Fat Augmentation Research Articles

Evaluation of soft tissue profile changes following autogenous fat or onlay PEEK augmentation versus sliding genioplasty for correction of deficient chin: Randomized controlled clinical trial

AimThe study was conducted to evaluate soft tissue profile changes using autogenous fat augmentation or onlay PEEK versus sliding genioplasty for correction of deficient chin in patients with retruded chin. Material and methodsThirty-three patients with deficient chins were included in the study. The patients were distributed into 3 groups: the fat augmentation group as intervention I, the PEEK augmentation group as intervention II, and the osseous genioplasty group as control group. Preoperative and postoperative CBCT were performed for all patients. With the aid of MIMICS,3-MATIC, and PROPLAN software, diagnosis, virtual planning, and evaluation were performed. The Face-Q questionnaire was used to assess patient satisfaction. ResultsThere was a statistically significant difference regarding soft tissue relapse in the fat group after 6 months when compared to the control group (mean difference= 0.770), while there was no statistically significant difference regarding soft tissue relapse between PEEK and control group (mean difference= -0.060). Intragroup comparison has shown no statistically significant difference regarding soft tissue relapse within all groups between follow-up periods (P = 0.1389 for the fat group, P = 0.8739 for the peek group, and P = 0.8410 for the control group). All patients showed a statistically significant increase in scores of satisfaction with the chin between follow-up periods (P = 0.0165, P = 0.0150, and P = 0.0293) respectively. ConclusionsFat augmentation can be a good intervention choice in mild-moderate deficient cases. PEEK PSI has a stable surgical outcome.

B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis

BackgroundThe increasing number of fatalities caused by gluteal fat grafting is concerning; thus, there is a need to determine ways to obtain the ideal aesthetic effect while ensuring a safe operation. In this study, three-dimensional (3D) measurements combined with B-ultrasound were used to evaluate the effect of gluteal fat augmentation in Asians, whose safety and effectiveness were confirmed using quantitative data. MethodsThirty-five consecutive female patients were evaluated in this prospective clinical study. All patients underwent B-ultrasound-assisted gluteal fat augmentation on the subcutaneous plane alone. 3D imaging and B-ultrasound analysis of the adipose tissue thickness in the gluteal region were performed preoperatively and at 1 week, 3 months and 6 months post-operatively. ResultsThe waist circumference of the patients decreased, gluteal circumference and length of the gluteal crease increased and average waist-to-hip ratio improved from 0.78 to 0.74. At 3 months and 6 months post-operatively, the adipose tissue thickness decreased by 5.1% and 15.1%, respectively. The fat retention rates calculated using 3D imaging measurements at 3 months and 6 months post-operatively were 77.9% and 64.7%, respectively. According to the BODY-Q scale scores, patients reported a high level of satisfaction post-operatively. ConclusionsB-ultrasound guidance can effectively prevent the occurrence of fatal fat embolism during gluteal fat grafting and maximise the augmentation effect. The quantitative data obtained using 3D measurements and B-ultrasound confirmed the safety and effectiveness of fat injections for gluteal augmentation under B-ultrasound guidance.

