Autologous Fat Injection Research Articles

PS-07-002 Penile augmentation by Division of the Suspensory Ligament of the penis and autologous fat injection: A 72-patient experience

To evaluate the outcome of penile augmentation (PA) surgery at one center. This was a retrospective review of patient outcomes after surgical PA from January 2018 to October 2018 at one centre. All patients underwent division of the suspensory ligament of the penis, with insertion of silicon buffer, and autologous fat injection. 60 patients underwent a standard halfmoon incision above the base of the penis in the pubic hairline and 12 patients had a V-Y-plasty incision. The following data were collected; pre and post-operatively: flaccid penis length and girth; patient reported satisfaction rates and complications. 72 patients were included the study. The mean patient age was 38 (26-62) years; mean follow-up period was 5 (1-9) months; mean pre-operative flaccid length and girth was 9.2 (6-14) cm and 8.8 (7-11.5) cm respectively; and the mean increase in flaccid penile length and girth was 4.4 (2-8) cm and 4.1 (2.5- 7.5) cm respectively. In terms of patient-reported treatment outcome: 50 patients reported very high satisfaction; 15 patients reported high satisfaction; 5 patients reported moderate satisfaction; and 2 patients low satisfaction. No serious complications were encountered, with the majority being managed conservatively: 5 patients who underwent V-Y-plasty incision developed superficial wound breakdown and infection which was managed conservatively; 5 patients developed phimosis which resolved spontaneously except in 1 patient who needed a circumcision; 5 patients had partial fat absorption with 3 requiring fat top-up; and 7 patients experienced the formation of a hard fat lump which was managed by hyalase injections in an outpatient setting.

Strap Muscle Type I Thyroplasty After Gore‐Tex Implant Extrusion: Case Report and Literature Review

To discuss the presentation and management techniques of implant extrusion following type I thyroplasty and to illustrate the potential of strap muscle for augmentation following implant removal. We report a unique case of a patient with late Gore-Tex implant extrusion after type I thyroplasty treated with removal and autologous strap muscle graft for augmentation. A 41-year-old female nearly 3.5 years status post Gore-Tex type I thyroplasty for left vocal fold paralysis presented for evaluation of dysphonia. Upon flexible laryngoscopy, erythema, edema, and granulation tissue were identified at the left vocal fold and ventricle. The patient subsequently underwent removal of her implant. Intraoperatively, a free portion of sternothyroid muscle was dissected free and placed into the paraglottic space. One month following surgery, the patient reported an improvement in her Voice Handicap Index (VHI) score from 40 to 0. In addition, no major complications were observed and complete glottic closure was achieved. Nine months postsurgery, she continued to function well with a VHI score of 0. At 50 months postop, the patient still reports a VHI score of 0. Implant extrusion is a rare complication of type I thyroplasty usually occurring in the first few months after surgery and more commonly presenting in females. Current management options consist of observation or augmentation with autologous fat or vocal fold injection following implant removal. This is the first report of a successful strap muscle free graft revision thyroplasty following implant extrusion. The patient's excellent long-term outcome highlights the potential of strap muscle augmentation as a feasible management option for implant extrusion.

Effect of Girth Supersizing on Patient Satisfaction After Semi-Rigid Penile Implant Insertion: A Prospective Case-Control Study.

Penile length and girth have long been sources of anxiety for men. The authors sought to measure satisfaction with intercourse and erectile function 3 and 6 months after girth augmentation in patients with semi-rigid penile implants who received autologous fat injections. Thirty married participants in Egypt were recruited and divided into 2 groups between January 2016 and August 2017. Fifteen patients who underwent semi-rigid penile implant insertion and 15 controls all received autologous fat injections and were followed-up for 3 and 6 months. Median penile girth increased significantly in both groups, although fat loss was noted after 6 months. There was a positive correlation between the amount of fat injected and the change in penile girth measured 6 months after the procedure in the controls. Autologous fat transfer is a simple and safe procedure that can be used to augment penile girth in patients whose girth is less than 11.5 cm after penile prosthesis insertion.

Autologous Breast Reconstruction With the Latissimus Dorsi Muscle With Immediate Fat Grafting: Long-term Results and Patient Satisfaction.

