também, levantamento de prontuários para obtenção dos seguintes dados: idade, alteração ponderal, volume enxertado por área, número de sessões de enxertia realizadas, história de tabagismo e complicações. RESULTADOS: As médias das avaliações do cirurgião e paciente foram, respectivamente, 2,6 ± 0,6 e 2,7 ± 0,5, havendo correlação estatisticamente significante (P < 0,0001). Não foi encontrada relação significativa entre as avaliações e idade, alteração ponderal, volume de enxertia ou tabagismo, com uma única exceção. CONCLUSÕES: A lipoenxertia estruturada demonstrou ser eficiente adjuvante na redefinição do contorno facial e sua eficiência não foi prejudicada por idade, alteração ponderal ou tabagismo. O volume a ser enxertado deve ser adequado às necessidades específicas de cada área.
... discussion Although microfat grafting for the nose is beneficial, it has not been the specific focus of many published articles, and it has been mentioned only sporadically in medical literature pertaining to general facial microfat grafting. [33][34][35] Because they are readily available and preferred by many physicians, various fillers have been injected to correct skin irregularities or depressions on the nose. However, if these materials are injected into the nose by inexperienced individuals, many complications can occur. ...
Background: Injectable fillers are sometimes necessary to correct slight skin irregularities. However, there have been reports of necrosis after injection of alloplastic materials and heterogeneous transplants. On the other hand, the advantages of autogenous tissue grafts over those fillers are well established. Volumetric reshaping of the face with autologous tissue injection is a popular and reliable method with good long-term results. However, procedures performed on the fragile skin of the nose are prone to complications.
Objectives: The author conducted a study of injectable autologous microfat grafting to the nose in patients with secondary nasal deformities.
Methods: During a 5-year period, 313 patients who had secondary nasal deformities with slight skin irregularities or severe nasal skin damage were treated with microfat grafting. At each patient’s first injection session, excess harvested fat was cryopreserved for subsequent injection. To correct minor irregularities, 0.3 to 0.8 mL of microfat was injected during each session; for major irregularities or defects, 1 to 6 mL was required for each session.
Results: One to 3 injections of microfat provided satisfactory results in all patients who had minor irregularities. For patients with multiple and severe irregularities, 3 to 6 injections were necessary and resulted in high patient satisfaction. In another group of patients, with severe traumatic skin damage, 6 to 16 injections were necessary for reconstruction. After repeated injections, each patient’s skin damage was repaired.
Conclusions: Autologous microfat injection appears to be safe and effective for correcting slight irregularities of the nose.
Level of Evidence: 4
... The deepest layer of injection is supraperiostal level. Ellenbogen [4] injected fat over the sternum of a lady with a mild pectus excavatum. He suggested that fat injected over the bone seems to persist, although it is not a fat environment. ...
Fat grafting has been widely used over the past100years for soft tissue augmentation. Despite a number of publications which show poor long-term results, it is still one of the most preferred soft tissue fillers. After liposuction became popular in 1980s, an easier method of transfer, lipoinjection, once again brought attention to fat grafting. New methods to increase durability of fat grafts were developed. Placing the fat graft into a well vascularized recipient site was one of the most accepted ideas. Fat grafting into the muscle and over periosteum showed satisfactory results in the long term. All the fat tissue transplanted into a recipient site will probably not survive; the area then contains necrotic fat tissue and this can cause depressions which are easily seen if the overlying skin is thin and has been previously traumatized. Placing the fat grafts subperiostally can be a solution to this problem. In our experimental study we compared subperiostal fat grafting with supraperiostal fat grafting in a rat model. Fat graft weight changes and histopathological examinations in both of the groups showed similar properties. Thus subperiostal grafting is an alternative augmentation technique in areas where the overlying skin is thin.
... Some other authors have previously reported their personal experiences with fat grafting to the nose [7][8][9][10]. Cárdenas and Carvajal [7] reported the use of lipoinjection of the nasal dorsum in combination with open rhinoplasties to obtain smooth dorsal contours with good results. ...
Clinicians are facing an increasing trend toward nonsurgical nose reshaping using synthetic injectables, mainly for patients who refuse standard rhinoplasties. Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results as well as fewer and milder side effects. The author reports his experience with fat grafting to the nose using his personal technique for 36 consecutive patients. The experience covers primary treatments of noses not treated by surgery, treatment of post rhinoplasty deformities, and combination fat grafting and rhinoplasties.
The technique used by the author for fat grafting to the nose does not differ significantly from that used for other body or face areas. It is based in the atraumatic extraction of fat fragments using a multi-orifice cannula and injection of these fragments using 1.4- to 1.6-mm cannulas or needles. In combining rhinoplasties with fat grafting, fat grafts are used in the same location instead of a prosthesis or cartilage grafts.
The initial analysis of postoperative results showed a good to high level of patient satisfaction, particularly in primary cases, with virtually no complications or severe side effects. Some easily corrected side effects probably were learning curve dependent.
Autologous fat grafting is an effective and reliable technique for aesthetic and reconstructive nose reshaping for patients who refuse surgical treatments. Although optimal results can be achieved with this technique, they are not comparable with those obtained by surgical rhinoplasties, and this is an important issue to discuss with the prospective patient.
... The international literature is rich in articles regarding the transfer of autologous fat using a variety of existing techniques [10,11]. Some articles highlight graft survival rates ranging from 0% to 80% [12]. The main disadvantage of these methods is the high rate for absorption of injected fat, which reaches 70% of its entire volume [13]. ...
The use of adipose tissue transfer in plastic and reconstructive surgery is not new and has been studied extensively. Due to different results with regard to adipose cell damage and the level of survival of the transferred tissue in clinical practice, the authors aimed to investigate the effects of centrifugation on fat aspirates to optimize the centrifugal force for fat transplantation and to obtain an increased number of intact adipose progenitor cells. The following different centrifugation forces were evaluated in vitro in terms of fat decantation: 3,000 rpm (1,500×g), 1,300 rpm (250×g), and 500 rpm (50×g). Moreover, the density level, morphology of fat cells, cell viability, and progenitor cell number also were evaluated. Centrifugation leads to a good fat tissue density, with a significant number of progenitor cells, and efficiently removes the liquid portion. High centrifugal forces (at 3,000 rpm) caused significant damage to fat cells with low cell viability, whereas very low centrifugal forces (at 500 rpm) showed little effect on adipose tissue density, resembling fat decantation. Fat aspirates, withdrawn from 30 healthy donors in vivo, were centrifuged at different rotations per minute (rpm), as follows. For the 10 patients in group A, Coleman's technique was used with a centrifugation of the aspirated fat at 3,000 rpm (1,500×g) for 3 min. For the 10 patients in group B, the authors' technique was used, with centrifugation of the aspirated fat at 1,300 rpm (250×g) for 5 min. For the 10 patients in group C, simple decantation of fat was used. In conclusion, a centrifugal force of 1,300 rpm resulted in better density of adipose tissue, with good cell viability and increased ability to preserve a significant number of progenitor cells.