Challenges in cosmetic gynecology surgery: A case series

Background: Cosmetic and functional gynecology is a novel specialty that is rapidly gaining tractionacross the globe, particularly in Europe, Asia, and America. These intricate procedures enhance theesthetics and restore the physiological function of the genitalia. This relates very closely to womensexuality, dignity, self-esteem, and overall confidence. Self-esteem is often closely mirrored anddependent on a person’s perception of her genitalia, both functionally and more recently esthetically. Anincreasing number of gynecologists are gradually embracing this art of restoration as the demand rapidlyincreases among patients. The outcomes are sometimes not pleasing to the patients and may requirerevision.Case series: We present four case series of undesirable outcomes from labiaplasty andperineovaginoplasty. The surgical procedures had to be repeated in two instances because of spousaldemand or from the lady herself.Case 1: Reconstruction after Type IV female genital mutilation (FGM)A 46-year-old grand multipara with Type IV FGM presented with sexual dysfunction and psychosexualproblems arising from FGM. She requested reconstruction of the labia minora, restoration of the labiamajora, and perineovaginoplasty. Examination revealed partial clitoridectomy, a narrowed vaginalintroitus with the removal of the labia minora, and excision of the labia majora. The missing tissues madethe reconstruction technically difficult. Labia minora was reconstructed from the labia majora by thegrooving technique, and labia majora fat augmentation with perineoplasty was performed with goodoutcomes.Case 2: Perineoplasty revision.A 43-year-old, para 3+0, presented with complaints of lax vaginal muscles after her third delivery. All herdeliveries were normal, vertex. She sustained a second-degree perineal tear after her last delivery, whichwas repaired. She was started on Kegel’s exercises with no improvement. She had a perineoplasty donesuccessfully, but she healed with a small rent. A revision was performed with good results.Case 3: Perineoplasty revisionThe patient underwent vaginoperineoplasty, but the perineum healed with a little bump, which both thepatient and the spouse did not like. Revision of perineoplasty was performed with excellent outcomes.Case 4: Revision of an overly tight vagina after vaginoperineoplastyThe patient had previously undergone vaginoperineoplasty but felt it was not tight enough. However,three months after revision, the spouse complained of incomplete penetration, whereas the patientcomplained of pain at the fourchette. Another revision was performed to address their concerns withgood outcomes. Conclusion: Cosmetic gynecological procedures must achieve satisfactory outcomes and restore theclient’s genital esthetics and functionality. Although some procedures are technically challenging and mayrequire repeat procedures, patient satisfaction is key. Knowledge of pelvic anatomy and restoration techniques is a prerequisite for achieving acceptable outcomes. Counseling of the couple is an integralpart of cosmetic gynecology to manage expectations and rule out psychosocial causes.

Facial masculinization surgery

Facial masculinization surgery

A High-Definition 3-Dimensional Exoscope With the ARTip Cruise System as an Effective New Tool for Phonosurgery: A Preliminary Report.

The aim of phonosurgery is to improve voice quality and efficiency by performing precise, minimally invasive, conservative treatment. Magnified visualization of the vocal folds is mandatory to achieve optimal results; operative microscopy has been utilized so far to perform phonosurgery. In recent decades, the use of an exoscope (extracorporeal telescope) has been proposed in several fields of surgery that necessitate magnification. Further technological advancements have enabled 3-dimensional (3D) technology to be added to existing exoscopes. Recently, a motorized holding arm (the ARTip Cruise System) was developed to allow smooth precise positioning of the 3D Vitom exoscope (Karl Storz, Tuttlingen, Germany) by the surgeon without need for assistance. To evaluate the feasibility of phonosurgery by means of this innovative system, we utilized it for six consecutive procedures for benign laryngeal pathologies, including two vocal fold polyps, two cysts, one Reinke's edema and one unilateral vocal fold paralysis treated by fat augmentation. All procedures were performed without any technical difficulty and with excellent results at follow-up, as demonstrated by GRBAS, VHI-10 and maximal phonation time evaluations. Main advantages of this technique were the enhanced depth of field and high definition of anatomical details. Communication with the operating room team was facilitated by the shared view of the same images on screen; furthermore, the surgeon could perform the procedures visualizing the surgical site without need to position the eyes on the microscope eyepieces and so being able to wear full face protection, which was of paramount importance in the era of the COVID-19 pandemic. In conclusion, the 4K 3D exoscope system with the ARTip Cruise System represents a promising innovation in the field of voice surgery to allow highly precise procedures optimizing safety and co-operation with the operating room team.

Fat Augmentation as Adjunct to CORE Facelift Surgery.

Ruling out cases with strong jawlines, well-developed mid-cheek regions, and good fat presence, if done artistically, fat augmentation strongly assists midface definition and can replenish hollowed regions of the face. This is particularly true for candidates with low bodyfat or smaller skull structures. Hence, fat grafting is a strong adjunct to conventional excisional techniques in facial rejuvenation surgery, regardless of experience, technique, or geographical embedding. While CORE facelift techniques remain the golden standard that define the top level of facelift surgery, fat augmentation has its unique place along the full stretch of an individual surgeon's learning scope, as it will potentially improve results regardless of where one stands.

