Autologous Fat Injection Research Articles

Man with facial rash.

A 43-year-old male presented to the emergency department (ED) with a rash to his right cheek 4 days after hyaluronic acid filler injections by a non-credentialed beautician. Examination was notable for serpiginous, violaceous erythema with overlying yellow crusting to the right mid-face and involvement of the nasal tip. Patient did not have vision complaints at this time. Accidental facial arterial cannulation with dermal filler injections can cause occlusion and embolization. Risks of embolization may depend on practitioner experience, injection pressure, rate of filler injection, and location of injection.1 On ED presentation, emergent dermatology and/or plastic surgery consult is required. There are serious adverse effects including tissue necrosis, blindness, or neurologic deficits.2, 3 Of all blood vessels affected, the ophthalmic artery was significantly associated with irreversible blindness. There are 2 common fillers used, autologous fat injections and hyaluronic acid. Autologous fat injection is more associated with vascular complications than is hyaluronic acid and has been reported to have more severe outcomes with higher rates of permanent blindness. Ophthalmology consult is required if the patient endorses vision changes or there are signs of skin involvement in the V1 distribution. Neurology consult is required if the patient endorses neurologic complaints. Treatment involves direct injection of hyaluronidase within and around the affected vessel, with multiple injections diffusely across the affected skin. Additional treatments include nitroglycerin paste and oral aspirin.4 Oral antibiotics should be considered if fat necrosis is present. Once blindness occurs, rates of full recovery are low so initial precautions during filler placement, including slow injection rates with low pressure, are crucial. The patient received hyaluronidase injections and nitroglycerin paste and started on oral aspirin and antibiotics. After a 3-month follow-up in plastic surgery clinic, the patient reported full recovery of the rash with no other sequelae.

Periorbital lipogranuloma after facial injection of autologous fat: A retrospective study of 18 cases.

To investigate the clinical features of patients who develop periorbital lipogranuloma after injection of autologous fat. This retrospective case series included 18 patients who developed a periorbital mass or swelling after undergoing injection of autologous fat for facial augmentation. The patients' medical records were reviewed for clinical history, radiologic findings, and treatment outcomes. All patients were women aged 24 to 50 years (mean, 31.6 years). Five patients (27.8%) involved both orbits. Presenting eye symptoms were a palpable mass (61.1%), eyelid swelling (44.4%), and ptosis (16.7%). The interval between the final injection and onset of eye symptoms ranged from 1 to 36 months (mean, 11.5 months). Thirteen patients underwent radiologic imaging. Fifteen patients received only one injection of autologous fat and three received two injections with the cryopreserved fat used in the second injection. Surgical excision was performed in 12 patients to remove the mass and identify the pathologic abnormalities. No recurrence was found during 1 year of follow-up. Two of the six patients who had refused treatment showed spontaneous resolution at the 6-month visit. Periorbital lipogranuloma after facial injection of autologous fat should be considered as a specific orbital disease entity for which MRI is an effective examination method. Surgery is warranted for this condition when conservative treatment is ineffective.

Acoustic Outcomes Comparison Injection Versus Medialization Laryngoplasty

Objectives: To determine whether injection laryngoplasty or medialization thyroplasty is more effective in the treatment of unilateral vocal fold paralysis. Methods: A prospective study of 75 patients with unilateral vocal cord paralysis who underwent autologous fat injection laryngoplasty or medialization laryngoplasty at the First Central Hospital of Mongolia between 15th Nov 2016 and 15th Jan 2020. The data analyzed included patient characteristics and type of intervention, along with the before treatment, 1 and 6 months after treatment voice parameters of electrogIottography and patients' subjective voice assessment. Results: Seventy-five patients were evaluated. The average time from intervention to post-treatment evaluation was 1 and 6 months. Improvements were demonstrated in all voice parameters (Maximum Foniation Time, Jitter, Shimmer, and Harmonic Noise Ratio) in both the injection and the medialization groups. Conclusions: In this study, objective and subjective voice analysis confirmed that injection and medialization laryngoplasty were effective in unilateral vocal cord paralysis. Both of these methods can be used to treat unilateral vocal cord paralysis.