The aim of this study was to describe a variation of the breast reconstruction technique with myocutaneous flap of the fat-grafted latissimus dorsi muscle and its outcomes and evaluation of patient satisfaction. This prospective cohort study included 18 patients and 19 reconstructed breasts, with 1 bilateral case. There were 7 cases of late reconstruction and 11 cases of immediate reconstruction. The flap was prepared with fat at the time of surgery, which was injected before its preparation. The evaluation of the results regarding shape, volume, and symmetry was performed through a satisfaction scale completed by patients and 2 physicians from 12 to 18 months after reconstruction. On average, 171.31 mL of fat was injected (100-275 mL); the average time of unilateral surgery was 3 hours 42 minutes (3 hours to 4 hours 30 minutes). After a mean follow-up of 26.38 months (13-38 months), we did not observe complications of this new technique. In the evaluation performed by patients regarding the shape, volume, and symmetry, more than 80% rated the outcome as excellent and good, and the evaluations by the medical team were also satisfactory. In the comparative analysis between immediate and late reconstruction, patients who underwent immediate reconstruction were more satisfied. This reconstruction technique with autologous fat injection was effective, with satisfactory and long-lasting results, and without the requirement for implants to set breast shape and volume.

Phonatory outcome of autologous fat injection in unilateral vocal cord palsy

Objective: Evaluate the outcome of autologous fat injection (AFI) in the management of unilateral vocal cord palsy (UVCP). Materials and Methods: In this retrospective study, we obtained data of all patients with UVCP of at least 6 months duration who underwent AFI. Preoperative and postoperative grade, roughness, breathiness, asthenia, and strain (GRBAS), voice handicap index (VHI), and multidimensional voice program scores were obtained and compared to evaluate the subjective and objective outcomes of AFI. Results: Sixty patients underwent AFI. There was significant improvement in perceptual voice, as graded by both – patient and observer, using VHI and GRBAS scale. Significant improvement was also seen in Jitter and Soft Phonation Index on voice analysis. Conclusion: AFI is a simple, safe, and cost-effective method with excellent phonatory outcomes for the management of UVCP.

Hyaluronic acid is superior to autologous fat for treatment of temporal hollowing after lateral orbital wall decompression: A prospective interventional trial

To compare injections of hyaluronic acid (HA) and autologous fat (AF) for the treatment of unsightly temporal hollowing after lateral orbital wall decompression in thyroid eye disease. In this nonblinded prospective comparative interventional study, patients received injections of HA in the right temple and AF in the left temple. Additional injections were given when needed at follow-up after 6, 12, 18, and 24 months. Follow-up included an interview; clinical examination with an evaluation of symmetry, contour, and skin surface; and ultrasound measurements. From photographs, the temporal hollowing was graded 1-3. The main endpoints were grading of temporal hollowing and temporal soft tissue thickness. Seventeen patients were treated bilaterally and 12 unilaterally (five received HA and seven AF). Injection(s) of HA and AF administered at each site were a median (range) of 1 (1-4) and 2 (1-5), respectively. The total combined volume of HA injected per site was 0.9 (0.2-2.0) ml and that of AF was 3.1 (0.5-9.6) ml. At the final examination, a statistically significant difference in mean (SD) grading scores of temporal hollowing due to HA (1.18 (0.26)) compared to those of AF (1.85 (0.44)) was observed (p < 0.001). Six months after administering an injection of HA, the temporal soft tissue thickness was 2.35 (0.24) cm compared to 2.19 (0.28) cm obtained with an injection of AF (p < 0.001). By using a linear mixed-effect model and adjusting for baseline values, age, sex, and refill, the difference in favor of HA persisted at all later follow-ups. Increased fibrosis of the subcutaneous tissue developed at 5/24 sites that received AF. Injection of HA is superior to that of AF for treating temporal hollowing after lateral orbital wall decompression.

Lipofilling of Fingertips for Volume Defects after Fingertip Injuries.