Pre- and post-operative high-speed videolaryngoscopy in unilateral vocal cord paralysis following autologous fat augmentation

PurposeTo compare high-speed videolaryngoscopy (HSV) parameters such as open quotient (OQ), amplitude symmetry index (ASI), phase symmetry index (PSI), and frequency symmetry index (FSI), of the unilateral vocal cord paralysis (UVCP) patients pre and post (after 6 months) autologous fat augmentation. Materials and methodsThis retrospective study evaluated all age and gender patients with UVCP that underwent autologous fat augmentation from July 2016 to July 2019. The OQ, ASI, PSI, and FSI were calculated from the HSV recordings by using the montage and fast Fourier transform point analysis. The pre-and post-operative means were compared using a paired student t-test, with a p-value less than 0.05 considered significant. ResultA total of 37 patients, age 41.2 ± 11.3 years (21 to 67 years), 59.4% females and 40.6% males, were included in the study. The average duration of symptom onset was 2.3 ± 0.87 months. The post-operative mean values of OQ, ASI, PSI, and FSI following the fat augmentation were significantly improved compared to the pre-operative mean values with p-values <0.0001, 0.0018, 0.0011, and 0.0006, respectively. ConclusionThere was a significant improvement in the OQ, ASI, PSI, and FSI in UVCP patients after 6 months of autologous fat augmentation, signifying an enhanced vibratory function. The ability of HSV to measure the minute details of vocal cord vibration by providing quantitative measurements has also been highlighted. The need for future prospective research with an increased sample size and longer duration of follow up is recommended.

Surgical Management of the Explant Patient: An Update on Options for Breast Contouring and Volume Restoration.

Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity. Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population. Surgical management options after implant removal include breast contouring and volume restoration. Fat augmentation has been used in both aesthetic and reconstructive breast surgery. The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.

Facial Fat Augmentation Finesse.

Volume restoration with autologous fat augmentation has become a key technique in facial rejuvenation. It is highly versatile and useful as an independent operation or as an adjunct to rhytidectomy and blepharoplasty. The goal of this article and the accompanying videos is to provide a detailed step-by-step guide to achieving predictable and optimized surgical results.

Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes.

There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). An academic tertiary referral center. Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.

CORAL: QSAR models of CB1 cannabinoid receptor inhibitors based on local and global SMILES attributes with the index of ideality of correlation and the correlation contradiction index

Obesity has acquired notable attention due to its high occurrence and link with grievous health problems such as hypertension, diabetes and heart disease. It has been reported that the endocannabinoid system executes a pivotal part in the management of food absorption, fat augmentation, and energy balance. In the present manuscript, we report a detailed QSAR analysis for 165 CB1 cannabinoid receptor inhibitors employing the Monte Carlo optimization process incorporated within the CORAL software. Eight splits are made from the whole dataset and sixteen QSAR models are developed from these splits employing two target function TF1 (without index of ideality of correlation) and TF2 (with index of ideality of correlation). All the QSAR models developed with TF2 have better predictive potential than the models developed with TF1. The model built for split 5 using TF2 is the leading model due to the higher value of the determination coefficient of the validation set (RValid2 ​= ​0.8518). The index of ideality of correlation (IIC) improves the statistical performance of CORAL-based QSAR-models and gives statistically robust predictive models of the investigated endpoint pIC50. In the present manuscript, a novel criterion “Correlation Contradiction Index (CCI)” is also applied to know its predictive potential. The absolute value of CCI for calibration set is less when QSAR models are developed employing IIC. The promoters of increase and decrease endpoint pIC50 are identified and these are applied to design seven new compounds. All the newly designed molecule were docked into in the active site of human cannabinoid receptor CB1 (PDB ID: 5tgz).

Autologous Fat Augmentation in The Treatment of Unilateral Vocal Fold Paralysis – A 15-Year Experience in a Single Institution

SUMMARYAutologous fat vocal fold augmentation is a widespread surgical procedure that aims to repair glottal incompetence in patients with unilateral vocal fold paralysis (UVFP). However, there are some concerns in the literature about the long-term results of this technique. At the ENT Department of the Zagreb University Hospital Centre, this technique has been in use for more than 15 years, and a retrospective medical chart review was conducted from June 2005 to November 2019. Overall, 78 patients with UVFP met the inclusion criteria for enrolment in the study. All patients underwent at least one preoperative and two postoperative voice assessments, one early (within 3 months from surgery) and one late (at least 1 year after surgery). All tested voice outcome parameters (maximum phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR)) significantly improved after surgery, both early and late postoperatively (p<0.001). The reoperation rate was only 10.3% (8/78), with the majority of patients in our series experiencing long-term benefits from this surgical procedure. According to the results of our study, autologous fat vocal fold augmentation appears to be a highly useful and effective surgical technique with long-lasting results in the majority of patients suffering from UVFP.