Patient Selection for Pedal Soft Tissue Augmentation.

BackgroundPedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy.ObjectivesThe authors aimed to determine if patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery.MethodsThe authors performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment were evaluated for correlation with patient characteristics, including gender, age, BMI, unilateral vs bilateral injections, flexible vs rigid arch, previous foot deformity or surgery, and presence of callus.ResultsForty-four patients received fat injections into the ball of their foot; 73% of them were women; their mean age was 61 years, and mean BMI was 26.6 kg/m2; 75% had injections performed bilaterally; 41% had a flexible arch, 73% had a past history of pedal deformity or surgery, and 43% had callus. Only female gender was found to correlate with an improvement in pain from the time of surgery to 12 months later (P = 0.02).ConclusionsBilateral rigid, high arched foot type is a risk factor for foot pain and disproportionately represented among these patients. The only patient characteristic found to be correlated with improvement in pain at 12 months post-surgery was female gender. BMI and laterality of injections impacted the course of improvement after surgery. Given current data, all patients with suspected pedal fat pad atrophy should be considered for soft tissue augmentation.Level of Evidence: 4

Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples.

Autologous fat is known for a reliable and natural safety profile, but complications do occur-even serious vascular adverse events. The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue. All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided. Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported. The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment.

Techniques enhancement for tissue expander/implant two-stage breast reconstruction

To investigate the outcomes of breast reconstruction with employing improved techniques throughout the tissue expander/implant two-stage breast reconstructed process, which involved the tissue expander placement, the saline filling intraoperatively and postoperatively, the implant selection, and the permanent implant replacement. In this study, 68 patients who had been provided immediate or delayed tissue expander/implant two-stage breast reconstruction with autologous fat injection post-mastectomy in Peking University Third Hospital from April 2014 to September 2018 were involved, and the relevant information was analyzed retrospectively. The enhancements of the techniques, involving the incision selection, the expander placement, the principle of expansion, the management of capsule, the prosthesis selection, and the assisted reconstruction method were summarized, and the reconstruction outcomes were evaluated objectively through three-dimensional surface imaging. Among the 68 patients in this study, immediate reconstruction was conducted in 25 patients and 43 patients underwent delayed reconstruction. The median time of tissue expansion was 7.0 (3.0, 20.0) months, and the average volume of expansion was (372.8±87.2) mL. The median size of breast implant was 215 (100, 395) mL. The median number of injections for fat grafting was 1 (1, 3), and the average volume of fat grafting was (119.3±34.1) mL. The median follow-up time was 7.0 (4.0, 24.0) months. During the process of breast reconstruction, the tissue expander leakage was observed in two patients, and one of them underwent expander replacement due to the secondary infection. In the immediate reconstruction cases, the volume symmetry of bilateral breasts after reconstruction got even better than that before mastectomy (t=4.465, P<0.01). And in the delayed reconstruction cases, the volume between bilateral breasts also achieved good symmetry after reconstruction (t=0.867, P>0.1). Good results of tissue expander/implant two-stage breast reconstruction could be achieved through the techniques enhancement, which involved the preferred transverse incision, the downward placement of expander, the rapid expansion of chest soft tissue, the release of capsule tension, the application of sizer in prosthesis selection, and the assisted autologous fat grafting.

Nontuberculous Mycobacteria Infection After Autologous Fat Grafting for Cosmetic Breast Augmentation.

Autologous fat grafting has been widely applied in cosmetic breast augmentation in recent years. However, nontuberculous mycobacteria infection, as one of the multiple complications described in the literature, has been less well discussed. The aims of the study were to report 5 cases of nontuberculous mycobacteria infection after autologous fat injection for the cosmetic breast augmentation and to explore its causes. In this noncomparative, retrospective, and interventional case series, we identified 5 patients with nontuberculous mycobacteria infection. All patients had a history of previous autologous fat injection into the breast for cosmetic purpose, performed in different plastic facilities. Five patients developed nontuberculous mycobacteria infection after autologous fat injection for cosmetic breast augmentation and came to our group for treatment. Grafted fat removal through multiple debridement and long-term intravenous and oral antibiotic therapy were required in our cases. The number of nontuberculous mycobacteria infection after autologous fat injection into the breast is increasing. Surgeons should be aware of the complication, which rarely manifests during the procedure itself. Strict aseptic principles should be obeyed throughout the surgery.

Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study: Erratum.

Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study: Erratum.

Treatment of varicella skin scars with sequential punch elevation, autologous fat injection and fractional CO2 laser

Varicella is a common viral infection that occasionally results in scar. Despite a number of measurements taken to combat this infection, they have all been either impractical or limited.The current study presents a 28-year-old woman diagnosed with varicella 10 years ago which caused her to have several depressed skin scars over the face. She was subjected to sequential treatment of punch elevation, fractional CO2 laser therapy, and autologous fat injection in one session. Over two years of postoperative follow-up, remarkable aesthetic improvements were observed in her face. This method had some advantages including high speed, convenience, application of conventional medical devices, and the minimal manipulation. The only limitation of our method was mild-to-moderate improvement of the previous hyperpigmentation of the scar.

Fat Grafting in Patients With Extensive Unilateral Facial Deficiency: Three-Dimensional Computer-Assisted Planning, Implementation, and Outcome Assessment.

Autologous fat injection is a widely used, simple, and less invasive technique to correct volume deficiency. This study developed a treatment method by using a 3-dimensional (3D) simulation to plan and implement fat injection in patients with an extensive facial deficiency and then validated the accuracy of the method and treatment outcomes. Seven patients with a large unilateral facial deficiency receiving autologous fat grafts between 2015 and 2017 were recruited. One patient received repeated treatment. Furthermore, 3D surgical simulation was used to measure the difference between the mirrored image and lesion side. An extra 20% to 30% of fat graft was added. A color map was provided, and contour lines 2 mm deep marked the location of the fat injection. Outcome assessments were then performed, and a 3D symmetry index was defined using the contour lines on the facial surface. No significant difference was noted between the predicted volume and postoperative fat graft retention (35.7 ± 7.4 and 31.6 ± 9.7 mL, respectively; P = 0.176). A comparison of preoperative (79.5% ± 4.3%) and postoperative (89.0% ± 3.3%) 3D symmetry indexes indicated significantly improved facial symmetry (P = 0.018). Patient-reported outcomes of satisfaction on FACE-Q questionnaires yielded an average score of 62.73, higher than the control score (59.83). By using the proposed method, we could predict the required fat graft volume; moreover, the contoured map aided accurate surgical implementation. Thus, this method is useful for planning and guiding fat grafting treatment in patients with major unilateral facial deficiency.

Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study.

The aim of this study was to compare major voice indicators in different sub-categories, the outcome of lipoinjection for patients might be refined and some voice prognostic factors could be more particularized in specific sub-groups. This is an observational study, and sub-grouped UVFP patients into 3 categories: male vs female, BMI ≥ 24 vs BMI < 24, Age ≥ 60 vs Age < 60 for more detailed exploring whether sub-categories affected voice diagnostic and prognostic parameters. Patients’ voice data is recorded before and after the autologous fat injection laryngoplasty by a multidimensional voice program. Overall, 73 patients’ voice performance were improved 12 months later by vocal fold lipoinjection. In the comparison of the male with female revealed female obtained better Jita than male by surgery (Female: 174.50 ± 100.58 Hz; Male: 294.82 ± 253.65 Hz; P < .05). BMI ≥ 24 vs BMI < 24 showed no statistical difference. Patients aged under 60 demonstrated better Highest F0, lowest F0, NHR and ShdB than elder ones 12 months after receiving vocal fold lipoinjection. Thus, Noise-to-harmonics ratio (NHR), voice turbulence index (VTI), and ShdB (Absolute shimmer, dB) may be the major post-operative evaluating markers of patients’ age under 60. Voice parameters showed no significant correlation with BMI. Female patients performed lower Jita (Absolute jitter, μsec) than male patients 1 year after receiving treatment. The experimental results in this study showed UVFP patients’ gender and age may stand as significant categories on analyzing clinical voice prognostic indicators, ShdB and Jita of autologous injection laryngoplasty.