... Over the past 110 years (Neuber, 1893), fat autografts (FAG) have been used in reconstructive surgery (ASPRS, 1998) to combat the high prevalence of facial soft tissue defects following surgical procedures or trauma, and to correct the aging face in cosmetic surgery (Chajchir and Benzaquen, 1989;Wilkinson, 1994). The use of FAG is controversial as resorption has been extensively observed (Ellenbogen, 2000) and documented (Billings and May, 1989), and because of the absence of an accurate and objective method to evaluate FAG survival (Bircoll, 1987). ...
It is not usual to perform quantitative analyses on surgical materials. Rather, they are evaluated clinically, through qualitative methods, and if quantitation is done, it is on a 2-dimensional basis. In this study, the long-term survival of fat autografts (FAG) in 40 subjects with facial soft tissue defects is quantified. An adipose tissue preparation from the abdomen obtained through liposuction and centrifugation is injected subcutaneously. Approximately 14 months later, the treated area is biopsied. Extensive computer-based histological analyses were performed using the stereological method in order to directly obtain three parameters: volume fraction of adipocytes in the fat tissue (Vv), density (number per volume) of adipocytes in the fat tissue (Nv), and the mean cell volume of adipocytes (VA) in each tissue sample. A set of equations based on these three quantitative parameters is produced for evaluation of the volumetric survival fraction (VSF) of FAG. The presented data evidenced a 66% survival fraction at the 14-month follow-up. In routine practice, it would be sufficient to perform this volumetric analysis on the injected and biopsied fat samples to know what fraction of the FAG has survived. This is an objective method for quantifying FAG survival and will allow a standardized comparison between different research series and authors.
Facial aging involves volumetric change, alteration of tissue quality, and the effects of long-standing facial muscular animation. These factors lead to soft tissue ptosis and static and dynamic rhytids. The traditional conept of beauty involves the “triangle of beauty” with high cheekbones and a defined jaw, whereas the “reverse triangle” or pyramid with flattened cheeks, drooping eyes, and jowling is considered unattractive. Facial rhytids can be classified as dynamic or static. Dynamic rhytids occur with muscle action and are best treated by specifically targeting facial muscles with botulinum toxin.
La radiodermite chronique est une altération des tissus cutanés et sous-cutanés qui survient plusieurs mois ou années après une irradiation. Elle peut être compliquée d’ulcérations chroniques ou radionécroses, de cicatrisation très difficile. La prise en charge de référence est chirurgicale, comprenant une excision des tissus irradiés et une reconstruction par lambeau. Le tissu adipeux est riche en cellules souches mésenchymateuses, facilement accessible, abondant et biocompatible. Les autogreffes de tissu adipeux (AGTA) ont été utilisées dans la chirurgie reconstructrice et cosmétique. Leurs indications sont de plus en plus nombreuses. L’objectif de notre étude était d’évaluer l’efficacité et la tolérance de l’autogreffe de tissu adipeux dans la prise en charge des ulcérations chroniques post radiques.
Patients et méthode :
Cette étude était rétrospective, monocentrique, observationnelle, sur une période de 8 ans (2010 à 2017). Tous les patients présentant une radiodermite chronique ulcérée ou radionécrose et ayant été traités par AGTA sur la période de l’étude ont été inclus. Le nombre de séances d’AGTA variait selon l’évolution de la radiodermite. Les AGTA étaient réalisées par la technique de Coleman ou la liposuccion assistée au Body jet®. Les patients étaient évalués en post opératoire précoce et à distance de l’AGTA par un examen clinique et des photographies. Le critère de jugement principal était la cicatrisation complète de l'ulcération. Les critères de jugement secondaires étaient la cicatrisation partielle de l'ulcération après chaque séance d'AGTA, la nécessité d'une chirurgie complémentaire à l'issue de l'ensemble des séances et la tolérance des autogreffes.
Résultats :
Huit patients ont été inclus, 7 femmes et 1 homme, d’âge moyen 64 ans. Sept patients avaient reçu de la radiothérapie pour une néoplasie et 1 patient avait été irradié lors de traitements de foyers arythmogènes cardiaques par radiofréquence. Le délai médian de survenue de la radiodermite était de 10 ans après l’irradiation. L’ulcération évoluait depuis un délai médian de 10,5 mois. Le nombre moyen de séances d’AGTA par patient était de 3,25. A l'issue de l'ensemble des séances, 5 patients sur 8 (63%) étaient totalement cicatrisés. Une patiente avait été perdue de vue. La prise en charge est encore en cours pour les deux autres patients, chez qui une cicatrisation partielle et amélioration nette de la trophicité cutanée ont été obtenues. La cicatrisation était obtenue après un délai médian de 5,1 mois. Aucune récidive n’a été notée, avec un recul de 20 mois en moyenne après la fin du traitement. Deux patients ont bénéficié d’une intervention chirurgicale complémentaire (section de bride cicatricielle et reconstruction mammaire). Aucune chirurgie de la radionécrose n’a donc été nécessaire. Six patients n’ont présenté aucune complication. Un érysipèle a compliqué la première séance d’AGTA chez une patiente, qui a justifié l’arrêt de la prise en charge par AGTA. Elle a ensuite été perdue de vue. Une autre patiente a présenté une inflammation locale qui n’a pas empêché la poursuite des AGTA.
Discussion :
Les AGTA sont donc une option thérapeutique dans la prise en charge des ulcérations chroniques post radiques. Leur efficacité et leur tolérance sont bonnes et remettent en cause la prise en charge chirurgicale de référence. En effet, les AGTA présentent des avantages par rapport à la chirurgie : le caractère moins invasif, le risque moindre de complications, le coût moindre et la simplicité des techniques utilisées.
Conclusion :
L'AGTA semble être une technique efficace, simple, peu onéreuse et bien tolérée pour la prise en charge des ulcérations chroniques post radiques, permettant d’éviter un traitement chirurgical.
Purpose: To report the complications of grafting of excised posterior orbital fat into the lower lid-cheek junction at the time of orbital decompression surgery.
Methods: Retrospective review of consecutive patients undergoing orbital decompression combined with grafting of posterior orbital fat to the pre-malar and lateral canthal area (FG). A second group of consecutive patients undergoing orbital decompression but no orbital fat grafting (NoFG) were also studied as a form of comparative control. Standard patient data, including age, sex, visual acuity, degree of proptosis, operative details, diplopia or any other complications was collected. Independent assessment of pre- and post-operative photographs graded the lower lid-cheek junction.
Results: Thirty-four orbits of 29 patients, of which 21 orbits underwent orbital decompression with orbital fat grafting (FG). There were no intraoperative complications, postoperative infections, or visual loss. Complications relating to fat grafting included prolonged swelling in 3 (17%) patients at 3 months, in 1 case lasting 6 months, lower lid lumps in 3 (17%), and fat seepage in 1 (6%). The FG group achieved a greater improvement in the appearance of the lower-lid-cheek junction at 12 months in comparison to NoFG. Mean grade improvement 1.24 ± 1.09 vs 0 ± 0.82 (p = 0.025). Median follow-up was 20 months (range 6–30 months).