Regardless of the good outcomes of conservatively treated fingertip injuries, many patients complain about volume defects and hypoesthesia. Injection of autologous fat into the defect zone may resolve the volume problem and stimulate digital nerve regeneration by adipose derived stem cell transplantation. We analyzed 5 volume defects resulting from conservatively treated fingertip injuries in 4 patients (male to female ratio, 2:2), 6 months after the injection of autologous abdominal fat into the defect zone retrospectively. The fat transplantation was performed after complete wound healing was achieved (2.5-13.5 months; mean, 6.5 months). Assessment of 2-point discrimination; finger pulp circumference; the Disability of the Arm, Shoulder, and Hand score; visual analog scale score; and a questionnaire regarding the treatment satisfaction were carried out both preoperatively and at a 6 month follow-up according to the standard of our clinic. In 3 patients, one session of lipofilling was sufficient to correct the contour, whereas 1 patient with 2 fingertip injuries was treated a second time. There was no significant change in finger pulp circumference, in the 2-point discrimination values and the Disability of the Arm, Shoulder, and Hand score results. There was a significant improvement in the visual analog scale scores in 4 of 5 cases, and all patients were very satisfied with the results of the procedure regarding the improvement in hand function in sports, at work and their daily routine. Lipofilling can be performed with little operative risks, might alleviate the patient's symptoms and reduce pain after conservative treatment of fingertip injuries.

Autologous Fat Augmentation in Post Type III Cordectomy Patients.

Neocord formation after Type III cordectomy is insufficient for complete glottic closure due to scarring and soft tissue deficit. This study evaluates the role of autologous fat injection (AFI) in phonosurgical management of patients who have previously undergone Type III cordectomy for early glottic cancer. Data was collected from hospital records of patients who underwent AFI after previously undergoing Type III cordectomy. A minimum duration of 6months post-cordectomy was maintained before fat injection. Trans-oral injection was performed at a single site. Pre-operative voice evaluation was done using VHI, GRBAS scale and MDVP software. Post-operative evaluation was done at 6weeks. 21 out of 62 post-Type III cordectomy patients chose to undergo fat augmentation and were included in the study. A comparison of pre-operative and 6months post-operative AFI voice analysis showed a significant improvement in VHI, all parameters of GRBAS scale, and improvement in Jitter, Shimmer, SPI and NHR. There was a decrease in fundamental frequency but this was not statistically significant. AFI is an effective procedure for surgical voice rehabilitation of patients who have undergone Type III cordectomy for early laryngeal cancer.

Association of Autologous Fat Injection in Facial Artery With Ophthalmological Complications: An Experimental Animal Study.

Complications caused by autologous fat filling have been reported. Comprehensive knowledge of the possible adverse effects of autologous fat filling is needed. To determine the association of autologous fat filling with ophthalmic function complications. Four adult New Zealand white rabbits were killed for a facial anatomy study. Sixty-four adult New Zealand white rabbits underwent fat harvest using the Coleman technique. Autologous fat was minced or digested with collagenase 1 and centrifuged to separate fat lipid and fat granules. Either 0.2 mL or 0.4 mL of minced fat, fat granules, fat lipid, or saline (control) was retrogradely injected into the facial artery of rabbit models. Electroretinography and ophthalmic fundoscopy were performed to measure the retina and fundus artery occlusions 2 weeks after surgery. Visual impairment, blindness, and death. Injection of 0.2 mL of fat granules, fat lipid, and saline resulted in 100% (8 of 8), 62.5% (5 of 8), and 0 ophthalmic complications, respectively; and 0.4 mL resulted in 87.5% (7 of 8), 12.5% (1 of 8), and 0 ophthalmic complications, respectively. Injection of 0.2 mL and 0.4 mL minced fat led to 100% (8 of 8) ophthalmic complications and death, respectively. The mortality rates were 37.5% (3 of 8), 12.5% (1 of 8), and 0 for 0.2 mL emboli injection, and 100% (8 of 8), 50% (4 of 8), and 0 for 0.4 mL, respectively. In this study, minced fat injection was associated with more ophthalmic complications than injection of fat granules and fat lipid. Increasing the injection volume of fat tissues could raise the incidence of morbidity and mortality. NA.

Face-neck lifting and ancillary procedures: A series of 203 cases.