Lifting effect of sequential autologous fat injection (SAFI) in three patients with small and flat malar bones

Lifting effect of sequential autologous fat injection (SAFI) in three patients with small and flat malar bones

自体脂肪注射治疗病理性瘢痕的研究进展

自体脂肪注射治疗病理性瘢痕的研究进展

The use of autologous fat grafts in breast surgery: A literature review.

Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.

Molecular Characterization of Lipoaspirates Used in Regenerative Head and Neck Surgery

Adipose-derived mesenchymal stem cells (ASCs) have been used commonly in regenerative medicine and increasingly for head and neck surgical procedures. Lipoaspiration with centrifugation is purported to be a mild method for the extraction of ASCs used for autologous transplants to restore tissue defects or induce wound healing. The content of ASCs, their paracrine potential, and cellular potential in wound healing have not been explored for this method to our knowledge. To evaluate the characteristics of lipoaspirates used in reconstructive head and neck surgical procedures with respect to wound healing. This case series study included 15 patients who received autologous fat injections in the head and neck during surgical procedures at a tertiary referral center. The study was performed from October 2017 to November 2018, and data were analyzed from October 2017 to February 2019. Excessive material of lipoaspirates from subcutaneous abdominal fatty tissue was examined. Cellular composition was analyzed using immunohistochemistry (IHC) and flow cytometry, and functionality was assessed through adipose, osteous, and chondral differentiation in vitro. Supernatants were tested for paracrine ASC functions in fibroblast wound-healing assays. Enzyme-linked immunosorbent assay measurement of tumor necrosis factor (TNF), vascular endothelial growth factor (VEGF), stromal-derived factor 1α (SDF-1α), and transforming growth factor β3 (TGF-β3) was performed. Among the 15 study patients (8 [53.3%] male; mean [SD] age at the time of surgery, 63.0 [2.8] years), the stromal vascular fraction (mean [SE], 53.3% [4.2%]) represented the largest fraction within the native lipoaspirates. The cultivated cells were positive for CD73 (mean [SE], 99.90% [0.07%]), CD90 (99.40% [0.32%]), and CD105 (88.54% [2.74%]); negative for CD34 (2.70% [0.45%]) and CD45 (1.74% [0.28%]) in flow cytometry; and negative for CD14 (10.56 [2.81] per 300 IHC score) and HLA-DR (6.89 [2.97] per 300 IHC score) in IHC staining; they differentiated into osteoblasts, adipocytes, and chondrocytes. The cultivated cells showed high expression of CD44 (mean [SE], 99.78% [0.08%]) and CD273 (82.56% [5.83%]). The supernatants were negative for TNF (not detectable) and SDF-1α (not detectable) and were positive for VEGF (mean [SE], 526.74 [149.84] pg/mL for explant supernatants; 528.26 [131.79] pg/106 per day for cell culture supernatants) and TGF-β3 (mean [SE], 22.79 [3.49] pg/mL for explant supernatants; 7.97 [3.15] pg/106 per day for cell culture supernatants). Compared with control (25% or 50% mesenchymal stem cell medium), fibroblasts treated with ASC supernatant healed the scratch-induced wound faster (mean [SE]: control, 1.000 [0.160]; explant supernatant, 1.369 [0.070]; and passage 6 supernatant, 1.492 [0.094]). The cells fulfilled the international accepted criteria for mesenchymal stem cells. The lipoaspirates contained ASCs that had the potential to multidifferentiate with proliferative and immune-modulating properties. The cytokine profile of the isolated ASCs had wound healing-promoting features. Lipoaspirates may have a regenerative potential and an application in head and neck surgery. NA.