Conclusion: Grafting of excised orbital fat during orbital decompression can improve the appearance of the lower lid-cheek junction in patients being treated for thyroid orbitopathy. However, 24% of patients will experience swelling and/or lumpiness requiring several months to settle or further fat excision.
Parotidectomy (superficial, total, or extended) is a surgical procedure that may be associated with a number of aesthetic and functional complications. Some of them (like facial asymmetry due to the presence of tissue depression following the removal of invaded structures, and Frey syndrome) particularly requested the attention of researchers aiming to find the optimal correction methods. A widely used technique in aesthetic and reconstructive surgery – autologous fat transfer – may be a great option for compensating the defect caused by extended parotidectomy, demonstrating good and very good results over time, from both aesthetic and functional points of view. Autologous fat grafting is a technique used in reconstructive surgery to reshape the soft parts, as recommended by a lot of advantages: it can be performed under local anesthesia, requires short execution time, has unlimited availability of reconstruction material, no additional scars, no morbidity at the donor site, it can be repeated to achieve the desired effect with minimum discomfort for the patient, and has good aesthetic and functional results stable over time. Additionally, the multipotent mesenchymal cells associated to the fat cells significantly contribute to the improvement in texture and nutrition of the tissues in the area where lipostructure is performed, tissues that are often altered by previous surgery for tumor excision or by additional treatment procedures (radio- and chemotherapy).
A youthful face is one that is full, smooth, and has volume. As we age, there is a significant amount of volume loss and facial deflation. Facial fat grafting provides an effective, long-lasting, and minimally invasive means to restore this loss of volume. As a result, this procedure can assist in rejuvenating the face.
Over the last several years, there has been an exponential growth in the number of noninvasive and minimally invasive procedures performed in the United States. In conjunction with the slowly fading stigma of aesthetic surgery, there have been significant changes in societal expectations of body image and well as an increasing acceptance of aesthetic surgery. This increased popularity demands improved comfort and surgical expertise in facial aging surgery. Thorough preoperative planning and patient education is essential for patient satisfaction and an ideal aesthetic result. Adequate preoperative surgical planning, mastery of the intraoperative surgical technique, thorough postoperative care, and the ability to recognize potential postoperative complications is essential.
There have been a number of key applications of facial fat grafting for the rejuvenation of the aging face. Some of these include malar augmentation, supraorbital rim and lower lid hollowing, correction of depressed nasolabial folds, lip augmentation, jowling of jaw line, posttraumatic contour irregularities, the treatment of craniofacial disorders (hemifacial microsomia, Parry–Romberg Syndrome), and HIV medication (antiretroviral and protease inhibitor) associated lipodystrophy.
Die Korrektur von Konturunregelmäßigkeiten und Volumendefiziten des Weichteilgewebes stellt nach wie vor eine Herausforderung in der Plastischen Chirurgie dar. Klinische Indikationen zur Rekonstruktion bzw. Substitution von Weichteilgewebe mittels Weichgewebsäquivalenten sind vielfältig und lassen sich im Wesentlichen in rekonstruktive und kosmetische Indikationen unterteilen. Der Leidensdruck der Patienten ist oft sehr hoch, denn entstellende Deformationen z. B. des Gesichts, der Extremitäten oder der Brust der Frau stigmatisieren, beeinträchtigen soziale Kontakte und führen oft zur gesellschaftlichen Isolation sowie zur professionellen und finanziellen Benachteiligung.
The hand is the organ responding to human desire, through which we experience and come into contact with the external world. Together with the face, it is the most exposed part of the body. Because of its development and mobility, and the perfect sensibility of its teguments, the hand represents a highly sensitive organ of touch.
Fat grafting has been widely used over 100 years for soft tissue augmentation. Despite a number of publications which show poor long term results, it is still one of the mostly preferred soft tissue fillers. After liposuction became popular in 1980s, an easier method of transfer, lipoinjection, once again brought attention to fat grafting. New methods to increase durability of the fat grafts were developed. Placing the fat graft to a well vascularized recipient site was one of the mostly accepted ideas. Fat grafting into the muscle and over periosteum showed satisfactory results in the long term. All the fat tissue transplanted in a recipient site will probably not survive; the area that contains necrotic fat tissue and this can cause depressions which are easily seen if the skin overlying is thin and has been previously traumatized. Placing the fat grafts subperiosteally can be a solution to this problem. In our experimental study, we compared subperiosteal fat grafting with supraperiosteal fat grafting in a rat model. Fat graft weight changes and histopathologic examinations in both of the groups showed similar properties. Thus subperiosteal grafting is an alternative augmentation technique in areas where the overlying skin is thin.
Lipostructure is a technique based on three-dimensional change of the anatomy, injecting fat autografting previously centrifugated. The innovation of this technique is refill atrophy and disappeared tissues with permanent, reliable and predictable results. Learn the correct technique is useful to correct as Aesthetic as Reconstructive defects. We have applied this procedure since 2000, with postoperative results to three years. In six face lipoinjections, two of them as adjunct procedure of lifting, very good aesthetic improvement for patient and surgeon was obtained. In the same way two patients with hemifacial atrophy and first and second arch brachial Syndrome have been benefited from fat autografting injections. Related to reconstructive problems we have repaired five patients with poliomyelitis sequelae, depressed gluteus tissues, midfacial scar, calf liposuction iatrognic sequelae, and mastectomy secuelae in a man with ginecomasty. Excellent results encourage us to increment indications.
Use of adipous tissue transfer for correction of maxillo-facial defects was reported for the first time at the end of the 19th century and has been the subject of numerous studies. Fat tissue grafting has been for many years one of the ideal fillers for enhancing and recontouring the face. Several techniques have been proposed for harvesting and grafting the fat but, due to the damage of many adipocites during these manoeuvres, the results were not satisfied, requiring a lot of fat for small correction. In 1988 the american plastic surgeon Sidney Coleman developed a personal technique, called "Lipostructure", that allows the fat to be harvested and injected minimizing the risks of necrosis and reabsorption. The Authors describe their experience in managing patients affected by facial defects (burns sequelae, post-traumatic, congenital and post-tumor exeresi deformities) using the lipostructure principle from June 2004 to June 2005.
Facial aging involves volumetric change, alteration of tissue quality, and the effects of long-standing facial muscular animation [1]. These factors lead to soft tissue ptosis and static and dynamic rhytids [1]. The traditional concept of beauty involves the “triangle of beauty” with high cheekbones and a defined jaw whereas the “reverse triangle” or pyramid with flattened cheeks, drooping eyes, and jowling is considered unattractive [2]. Facial rhytids can be classified as dynamic or static. Dynamic rhytids occur with muscle action and are best treated by specifically targeting facial muscles with botulinum toxin [2]. Facial expression not only contributes to the development of facial lines but also influences atrophy of soft tissue and malposition [3]. More facially animated individuals typically demonstrate increased lines and furrows relative to their less-animated counterparts [3]. Static rhytids result from the natural aging process with collagen loss and photodamage [4]. They are visible at rest and are addressed with volume replacement or combination therapy. Sun exposure and smoking additionally contribute to facial aging [3]. The trend in facial rejuvenation has increasingly emphasized the three-dimensional aspects of facial aging [5]. The three critical components of facial augmentation involve control of movement, improvement of contour, and restoration of volume [5]. The volume loss in the aging face involves atrophy of subcutaneous fat, which is variable between race and gender [5]. Bone loss plays a minor role as well [5]. Characteristics of the aesthetic ideal differ between men and women and need to be considered when developing a treatment plan [5].