Various methods and ancillary procedures have been defined in the era of face-lifting surgery.The purpose of this study was to evaluate the esthetic outcomes of our face-neck cases and the importance of adding ancillary procedures based on individual assessment.We conducted a retrospective review of 203 face-neck cases, basically following the endoscopic and open principles of Vasconez. The ancillary procedures added in selected cases included genioplasty, augmentation with autologous facial superficial fascial tissue or fat injections, upper lip shortening, perioral dermabrasion, ear lobe reduction, buccal fat reduction, mentum lifting, and upper orbital rim shaving. Complications, postoperative follow-up, esthetic outcomes, and contribution of the ancillary procedures were recorded.Our esthetic face complication rates were comparable to those of previous studies and included chemosis, hematoma, cyst on the eyelid suture line, skin sloughing, scar abnormalities (hypertrophic scar and widespread scar), pseudoparalysis of the marginal mandibular branch, temporary hypoesthesia of the forehead, irregularity of the glabella after endoscopy, and asymmetry. We did not observe any comorbidity owing to genioplasty and augmentation with autologous tissue except for a case with infection after fat injection.More improvement can be obtained with careful planning of ancillary procedures in face-neck lifting surgery.

Autologous Fat Grafting in the Treatment of Facial Scleroderma.

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.

Percutaneous Autologous Fat Injection Following 2-Layer Flap Lower Blepharoplasty for the Correction of Tear Trough Deformity.

Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue.Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended.No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection.Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure.

Office-Based Autologous Fat Injection Laryngoplasty for Glottic Insufficiency in Patients Under 50 Years Old

We sought to determine the outcomes of office-based autologous fat injection laryngoplasty in the treatment of patients under 50 years old with glottic insufficiency but without neurological problems or acquired organic lesions in the vocal fold. We conducted a retrospective chart review of consecutive patients under 50 years of age who underwent office-based autologous fat injection laryngoplasty for glottic insufficiency. None of the patients presented neurological problems or acquired organic lesions in the vocal fold. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were evaluated before and after treatment. The 23 patients (7 men and 16 women) in this study presented significant improvements in phonatory function in terms of maximum phonation time, jitter, grade, asthenia, and Voice Handicap Index-10 (VHI-10) values at 3 months. Significant improvements in terms of jitter, noise-to-harmonic ratio, grade, roughness, breathiness, asthenia, and the VHI-10 values were also observed at 6 months. Glottic insufficiency in younger patients without neurological problems or acquired organic lesions in the vocal fold can be treated effectively using office-based autologous fat injection laryngoplasty. Significant improvements in phonatory function were observed even 6 months after surgery.

Bicyclist's vulva: Diagnostic and therapeutic aspects

The authors report a case of a rare vulvar condition in a young cyclist, known as bicyclist's vulva. The diagnosis was based on the clinical context (intensive cycling training with repeated saddle sores, responsible for painless unilateral swelling of the labium majus to a significant size and functional discomfort). Imaging examinations were used to characterize the lesion and its relationship with the pelvic organs. The lesion was composed of connective tissue, poorly demarcated and heavily collagenised without necrotic or hemorrhagic areas. Large cicatricial collagen bundles were observed. The fibroblasts revealed no atypia and just a few scattered undilated vessels ere noted. Special staining did not reveal any amyloid deposits. A complementary immunohistochemical analysis with anti-CD 34 antibody showed vascularization that was homogeneous and morphologically normal. The treatment was surgery, and in our case the cosmetic and functional impact of wide surgical excision of the lesion was improved by in situ injection of autologous fat. The pathology findings enabled us to rule out other perineal tumors such as aggressive angiomyxoma of the vulva and to describe the lesion microscopically.

Autologous chyle fat grafting for the treatment of hypertrophic scars and scar-related conditions

BackgroundScarring is the product of natural restoration, yet its treatment remains challenging. Both collagen and fibroblasts are abnormally abundant in scars, leading to scar hyperplasia or contracture. Several clinical studies have reported that wrinkles at the recipient site are reduced, pores are narrowed, pigmentation is decreased, and skin is softened after autologous fat transplantation. In this study, we investigated the ability of autologous chyle fat injection to normalize the fibroblasts and collagen of scar tissue in 80 adult patients with hypertrophic scars resulting from severe burns received more than 1 year previously.MethodsThe patients underwent autologous chyle fat injection, and scar samples were collected at different time points. Differences in the number of adipocytes before and after chylosis were assessed by cell culture, and changes in the structural organization of the scars were detected via histologic and immunohistochemical analyses.ResultsAfter preparation, the chyle fat contained few autologous adipocytes and large amounts of extracellular matrix. Following the injection of chyle fat, the thickness, color, and elasticity of hypertrophic scar tissue tended toward normalization, and patient satisfaction increased. The three adipose tissue donor sites used for the preparation of chyle fat were the abdomen, buttocks, and inner thigh, of which the inner thigh yielded the best therapeutic outcomes. The density and quantity of fibroblasts in the scars decreased following the injection of chyle fat, and the arrangement, quantity, and shape of type III collagen fibers tended toward normalization. After three treatments, the results of immunohistochemical staining showed that type III collagen was significantly less abundant than before treatment.ConclusionsAutologous chyle fat transplantation has a good therapeutic effect on hypertrophic scar tissue. The injection of chyle fat into hypertrophic scar tissue reduced the density and quantity of fibroblasts and prompted the arrangement, quantity, and shape of type III collagen to normalize.