"Brazilian Butt Lift" Performed by Board-Certified Brazilian Plastic Surgeons: Reports of an Expert Opinion Survey.

Gluteal fat augmentation has increased worldwide, and so have major complications. Brazilian plastic surgeons have been performing this procedure for more than 30 years, and more often every year. Therefore, the authors performed a study among board-certified plastic surgeons, members of the Brazilian Society of Plastic Surgery, to evaluate their techniques; identify their preferences, complications, and outcomes with this procedure; and make some recommendations. An anonymous Web-based survey consisting of 16 questions was sent to 5655 members in July of 2017. A supplementary survey was subsequently sent to obtain more information about major complications. A total of 853 responses were analyzed. The highest percentage of responses in the different categories were as follows: fat decantation for processing, injection with a 3-mm-diameter cannula, use of superior incisions, subcutaneous fat grafting only, and with a volume of 200 to 399 ml of fat per buttock. The majority of surgeons received training in this procedure during residency. The most common complications were contour irregularities. The estimated mortality rate was one in 20,117 cases, and the rate of nonfatal fat embolism was one in 9530. The risk of death was 16 times greater when fat was injected intramuscularly. Based on this survey, the authors recommend injecting fat only subcutaneously, by means of superior incisions, using cannulas 3 mm in diameter or more. They find that by following these recommendations, this procedure can be as safe as any other. More research to establish guidelines and increase its safety is necessary.

Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting.

Vocal fold scarring is the cause of severe dysphonia and represents a therapeutic challenge; dysphagia can also be present in case of soft tissue defect due to previous oncological surgery. The ideal surgical solution should concurrently provide vocal fold augmentation and re-establishment of tissue elasticity. Nanofat technique has given so far promising results in remodeling skin scars and improving tissue pliability. The present paper describes for the first time the use of nanofat injected into the vocal fold cover for pliability restoration, combined with traditional microfat for vocal fold augmentation. Seven patients (aged 23-77 years) affected by severe dysphonia, related to extensive vocal fold scarring (3 of them were also affected by dysphagia for liquid consistencies), underwent a single procedure of concurrent microfat and nanofat vocal fold injection under direct microlaryngoscopy in general anesthesia. Results were evaluated by objective outcome measures and auto evaluation performed by questionnaires concerning the phonatory and swallowing efficiency. The voice quality and the perceived swallowing capability of all patients improved after surgery and are stable at follow-up (4-8 months). The reported preliminary data show that nanofat, due to its regenerative potential related to adipose-derived stem cells and growth factors, can be a promising adjunct to traditional fat augmentation to improve elasticity of the delicate multilayered structure of the vocal fold and to enhance its vibratory capabilities. Further experience on a wider number of patients and long-term follow-up are necessary to confirm the validity of this technique.

Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis.

In recent years, gluteal fat augmentation has exhibited some of the most significant growth among all plastic surgery procedures. However, as the popularity of and media attention to gluteal fat augmentation continue to rise, reports of fatalities, largely attributed to fat embolism, have raised valid concerns. Many plastic surgeons inject fat in the intramuscular plane and claim better graft take in the muscles and the possibility of injecting more volume in the gluteal region. Because of the large caliber of vessels, subcutaneous fat augmentation has been a preference of many. However, the long-term outcome of fat injected into the subcutaneous layer has been questionable, and there is a lack of prospective quantitative studies of subcutaneous-only fat grafting. Therefore, the authors evaluated the long-term maintenance of gluteal adipose thickness when fat was injected only subcutaneously. Fifty consecutive female patients were evaluated in this prospective clinical study. All patients underwent gluteal fat augmentation in the subcutaneous plane only. Ultrasound analysis of the adipose tissue thickness of the gluteal region was performed preoperatively, immediately postoperatively, and at 12 months postoperatively. Immediate postoperative measurements revealed an average increase in gluteal subcutaneous layer thickness of 56.51 percent (range, 39.5 to 108.6 percent) (p < 0.0001). At 12 months postoperatively, the gluteal adipose tissue thickness decreased by an average of 18.16 percent (range, 6.8 to 24.8 percent) (p < 0.0001). Subcutaneous-only gluteal fat augmentation is shown to be as effective as previous studies reporting intramuscular fat injection with regard to long-term fat retention in the buttocks. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

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.