Patients usually complain about numbness in the nasal tip after microfat injections. The present study evaluated the severity of the numbness in the nasal tip after the procedure.
To address the research question, a prospective study of young women was designed and performed at the Beijing Anzhen Hospital. Time was the primary predictor variable. The nasal tip sensation, which was evaluated using objective and subjective assessments, was used as the primary outcome variable. The McNemar-Bowker test (time vs nasal tip sensation) was used to detect statistical significance.
A total of 30 young women (age 20.04 ± 3.63 years) were recruited for the present study. The preoperative mean touch threshold value was 3.60 units. One week after the injection, the women experienced a decrease in the touch threshold value by 2.50 units. However, the sensation recovered gradually during the follow-up period (1.51 units at week 2, 2.39 units at week 4, 3.01 units at week 8, and 3.35 units at week 12). Significant differences were detected between multiple different measurement points (P < .05). The percentage of those experiencing paresthesia after the microfat injections also gradually diminished to none.
Postoperative numbness occurs in most patients receiving nasal microfat injections. Partial to complete recovery of nasal tip sensation can be expected to occur over a 3-month period.
Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
BACKGROUND:
In recent years, fat grafts have become useful in plastic surgery. They are
mainly used to fill soft tissues, refine breast reconstructions, and for volumetric
facial rejuvenation. They are also a rich source of mesenchymal stem cells (i.e.,
adipose-derived stem cells [ADSCs]), which directly influence fat graft survival.
Since ADSCs play an important role in angiogenesis and adipogenic differentiation,
it is essential to optimize their isolation. Therefore, in this study, we evaluated
and compared 2 procedures used to isolate viable cells from the stromal vascular
fraction of abdominal adipose tissue and assess the expressions of surface markers.METHODS: We examined 9 female subjects who were scheduled to undergo
liposuction. The adipose tissue was isolated from the abdominal infraumbilical
region. Fat (20 mL) was collected from the right side by using a cannula attached
to a syringe; the plunger was pulled back every 2 cm3 to create low-pressure
suction (manual group). The same procedure was repeated on the left side, but
the cannula was attached to a sterile and intermediate collector coupled to
a vacuum pump that provided a constant negative pressure of 350 mmHg (pump group).
The samples were centrifuged, and the adipocytes of the intermediate layer were
counted, cultured, and immunophenotyped.RESULTS: The isolation of abdominal adipocytes with a pump providing
a negative pressure of 350 mmHg yielded a higher concentration of cells in the
stromal vascular fraction than that obtained using 10-mL syringes and low-pressure
suction, although the difference was not significant.CONCLUSIONS: A negative pressure of 350 mmHg may be safely applied to
isolate ADSCs. The cell yield did not indicate any statistically significant
difference between the techniques.
Background: Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results and fewer and lesser side effects than synthetic injectables.
Objectives: The author reports his experience in fat grafting to the nose using his personal technique in 48 consecutive patients. The experience covers primary treatments of non-operated noses, treatment of postrhinoplasty deformities, and the combination of fat grafting to the nose with rhinoplasties.
Methods: The technique used by the author for fat grafting to the nose does not differ too much from that used in other body or face areas. It is based in the atraumatic extraction of fat fragments using a multi-orifice cannula and the injection of these fragments using 1.4–1.6-mm cannulas or needles. When combining rhinoplasties with fat grafting, fat grafts were used instead of prosthesis or cartilage grafts in the same location.
Results: The initial analysis of postoperative results showed a good to high level of patient satisfaction, particularly in primary cases, with virtually absence of complication or severe side effects. Some easily corrected side effects were probably learning curve dependent.
Conclusions: Autologous fat grafting is an effective and reliable technique to perform aesthetic and reconstructive nose reshaping in those patients who refuse surgical treatments. Although clinicians can get optimal results with this technique, these are not comparable to those obtained by surgical rhinoplasties, and this is an important issue to discuss with the prospective patient.
Gli innesti adiposi autologhi sono realizzati dalla fine del XIX secolo, ma solo dagli anni ′90 questa tecnica è stata padroneggiata e codificata. Grazie all’apporto della lipoaspirazione e a una migliore comprensione della fisiologia degli adipociti basata in particolare sulla necessità di manipolarli in modo atraumatico, noi disponiamo oggi di un procedimento chirurgico efficace e sicuro. Esso permette di ripristinare i volumi migliorando, al tempo stesso, il trofismo cutaneo in numerosissime indicazioni in chirurgia riparatrice e in chirurgia estetica, con dei risultati duraturi e riproducibili.
L’uso del tessuto adiposo come prodotto di riempimento in chirurgia plastica ed estetica è antico ed è stato oggetto di numerosi studi. È alla fine del XIX secolo che l’innesto di tessuto adiposo è stato utilizzato per la prima volta. Le idee e le tecniche sono notevolmente progredite nel corso dell’ultimo secolo. L’innesto di tessuto adiposo ha beneficiato di un ritorno di interesse in questi ultimi anni. Varie tecniche sono state presentate nella letteratura, ma il ritorno in voga è venuto in seguito ai lavori di Coleman. Egli ha presentato una tecnica poco traumatica basata su un materiale specifico e su una metodologia rigorosa. Diversi lavori hanno mostrato, in seguito, la sopravvivenza del tessuto adiposo trapiantato. Davanti alla dimostrazione della sopravvivenza cellulare e ai buoni risultati ottenuti, l’uso di questa tecnica allo scopo di riparare i difetti di contorno e di volume si è progressivamente generalizzato. È una tecnica semplice, efficace e riproducibile. Essa sembra attualmente il mezzo migliore per riparare i difetti di volume. Inoltre, noi sappiamo, oggi, che il tessuto adiposo è la più grande fonte di cellule staminali mesenchimali dell’organismo e questo lo pone al centro dei lavori sulla medicina rigenerativa. Dopo una descrizione delle proprietà del tessuto adiposo, della storia e della tecnica attuale del trapianto di adipociti, sono elencate e illustrate le applicazioni attuali di quest’ultima.