Adipose-Derived Tissue in the Treatment of Dermal Fibrosis: Antifibrotic Effects of Adipose-Derived Stem Cells.

Treatment of hypertrophic scars and other fibrotic skin conditions with autologous fat injections shows promising clinical results; however, the underlying mechanisms of its antifibrotic action have not been comprehensively studied. Adipose-derived stem cells, or stromal cell-derived factors, inherent components of the transplanted fat tissue, seem to be responsible for its therapeutic effects on difficult scars. The mechanisms by which this therapeutic effect takes place are diverse and are mostly mediated by paracrine signaling, which switches on various antifibrotic molecular pathways, modulates the activity of the central profibrotic transforming growth factor β/Smad pathway, and normalizes functioning of fibroblasts and keratinocytes in the recipient site. Direct cell-to-cell communications and differentiation of cell types may also play a positive role in scar treatment, even though they have not been extensively studied in this context. A more thorough understanding of the fat tissue antifibrotic mechanisms of action will turn this treatment from an anecdotal remedy to a more controlled, timely administered technology.

A Pig Model for the Histological Analysis of Adipocytes after Co - injections of Autologous Fat with Fillers

A Pig Model for the Histological Analysis of Adipocytes after Co - injections of Autologous Fat with Fillers

A case of patulous eustachian tube treated by submucosal autologous fat injections

A case of patulous eustachian tube treated by submucosal autologous fat injections

Computed tomographic assessment of autologous fat injection augmentation for vocal fold paralysis.

ObjectiveTo perform a quantitative computed tomography (CT) assessment of short‐ and long‐term outcomes of autologous fat injection augmentation in patients with unilateral vocal fold paralysis.Study DesignRetrospective case series.MethodsTwelve patients who had undergone autologous fat injection augmentation for unilateral vocal fold paralysis in our hospital between 2011 and 2015 were enrolled in this study. The autologous fat for injection was acquired from periumbilical subcutaneous tissue and was injected orally using a special‐purpose laryngeal injection needle. To evaluate the injected fat at the follow‐up assessments, CT was performed at several times after surgery in clinical practice. All thin‐section CT images were transferred to a workstation, and the volume of the injected fat was calculated.ResultsPatients comprised 6 men and 6 women with a mean age at the time of surgery of 62.9 years (range, 46–82 years). The actual injected fat volume was 1.1–2.5 ml (mean, 1.6 ml). In seven patients assessed by CT two days after surgery, the average residual rate of the injected fat was 63.9%. The mean residual rates of the injected fat were 30.0% at 3 months, 33.7% at 6 months, 29.2% at 12 months, and 32.0% at 24 months.ConclusionsAlthough the injected fat volume decreased within the first three months and the residual rate of the injected fat was 30.0% at three months after injection, the residual fat volume remained at the same level for 24 months after injection.Level of Evidence4

Segmental ischaemic infarction of the iris after autologous fat injection into the lower eyelid tissue: a case report

BackgroundAutologous fat injection is getting popular in cosmetic procedures, however, still has a risk of fat embolism. Herein, we report the first case of segmental ischaemic infarction of the iris, which occurred after autologous fat injection into the lower eyelid.Case presentationA 28-year-old Korean woman complained of the discolouration of the iris after the fat injection. Slit-lamp biomicroscopy revealed segmental depigmented atrophic iris with sectoral sphincter palsy.ConclusionsWe found that iris atrophy could be caused by autologous fat transplantation. The plastic surgeons should pay more attention to possibility of fat embolism-induced ocular complications in the procedure of fat injection.