Autologous Fat Injection Pharyngoplasty in Adults with Velopharyngeal Insufficiency.

Understand the utility and technique of injection pharyngoplasty with autologous fat for the treatment of mild to moderate velopharyngeal insufficiency in adults without a history of cleft palate. Consecutive case series of 11 patients (mean [SD] 41 ± 21 years of age) who underwent injection pharyngoplasty with autologous fat from 2012 to 2018 at a tertiary care center. Patients were followed for a mean of 8.6 ± 8 months with pre versus postoperative evaluations of improvement in rhinophonia, dysphagia, and velopharyngeal closure by nasopharyngoscopy (scored: 0, none; 1, mild; 2, moderate; 3, near-complete; 4, complete). Patient selection and surgical techniques are described. Mean improvements were 2.3 ± 0.86 for rhinophonia, 2.0 ± 0.89 for dysphagia, and 3.0 ± 0.95 for velopharyngeal closure by nasopharyngoscopy. Five (45%) patients underwent subsequent intervention, including four repeat fat injections and three sphincter pharyngoplasties. There were two transient complications-donor site hematoma and subjective nasal obstruction. Although objective assessments are lacking to date, this is among the first reports to demonstrate the effectiveness and safety of injection pharyngoplasty with autologous fat for velopharyngeal insufficiency in a population of adults without a history of cleft. We found, on average, moderate improvement in rhinophonia and dysphagia, and near-complete improvement in velopharyngeal closure by nasopharyngoscopy; however, a portion of patients required subsequent intervention.

Role of Autologous Fat Injection in Neglected Patients With Anterior Plagiocephaly.

Anterior plagiocephaly is a type of non-syndromic craniosynostosis requiring surgery. In this study, the authors have presented 15 neglected patients with anterior plagiocephaly. Two of patients had moderate plagiocephaly whereas others had mild plagiocephaly. A total of 38 procedures (fat injections) were performed on these patients. Following procedures, 2 of patients were under corrected, 2 of who were over corrected, and others were adequate corrected. One of the patients developed fat necrosis. None of them showed persistent over correction. Authors believe that autologous fat transplantation is a safe and effective method, in patients with anterior plagiocephaly who have not been operated, to improve patients' appearance and, subsequently, their self-esteem as well as their social function.

Analysis of clinical features of ophthalmic and cerebral artery occlusion after facial cosmetic injection

Objective To observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection. Methods A retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi’an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination. Results The visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15%) were obstructed by simple ophthalmic artery; 5 eyes (25%) were obstructed by ophthalmic artery combined with cerebral artery; 7 eyes (35%) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes); 1 eye (5%) was CRAO with ciliary artery branch obstruction; 1 eye (5%) was branch artery occlusion with ischemic optic neuropathy; 2 eyes (10%) were CRAO with nasal dorsal artery occlusion; 1 eye (5%) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20%) had eye movement disorder and eyelid skin bun; 2 patients (10%) had facial pain and nasal skin ischemic necrosis. MRA revealed 6 patients (30%) of new intracranial ischemic lesions. Among them, 5 patients of hyaluronic acid injection showed asymptomatic small blood vessel embolization; 1 patient of autologous fat injection showed ophthalmary artery occlusion, cerebral artery occlusion, ipsilateral eye blindness, eye movement disorder and contralateral limb hemiplegia. Conclusion Facial cosmetic injection can cause severe iatrogenic complications such as RAO, ciliary artery occlusion, ischemic optic neuropathy, ophthalmic artery occlusion, and cerebral artery occlusion. Key words: Retinal artery occlusion; Ciliary arteries occlusion; Cerebral artery occlusion; Facial cosmetic injection