El tejido adiposo se utiliza como producto de relleno en cirugía plástica y estética desde hace mucho tiempo y ha sido objeto de numerosos estudios. El injerto de tejido adiposo se utilizó por primera vez a finales del siglo xix. Los conceptos y las técnicas han evolucionado en gran medida en el último siglo. En estos últimos años, ha surgido un renovado interés por el injerto de tejido adiposo. Se han publicado distintas técnicas, pero la novedad ha surgido gracias a los trabajos de Coleman, que ha presentado un procedimiento poco traumático basado en un material específico y en una metodología estricta. Distintos estudios han mostrado después la supervivencia del tejido adiposo trasplantado. Ante la demostración de la supervivencia celular y los buenos resultados obtenidos, la utilización de esta técnica con el fin de restaurar los defectos de contornos y de volúmenes se ha generalizado de forma progresiva. Se trata de una técnica sencilla, eficaz y reproducible. En la actualidad, parece ser el mejor método de restaurar los defectos de volumen. Además, hoy día se sabe que el tejido adiposo es la mayor fuente de células madre mesenquimatosas del organismo, lo que le coloca en el punto central de los trabajos sobre medicina regenerativa. Después de una descripción de las propiedades del tejido adiposo, de su evolución histórica y de la técnica actual de injerto de adipocitos, se enumerarán y se ilustrarán sus aplicaciones actuales.
Background:
Temporal depression after temporalis muscle flap transposition is characterized by a concavity of the soft tissue and associated with the relief of the orbital rim and zygomatic arch. The purpose of this study was to describe the use of autologous fat grafting for the treatment of postsurgical temporal contour deformities.
Methods:
Between March 2008 and April 2011, 45 patients were treated with lipofilling. A virtual 3-dimensional preoperative assessment was used to objectively quantify the loss of volume of the affected side. Two different methods were used to evaluate the surgical outcomes.
Results:
A noticeable soft tissue augmentation of the temporal region was noted in all cases. In 35 patients, a second procedure was required and in 1 patient, a third procedure was required. The final result was assessed as fully satisfactory by 39 patients (86.6%), as satisfactory by 5 patients (11.1%), and as unsatisfactory by 1 patient (2.2%).
Conclusion:
We believe that structural fat grafting at the temporalis muscle flap donor site is an effective technique that provides a high satisfaction rate and only a few complications.
Most authors supported the theory of adipocyte survival. The viability of these cells has been demonstrated by various experimental clinical, radiological and biochemical studies. After a review of the literature, the authors report the various factors, which influence the survival of the transplanted adipocytes. These factors are presented according to their chronology in the operative procedure. The techniques used are very diverse. The reference technique chosen is that described by Coleman (Lipostructure®). The following factors are studied: type of anaesthesia, infiltration, donor site of adipose tissue, method of harvesting, method of refining adipose tissue, anabolic complements, receiving site, reinjection technique, number of grafting sessions, freezing of adipose tissue and complementary postoperative treatments. It seems imperative that each phase of the operative procedure should be carried out without damage to the adipocytes, in particular their harvesting, refining and reinjection. All the other factors studied require comparative analysis in order to demonstrate their true importance. This opens up various directions of research aiming to improve the survival of the transplanted adipocytes.
Autologous fat can be considered to be a gold standard implant by virtue of its volumetric qualities and its action on skin trophicity. Improved techniques have transformed fat injections into reproductible adipocyte grafts with permanent results.
The utilisation of adipose tissue as filling product in plastic and aesthetic surgery is an ancient technique that has been largely studied. The use of autologous adipose transplant has been reported for the first time at the end of the nineteenth century. During the twentieth century, concepts and techniques have considerably evolved, and a renewed interest for adipocyte grafting is observed these last years, particularly after the description of the Lipostructure® by Coleman. This is a recent technique of adipocyte grafting that requires the utilisation of a specific material and a rigorous methodology. Several published works have shown the atraumatic character of this technique and the survival of the transplanted adipose tissue. Such demonstration and the good results that were obtained have promoted the utilisation of this technique for the restoration of all volume defects. In addition to the description of the properties of adipose tissue, history, and current technique for adipocyte grafting, the current applications of adipocyte grafting are listed and illustrated. Indications for face, thorax, breast, and limbs are described. This a simple, efficient, and reproducible technique that currently appears to be the best means for restoration of volume defects. Its application in all fields of plastic surgery constitutes a considerable improvement.
Use of adipous tissue transfer in plastic and reconstructive surgery is not new, and has been the subject of numerous studies. Transfer of autologous adipose tissue was reported for the first time at the end of the 19th century. Ideas and techniques have greatly changed during the last century. Adipocyte transfer has attracted renewed interest in recent years, due in particular to the development of Lipostructure® by Coleman, who introduced a procedure based on strict methodology and the use of specific material. The history of adipous tissue transfer is retraced through the works of various authors and briefly recounted by highlighting the major landmarks of its advance. The evolution of ideas and techniques can be divided into three periods. The period before the introduction of lipoaspiration was termed “open surgery”, when adipose tissue was harvested by surgical excision. The next period is that following the discovery of lipoaspiration, called the “unrefined” period, during which adipose tissue was obtained by aspiration and reinjected without preparation. During the third period, following the works of Coleman, the adipose tissue now undergoes non-traumatic refinement before grafting; this period is called “non-traumatic refined”. Various studies have shown that this technique causes little damage to the cells and have demonstrated survival of the tissue transferred. Discovery of the developmental capacities of the various lineages from a mesodermal stem cell, and in vitro culture of these cells, opens up new research perspectives and clinical applications. From this precursor cell, adipocytes, osteoblasts, chondrocytes, myocytes and neurone-like cells can be developed. The future of autologous reconstruction appears promising.
Cosmetic procedures are becoming increasingly popular with dermatologists. They are used to reverse the effects of aging, to improve the quality of the skin, to augment facial structures, and to improve the patient's appearance in general. They can also be beneficial for certain dermatoses. We present an introduction to cosmetic dermatologic procedures, focusing on chemical peels, botulinum toxin injections, and the use of filler substances. Following this review, the reader should have the basic knowledge to consider training to perform such procedures safely and effectively, even if he or she has not done so previously.
The Ramsay Hunt syndrome is a rare disease caused by an infection of the geniculate ganglion by the varicella-zoster virus. The main clinical features of the syndrome are as follows: Bell palsy unilateral or bilateral, vesicular eruptions on the ears, ear pain, dizziness, preauricular swelling, tingling, tearing, loss of taste sensation, and nystagmus. We describe a 23-year-old white woman, who presented with facial paralysis on the left side of the face, pain, fever, ear pain, and swelling in the neck and auricular region on the left side. She received appropriate treatment with acyclovir, vitamin B complex, and CMP nucleus. After 30 days after presentation, the patient did not show any signs or symptoms of the syndrome. At follow-up at 1 year, she showed no relapse of the syndrome.