Paralytic Lagophthalmos: Comprehensive Approach to Management

Facial paralysis can lead to lagophthalmos, loss of corneal protection, and devastating ocular consequences like corneal ulcers or even blindness. The purpose of this review is to discuss the importance of comprehensive and early eye care. Treatment of paralytic lagophthalmos should be individualized to each patient’s situation; depending on the severity of the problem and the prognosis for recovery, treatment modalities are broad and include lubrication, selective chemodenervation, filler injection, fat augmentation, and surgical procedures like canthopexy and tarsorrhaphy. This paper serves to highlight the importance of treating paralytic lagophthalmos and provides an overview of the optimal management algorithm of the compromised periocular complex to help improve function and quality of life. Prospective studies and long-term comparisons of surgical techniques for repair of paralytic lagophthalmos will help improve our understanding of this complex problem and perhaps introduce novel treatment strategies.

The Evolving Role of Blending of the Lid-Cheek Junction in Lower Blepharoplasty.

Lower blepharoplasty has evolved from traditional lower blepharoplasty involving skin-muscle flaps and fat resection to newer concepts that emphasize blending the lid-cheek junction. It is the objective of this review to evaluate these new concepts for their efficacy in blending the lid-cheek junction. A comprehensive review of literature was performed using PubMed/MEDLINE to identify studies evaluating fat conservation, fat augmentation, fat repositioning, orbicularis retaining ligament (ORL) release, septal reset, and use of fillers in deep cheek fat compartments to obtain aesthetically pleasing lid-cheek junction. A total of 22 studies meeting inclusion criteria and evaluating fat conservation, fat augmentation, fat repositioning, ORL release, septal reset, and use of fillers in deep cheek fat compartments are analyzed and discussed. This review provides the current evidence for various strategies that can be used alone or combined to obtain youthful lid-cheek junction. It provides the current evidence-based scientific rationale for optimal management of the lower eyelid cheek area for facial rejuvenation.

Improving aesthetic outcomes after head and neck reconstruction

Tremendous advancements have been made in head and neck reconstruction following oncologic resection. Despite this, many patients are left with disfiguring postoperative changes. The focus of this review highlights various techniques aimed at improving aesthetic outcomes following head and neck cancer therapy, with a focus on liposuction and fat augmentation. Over the past decade, the use of liposuction in treating lymphedema after head and neck cancer therapy has showed promising results. Owing to great improvements in harvesting and purification techniques, fat augmentation has been effectively utilized in correcting a wide array of defects. Although free tissue transfer is frequently used in head and neck reconstruction, there is a scarcity of literature on the indications for flap revision procedures. Head and neck reconstructive surgery can lead to significant cosmetic and functional morbidity. Several tools are available to help improve aesthetic outcomes in this patient population. A thorough understanding of the various techniques and their indications is essential for achieving optimal results.Video abstract available: See the Video Supplementary Digital Content 1, http://links.lww.com/COOH/A34.

Real-Time Ultrasound-Assisted Gluteal Fat Grafting.

The number of gluteal fat augmentation procedures has increased recently and so has the number of complications. Because of the increased risk of morbidity and mortality when fat is injected intramuscularly, not knowing where fat is injected is concerning. We sought to identify the planes in which fat is injected during the procedure. We selected 15 consecutive female patients who desired gluteal fat augmentation. All patients had epidural anesthesia and the gluteal region was infiltrated with a vasoconstrictive solution. With the patient in prone position, an ultrasound probe placed on the buttocks was used to identify the fascial layers. While decanted fat was being injected with a blunt cannula, the images were projected wirelessly to a screen, so that the surgeon and assistant could follow the planes in which the cannula was being introduced and the fat injected. The mean volume of harvested fat was 3533 ml and the mean volume of fat injected per gluteal region was 528 ml. The evaluation of the depth and location of the cannula was performed in real time with the ultrasound, accurately and reliably identifying the planes of fat injection. All injections were subcutaneous. The downsides of this technique were the purchase cost of the ultrasound device, increased surgical time, the need for an assistant to follow the cannula and the probe constantly, and the learning curve. Real-time ultrasound-assisted gluteal fat grafting is reliable and may avoid injuring the deep vessels, further decreasing the risks of major complications.