Patient Characteristics Predict Success Following Pedal Soft Tissue Augmentation

INTRODUCTION: Pedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy. We aim to determine whether patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery. METHODS: We performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment was measured using the Manchester Foot Pain and Disability Index. One-way analysis of variance statistical analyses were used to evaluate correlation between patient characteristics and an improvement in survey scores assessing pain and functional impairment from the time of surgery to 6 months, to 12 months, and from 6 to 12 months. Patient characteristics examined include gender, age, body mass index (BMI), unilateral or bilateral injections, a flexible or rigid foot arch, previous foot deformity or surgery, and the presence of callus. RESULTS: Forty-four patients received fat injections into the ball of their foot. Seventy-three percent of them were women; their mean age was 61 years old, and mean BMI was 26.6 kg/m2. Seventy-five percentage had injections performed bilaterally. Forty-one percentage had a flexible arch, 73% had a history of pedal deformity or surgery, and 43% had callus. Significant findings included a correlation between female gender and an improvement in pain from the time of surgery to 12 months later (P = 0.02), a correlation between unilateral injections and an improvement in pain from the time of surgery to 6 months later (P = 0.03), and a correlation between a healthy BMI and an improvement in functional impairment from 6 months postsurgery to 12 months postsurgery (P = 0.01). CONCLUSION: Patient characteristics correlate with the impact of pedal fat grafting surgery and the time course of improvement following surgery. Female gender was found to correlate with improvement in pain at 12 months postsurgery. Patients undergoing unilateral foot fat grafting may see clinical improvements in pain faster than those receiving bilateral injections. Ultimately, both groups see clinical improvement at 1 year. Similarly, patients classified as overweight may see faster improvement in functional impairment than those with lower BMI with no difference at 1 year. Given our findings, we advocate for all patients with suspected fat pad atrophy to be considered for soft tissue augmentation. Large-scale studies are called for to further elucidate the impact of various patient characteristics on the probability of success in pedal fat grafting.

Volumetric Analysis of Fat Injection by Computerized Tomography in Orthognathic Surgery: Preliminary Report on a Novel Volumetric Analysis Process for the Quantification of Aesthetic Results.

Integrated approaches to orthognathic surgery should include accurate volumetric evaluation of the skull and soft tissues. In patients with dentofacial deformities, the most frequent aesthetic deficits are attributable to an underdevelopment of hard and soft tissues. Traditional osteotomic procedures often fail to guarantee a stability of soft tissues over time. For this reason, in selecting a surgical strategy, the surgeon should consider not only traditional osteotomies, but also soft-tissue improving procedures, such as lipofilling. Preoperative surgical planning systems, such as the Virtual surgical planning (VSP) protocol, are based mainly on skeletal movement prediction. Quantitative estimation of soft-tissue modifications is not part of common clinical practice. Most commonly, the evaluation of soft-tissue modifications after orthognathic procedures is instead performed by clinical qualitative means.The purpose of this study was to describe a novel computed tomography (CT)-based volumetric analysis process for the quantification of injected autologous adipose tissue in patients who have undergone simultaneous orthognathic and lipofilling procedures. This was a retrospective review of consecutive patients who underwent combined orthognathic surgery and lipofilling from June 2016 to May 2017 for malocclusion with functional and aesthetic impairments. Preoperative planning included clinical evaluation and virtual osteotomy planning according to the VSP protocol. The volume of fat to be injected was estimated clinically by comparing virtual renderings with preoperative clinical photographs. The surgical technique involved Le Fort I and sagittal split mandibular osteotomies, combined with autologous fat injection in the malar and perioral regions. Postoperative evaluation was performed with a novel imaging process based on CT image segmentation to quantify the exact volume of injected fat. Skeletal stability was also evaluated at 3 months. Sixteen patients were enrolled in the study, all females, with a mean age of 24.5 years (range, 18-36 years). The mean difference between the fat tissue injected and that quantified postoperatively was 6.01 cm. All patients had clinically satisfactory facial convexity, with complete restoration of the cheekbone contour, at 3 months. This study introduces a novel CT-image based technique to quantitatively assess the contribution of injected fat to the postoperative soft-tissue volume increase after combined orthognathic surgery with autologous lipofilling. In the future, this CT-based volumetric analysis technique could be the gold standard for evaluating facial lipofilling outcomes, and for assessing clinical aesthetic outcomes based on the injected volume of fat.