Acetaminophen and diclofenac are prescribed as postoperative analgesic agents in children. However, the efficacy of their combination is not studied sufficiently. We compare the analgesic effects of acetaminophen, diclofenac, and their combination after cleft palate surgery. In this randomized clinical trial, 120 children (1.5-5 y) who were scheduled for cleft palate repair were studied. Children were randomized to receive placebo, acetaminophen (40 mg/kg), diclofenac (1 mg/kg), or acetaminophen (40 mg/kg) plus diclofenac (1 mg/kg) rectally just after surgery. Acetaminophen (30 mg/kg) and diclofenac (1 mg/kg) were administered every 8 hours until 48 hours. Postoperative pain was assessed regularly with the Children Hospital of Eastern Ontario Pain Scale, and rescue analgesia was provided if scores were 7 or greater. Time to the first prescription of meperidine, total postoperative meperidine consumption, and adverse effects were the main outcomes.After surgery, pain scores were higher in placebo than in other groups in all time intervals. In the first 12 hours, pain scores in the combined group were less than those in the acetaminophen (P < 0.05) and diclofenac (P < 0.05) groups. Postoperative meperidine consumption was the highest in placebo and was the least in combined group (P < 0.05). It was significantly higher in the acetaminophen group than in the diclofenac group (P < 0.05). Time to the first prescription of meperidine was significantly different among all groups. Adverse effects were comparable among groups.Rectal acetaminophen plus diclofenac was found to be the most effective in pain control. However, both rectal acetaminophen and diclofenac were more effective than placebo, whereas diclofenac was more effective than acetaminophen.
Nasolabial cysts are uncommonly diagnosed nonodontogenic soft tissue lesions located close to the nasal alar region of the face, presenting as extraosseous swelling in the region of the nasolabial fold. Nasolabial cysts are likely to remain undetected unless and until they become infected or are associated with facial deformity. Histologically, it is lined with nonkeratinized squamous epithelium or, more frequently, with respiratory-type cylindrical epithelium with goblet cells. The aim of this article was to present and discuss the surgical management of a case of nasolabial cyst and to briefly review the literature.
In the present clinical report, we describe the management and the long-term (3-year) outcome of a periodontally compromised lower second molar healed by orthodontic-aided extraction of the neighboring impacted third molar.
A healthy 21-year-old woman referred signs and symptoms of pericoronitis of impacted tooth 48 and periodontal injury on the distal aspect of tooth 47. The wisdom tooth was surgically exposed, and an orthodontic appliance was anchored to the neighboring teeth to stimulate eruption. After 5 months, third molar could be easily extracted.
Three years after extraction, clinical and radiographic controls revealed a complete healing of the periodontal defect.
Orthodontic-aided extraction of impacted third molars may improve the periodontal status of the neighboring tooth. This protocol is not free from drawbacks and limitations and should be applied only when third-molar extraction is associated with a concrete risk of postoperative complications.
In this article, we describe an alternative procedure to restore the retrobulbar volume in enophthalmic patients. We report the case of a patient with a late enophthalmos we submitted to retrobulbar lipofilling to correct the defect. The preoperative assessment and the surgical technique are described in detail. The volume of fat injected was 3.2 mL, with a satisfying increase in exophthalmometry measurements. The procedure was well tolerated without complications. Retrobulbar lipofilling for enophthalmos appears to be a safe alternative technique for orbital volume enhancement. It avoids the use of alloplastic materials and allows to obtain good cosmetic results with an easy technique and minimal donor-site morbidity.
Lower eyelid scaring and malposition following violation of all three lamellae pose a significant ophthalmologic reconstructive challenge. The purpose of our study was to document a staged approach for this problem using: 1) transconjunctival scar release followed by palatal graft below the tarsal plate and subciliary scar release followed by full-thickness skin graft superficial to the tarsal plate and 2) subsequent autologous fat grafting to the lower eyelid.
Cadaveric anatomic dissections were performed. Post-traumatic and post-surgical lower eyelid deformities requiring reconstruction were reviewed and outcome assessment was based on symptomatic improvement, perioperative complications, reoperations and long-term follow-up (> 1 year).
Cadaver dissections demonstrated consistent lower eyelid tarsal plate and lamellar anatomy for the use of palatal graft and skin grafting. Clinically, 75% cases resulted from full thickness traumatic laceration of the lower eyelid or malar region and 25% of cases occurred after transconjunctival incisions were made for zygomatic maxillary repositioning following partial lower eyelid laceration. Preoperative symptoms of: epiphora, tearing, redness, blurry vision and dryness improved in all patients and complete resolution was seen in 63% of patients. Thirty-seven percent of patients had complications: Redundancy of palatal graft, Partial FTSG loss, cellulitis after fat transfer.
We describe an approach for the scarred and displaced lower eyelid following injury to all three lamellae that provided symptomatic improvement after lower lid scar tissue release, lengthening of the contracted septum, support of the posterior lamellae with a palatal graft and a replacement of anterior lamella with full thickness skin graft.
Die Rekonstruktion von Weichteilgewebedefekten nach thermischen Unfällen oder tumorchirurgischen Eingriffen stellt weiterhin ein ungelöstes Problem in der Plastischen und Rekonstruktiven Chirurgie dar. Bei begrenzten chirurgischen Möglichkeiten eröffnet das Tissue engineering von Fettgewebe neue Perspektiven. Notwendige Voraussetzungen für eine erfolgreiche Rekonstruktion sind: ein ideales dreidimensionales Konstrukt, autologe Zellen, optimale Kultivierungsbedingungen und eine ausreichende Vaskularisation für spätere in vivo Anwendung. In dieser Studie wird ein Konstrukt aus einem neuen Material (Polyesteramid Typ C) vorgestellt, das mit Fettgewebsvorläuferzellen, so genannten Präadipozyten, besiedelt wurde. Vor Besiedelung der Konstrukte wurden die der Oberfläche anhaftenden Ver¬unreinigungen mit Hilfe eines speziellen Extraktionsverfahrens entfernt und die Vliese nachfolgend gammasterilisiert. Die Präadipozyten wurden aus frisch exzidiertem Gewebe von gesunden Patienten entnommen, die sich elektiven Eingriffen (Abdominoplastiken oder Liposuktionen) unterzogen hatten. Einige Vliese wurden mit Fibronektin beschichtet, um eine bessere Oberflächenstruktur zu schaffen und somit eine Anhaftung der Präadipozyten an die Fasern des Konstruktes zu erleichtern. Nach Besiedelung wurden die Zellen auf den Konstrukten kultiviert und anschließend histologisch zur mikroskopischen und laborchemischen Analyse aufgearbeitet. Um das Verhalten der Präadipozyten sowohl in vitro als auch später in vivo analysieren zu können, wurden Versuche mit verschiedenen Fluoreszenzfarbstoffen durchgeführt. Dazu wurden die Fettgewebsvorläuferzellen sofort nach Präparation aus frisch exzidiertem Fettgewebe mit den Markern PKH-26, CM-DiI und CFDA-SE gefärbt und über 30 Tage kultiviert. Das Fluoreszenz-Färbungsmuster wurde mikroskopisch beobachtet und mittels FACS quantifiziert. Die Fettzellreifung ist ein komplexer Prozess, der aus mehreren Entwicklungsstufen besteht und sich somit als langwierig darstellt. Die adipogene Konversion ist