Autologous Fat Grafting in the Treatment of Facial Scleroderma.

Mehdi Gheisari,Nilofar Nobari,Behzad Iranmanesh,Nikoo Mozafari,Arman Ahmadzadeh

doi:10.1155/2018/6568016

Abstract

Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations of systemic sclerosis are extremely disabling and treatment options are limited. In this study, we aimed to assess the safety and efficacy of autologous fat grafting in the face of patients with systemic sclerosis. We enrolled 16 SSc patients suffering from facial sclerosis and limited mouth opening capacity. Autologous fat injection ranging from 15 to 40 ml was administered per patient, based on their face morphology. The patients were evaluated at baseline and 3 months after fat injection. Evaluations included mouth opening capacity, mouth handicap in systemic sclerosis (MHISS), Rodnan skin sclerosis score, skin biophysical properties using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT), volumizing and aesthetic effects based on pre- and posttreatment photographs, possible side effects, and global patient satisfaction. Clinical assessment showed autologous fat transfer significantly improved mouth opening capacity and the MHISS and Rodnan score of patients with facial scleroderma (p value <.001). The aesthetic and/or functional results of fat injection were satisfying to about 80% of the patients. The changes in CRRT values were not significant. Our findings support the possible therapeutic role of autologous fat grafting in improving facial scleroderma both in aesthetic and in functional aspects. This trial is registered with IRCT20180209038677N1.

Highlights

Systemic sclerosis (SSc) is a rare systemic autoimmune connective tissue disease of unknown etiology, characterized by cutaneous and visceral fibrosis [1]
The present study demonstrated that autologous fat transfer (AFT) in the face of patients with scleroderma improves facial aesthetic aspects but significantly enhances the mouth opening capacity and reduces skin wrinkles and facial sclerosis
Our study showed that AFT was safe for patients with scleroderma and resulted in the reduction of mouth handicap as assessed by the mouth handicap in systemic sclerosis (MHISS) score

Summary

Introduction

Systemic sclerosis (SSc) is a rare systemic autoimmune connective tissue disease of unknown etiology, characterized by cutaneous and visceral fibrosis [1]. Systemic sclerosis is a heterogeneous disease, but two major clinical subtypes based on the extent of skin involvement are typically recognized, namely, limited cutaneous SSc with skin involvement from the distal to the elbows and knees and diffused cutaneous SSc with skin involvement extending to the proximal limbs and/or trunk [2]. The face is frequently involved in both subtypes of this disease. Facial involvement is associated with disfigurement and limited expression with a mask-like stiffness of the face. Dry mouth or xerostomia because of salivary gland fibrosis and reduced saliva production is a frequent symptom in these patients that increase the risk of periodontal diseases and caries [4]. The orofacial manifestations of systemic sclerosis are extremely disabling and severely impair the patients’ selfimage and compromise their quality of life [4]

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Conclusion