durch komplexe Kulturbedingungen optimierbar. In der Literatur wird eine adipogene Wirkung von Stickstoffmonoxid beschrieben, die jedoch eine inadäquate Ausdifferenzierung der Zellen zeigt. Um dies zu evaluieren und das Differenzierungskonzept zu optimieren, wurden unterschiedliche Konzentrationen des NO-Donors DETA/NO im Vergleich zum Trägermolekül DETA verwendet und der Effekt auf die Präadipozyten analysiert. Nach Optimierung der Vliesreinigung ließ sich ein Konstrukt herstellen, welches Präadipozytenanhaftung, Proliferation und Differenzierung ermöglichte. Es zeigten sich vitale Zellen mit guter Anhaftung an die einzelnen Fasern und guter Verteilung innerhalb des gesamten Konstruktes. Die Beschichtung mit Fibronektin, einem Glykoprotein in der Extrazellularmatrix, erlaubte den Fettgewebsvorläuferzellen eine Verbesserung der Zellanhaftung an die einzelnen Fasern des biodegradierbaren Konstruktes, die Proliferationsrate in den Fibronektin-beschichteten Konstrukten war jedoch schwächer als in unbeschichteten Konstrukten. Die Analyse der Fluoreszenzfarbstoffe zeigte relativ hohe Toxizitätsraten für CM-DiI und CFDA-SE. PKH-26 wies eine deutlich niedrigere Toxizitätsrate und die beste Stabilität in den Zellen auf. Alle drei Farbstoffe hatten keinen Einfluss auf das Proliferations- und Differenzierungsverhalten der Zellen. Die Versuche mit dem NO - Donor DETA/NO bestätigten eine adipogene Wirkung von Stickstoffmonoxid auf die Präadipozyten, jedoch mit einer geringen therapeutischen Breite. Die Studie zeigt, dass es sich bei Polyesteramid Typ C um ein viel versprechendes neues Material handelt. Die Vorteile bestehen in einer pH-Stabilität während der Degradation und in einer flexiblen dreidimensionalen Struktur, die sich der Form der Zellen anpassen kann und somit zu einer weitgehend ungehinderten Zellreifung beiträgt. Die zur Optimierung der in vivo Analytik verwendeten Fluoreszenzfarbstoffe sind für lange Versuchverläufe nicht anwendbar, da die Intensität der Markierung infolge der hohen Proliferationskapazität der Präadipozyten drastisch abnimmt und die gefärbten Zellen somit nach geringer Zeit nicht mehr nachweisbar sind. Letztendlich bleibt die Problematik bei der Fettgewebszüchtung bestehen: die insuffiziente Vaskularisierung. Es gibt viele gute Ansätze zur Behebung dieser Problematik, jedoch sind weiterführende Studien zur Erforschung dieser Thematik notwendig. The reconstruction of soft tissue defects after burn injuries or breast resection due to cancer are still an unresolved problem in plastic and reconstructive surgery. Since there are limited surgical possibilities, adipose tissue engineering with preadipocytes offers new perspectives. Essential requirements for successful reconstruction are: adequate threedimensional construct, autologous cells, ideal cultivation conditions and sufficient vascularization for further in vivo experiments. This study evaluates an innovative material consisting of polyesteramide in a 3D nonwoven seeded with preadipocytes, adipogenic precursor cells. Surface contaminations were removed by a surface cleaning procedure followed by vacuum drying and gamma sterilisation. Preadipocytes were isolated out of human subcutaneous adipose tissue of healthy patients who had undergone elective operations. After the isolation procedure, preadipocytes were cultivated in culture dishes and then seeded on the scaffolds. Nonwovens were either precoated with fibronectin or directly used for seeding. Scaffolds were then examined for preadipocytes proliferation and differentiation. To analyze the attitude of preadipocytes in vitro and later in vivo, preadipocytes were tracked with three different fluorescent dyes: PKH-26, CM-DiI and CFDA-SE. After the isolation procedure, preadipocytes were cultivated in culture dishes and stained with the cell tracker according to the recommendation of the manufacturer. Preadipocytes were cultivated for 30 days for microscopical and FACS analyses. The adipogenic conversion consists of several stages of development. As described in the literature, nitric oxide has an adipogenic effect on preadipocytes but shows inadequate differentiation. In order to evaluate this effect and optimize the concept of preadipocyte differentiation, different concentrations of the NO-Donor DETA/NO compared to DETA were used and the effect on preadipocytes was evaluated. After optimizing the cleaning procedures of the construct, the analyses of the nonwovens demonstrate good adherence and spreading of preadipocytes on polyesteramide derived nonwovens. Cells are adequately distributed and most cells are attached to fibers. Precoating with fibronectin displays a significantly higher cell number after seeding. Comparing the three tracking dyes, PKH-26 seems to be the most promising reagent considering toxicity and long-lasting of the labelling. All the three dyes had no effect on proliferation and differentiation of preadipocytes. Analyses with the NO-Donor DETA/NO approve the adipogenic effect of nitric oxide on preadipocytes, but with a low therapeutic index. The results of this study display that polyesteramides are promising materials with high potential for clinical application especially due their pH stability during degradation what leads to less formation of acid degradation products which are often responsible for inflammatory reactions after scaffold implantation. The fluorescent dyes used for optimizing the in vivo analyses are not applicable for long lasting experiments as the luminosity diminishes dramatically due to the high proliferation capacity of preadipocytes. The fact is that the major problem of tissue engineering is still unresolved: the insufficient vascularization. There are many approaches to solve this problem but further experiments are still necessary.
The purpose of this study was to analyze the role of fat grafting for restoration of facial contour deformities (volumes) in traumatic and malformation cases. Outcomes were evaluated for each facial aesthetic subunit to demonstrate the role of the recipient site. An algorithm for the treatment of facial malformations and traumatic sequelae by subunits, in relation to the results obtained in this study, is proposed.
This retrospective study involved 100 patients treated by structural fat grafting of the facial region. Results were evaluated by a subjective self-evaluation survey (i.e., a questionnaire answered by patients) and an objective assessment by a five-member jury. Each subunit of the face was studied separately. Results were presented separately and compared.
The average follow-up period was 23 months. The overall satisfaction rate of patients was 74 percent. The average score for subjective evaluation was 14.5 of 20. The objective score was 13.9 of 20. The results were significantly different depending on the aesthetic subunit of the face. The best results were achieved in the malar (89 percent good results) and lateral cheek areas (84 percent good results). The poorest results were registered for the lower and upper lip areas (34 percent and 31 percent good results, respectively). Minor complications were observed in 3 percent of the cases.
Fat tissue grafting is a simple, efficient, and reproducible technique for restoration of facial volumes. In the absence of functional disorders, it is the authors' first choice in the decision-making process for the treatment of facial soft-tissue deficiencies.
There has been no ideal option for patients who are unhappy with their facial shape but do not want to undergo complex surgeries or pay the high price of temporary injectable treatments. In this article, we describe the treatment of facial complaints such as the gaunt face, long face, bottom-heavy face, chubby face, midface retrusion, and asymmetric face, as well as the modification of racial and ethnic characteristics, through the use of less invasive methods.
Fat grafting was used to accentuate the cheekbones in most patients complaining about their facial shape. For the long face, this technique increased the horizontal facial diameter. Lipoplasty combined with buccal lipectomy effectively decreased the fullness of the lower face and improved facial contour in the bottom-heavy face and chubby face. A skin-tightening face lift may also be necessary in patients with neck laxity. Fat grafting was used to fill in depressions or defects in the gaunt face and to treat midface retrusion and facial asymmetry. Added facial projection was obtained with nasal and chin implants. Photographs of representative patients treated for facial reshaping using the described techniques are presented. By using the less invasive techniques described, plastic surgeons can reshape a patient's face without the prolonged downtime or morbidities associated with more invasive procedures.
In the past, the traditional method of contouring the iliac crest and lateral femoral areas has been liposuction or the surgical removal of the bulges. Unfortunately, this method fails to correct the deep gluteal depression juxtaposed at these two sites. Since we use autologous fat grafts to correct contouring deficiencies elsewhere, it seems logical to investigate whether this technique is applicable to correcting this deformity. We have performed autologous fat grafting to the gluteal depression on 12 patients who underwent lipoplasty of the iliac crest and lateral femoral sites. The longest followup was one year. We have found that this method corrects the deep gluteal depression and yields an improved aesthetic contour. This article describes the technique, addresses the problems encountered, and shows postoperative results.
Syringe liposculpture is a method that combines two relatively new techniques of plastic surgery: syringe liposuction and fat grafting. We can reshape the face and the body by removing localized fat deposits and reinjecting this fat where needed. When we do not reinject, we call the technique reduction liposculpture. In 1989 we introduced a new technique--superficial syringe liposculpture--to treat patients with flaccid skin, superficial irregularities or depressions, "cellulite," and liposuction sequelae. The technique combines syringe liposculpture, superficial liposuction, and our method of treating skin irregularities by breaking the fibrous adherences and injecting fat superficially.
Free fat graft autotransplantation for soft-tissue replacement has been a neglected subject in recent years. In a review of the literature, investigations of the various uses of free fat autotransplantation in animals and humans provide an understanding of the problems associated with the use of fat as a free graft. Results of free fat autotransplantation were found to be quite unpredictable, with wide variations in the resulting bulk of the graft. Microscopic studies of this behavior led to controversy as to whether the graft ultimately was made of surviving graft adipocytes (cell survival theory) or host adipocytes (host replacement theory). Studies revealed a "fibroblast-like" mesenchymal cell within adipose tissue that was believed to be an immature adipocyte precursor or preadipocyte. Further characterization of the preadipocyte and its complete differentiation was accomplished using tissue-culture techniques. These investigations provide evidence of the dynamic nature of adipose tissue that strongly supports the cell survival theory and gives explanation to the unpredictable behavior of free fat autografts. Many conditions treated by plastic surgeons require soft-tissue augmentation. Autogenous adipose tissue is the most appropriate and natural replacement material. With new culturing techniques, preadipocytes in a single cell suspension may provide an injectable soft-tissue replacement. This subject appears ripe for investigation.
Long-term results for 167 cases of the fat injection technique performed between June 1983 and June 1987 are presented. During this four-year period, stable results appear to have been obtained in only a few cases. This report also includes the disappointing preliminary findings of attempts to use fat to fill wrinkles in the face. Although these preliminary long-term results may not be encouraging, various laboratory studies seem to demonstrate the hypothetical possibility of fat cell survival and tend to encourage continued research in this field.
Free autogenous fat grafts between 4 and 6 mm (the size of a pearl) have been used successfully to correct pitting acne, nasolabial folds, eyelid depressions, facial atrophy, facial wrinkles, depressed scars, and in chin augmentation. Theoretical measures taken to ensure the maximum amount of survival of donor fat include exogenous vitamin E, treatment with insulin, small size of grafts, and atraumatic antiseptic technique. Numerous supportive clinical, historical, and laboratory references are cited, dating from 1893. Considering the abundance of fat tissue available and the prolific amounts discarded during blepharoplasty, liposuction, lipectomy, and platysma cervical lift, fat should be reconsidered as the soft tissue substitute. This is a preliminary report and further study is needed.
Eighteen months' experience with the injected fat grafting technique used in 208 patients to correct various problems such as buttocks (augmentation and reshaping), trochanteric depressions, breast augmentation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg's disease), nasolabial fold, upper outer breast quadrant, liposuction sequela, fingers and hands is presented. This method shows major advantages with few complications. Some technical details and recommendations for successful fat grafting are also presented.
Nine cases of idiopathic constitutional subcutaneous fat atrophy in the cheek area during the years 1988-1992 were treated by the autologous transplantation of fat for purely aesthetic reasons. The fat graft suspension was obtained by the low-power aspiration technique with the use of a vacuum pump. The contour defects were initially overcorrected by approximately 50 percent more volume than required. The patients were followed up for 1.5 to 4.5 (mean, 3.5) years. Contrary to the experience of others, only the partial resorption of the transplanted fat occurred. This result was verified by six biopsy specimens obtained in the time range of 7 to 36 months after transplantation. The additional injections of fat were not necessary. Delicate tissue handling and the small total amount of fat transplanted by careful distribution in the recipient tissues are probably the factors responsible for the long-lasting improvement in these patients. As an experiment, suction of fat under -0.5 atm and -0.95 atm was performed in five patients undergoing abdominal liposuction. Aspiration under maximum negative pressure caused partial breakage and vaporization of the fatty tissue. The diameter of the fat cells in the remaining beads of fat was in all five cases mechanically distended and thus was larger than in the lipocytes extracted at -0.5 atm.
The authors describe a series of sections of adipose autografts in humans, focusing on the histological viability and the alterations observed in a postgraft followup. Five female patients aged 29 to 43 years were subjected to seven grafting sessions prior to a classic abdominoplasty. The autologous adipose tissue was grafted in the infraumbilical region. The grafting intervals were 60, 30, 21, 15, 8, 5, and 2 days before the surgical procedure. The grafted tissue of all groups was surrounded by a collagen capsule. The viable tissue was observed in the peripheral zone approximately 1.5 +/- 0.5 mm from the edge of the graft. A loss of approximately 60% of the grafted tissue was still noticed in this viable zone.
To document the amount and rate of re-absorption of fatty tissue transplanted using the author's technique, the author initiated controlled studies in 1987. A selected crease was infiltrated with autologous fatty tissue using a nearby crease as control. At specific time intervals the infiltrated crease was compared to the nearby control crease to evaluate percentage of recurrence. Photographs were taken in the first week, then at least yearly over six years. All views, all positions of the mouth, and all lighting situations demonstrated the continued absence of any crease in the area of infiltration. In contrast, the nearby control crease remained unchanged or deepened from its preoperative condition, giving every indication of a permanent correction. This experiment demonstrates the potential lasting nature of corrections performed with the transplantation of fatty tissue and is supported by over 400 infiltrations into the nasolabial folds in the author's practice.