Fat Augmentation Research Articles

Fat Augmentation of the Anterior Vaginal Wall: A Novel Use of Fat Augmentation in Enhancing the Female Sexual Experience

This is a case series of 2 female patients with long-standing histories of decreased sexual function and pelvic organ prolapse who underwent augmentation of the anterior vaginal wall using autologous fat grafting, in conjunction with other cosmetic procedures. Fat augmentation of the anterior vaginal wall with its enhanced permanence could be a safe and long-lasting alternative to improve female sexual function in this group.

Partial penile reconstruction following fat augmentation with anterolateral thigh perforator flap

Augmentation phalloplasty of the normal penis although is gaining popularity among a subgroup of men, is not free of complications. A 27 years old healthy man with normal functioning penis underwent a lipofilling penile augmentation. The procedure was complicated by a post-operative haematoma and infection resulting in a full thickness dorsal penile skin necrosis and a pedicled anterolateral thigh (ALT) perforator flap was required for reconstruction. His presentation, operation and final outcome are reported and the possible options for reconstruction are discussed.

Autologous fat augmentation for phonatory gap: Prospective study of postoperative voice outcome

Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.

Autologous Gluteal Lipograft

In the past 25 years, several different techniques of lipoinjection have been developed. The authors performed a prospective study to evaluate the patient satisfaction and the rate of complications after an autologous gluteal lipograft among 351 patients during January 2002 and January 2008. All the patients included in the study requested gluteal augmentation and were candidates for the procedure. Overall satisfaction with body appearance after gluteal fat augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was made at follow-up times of 12 and 24 months. The total amount of clean adipose tissue transplanted to the buttocks varied from 100 to 900 ml. In nine cases, liponecrosis was treated by aspiration with a large-bore needle connected to a 20-ml syringe, performed as an outpatient procedure. Infection of the grafted area also occurred for four patients and was treated by incision drainage and use of antibiotics. Of the 21 patients who expressed the desire of further gluteal augmentation, 16 had one more session of gluteal fat grafting. The remaining five patients did not have enough donor area and instead received gluteal silicone implants. At 12 months, 70% reported that their appearance after gluteal fat augmentation was "very good" to "excellent," and 23% responded that their appearance was "good." Only 7% of the patients thought their appearance was less than good. At 24 months, 66% reported that their appearance after gluteal fat augmentation was "very good" (36%) to "excellent" (30%), and 27% responded that their appearance was "good." However, 7% of the patients continued to think that their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 4.9 years. The key to successful gluteal fat grafting is familiarity with the technique, knowledge of the gluteal topography, and understanding of the patient's goals. With experience, the surgeon can predict the amount of volume needing to be grafted to produce the desired result. Although the aim of every surgeon is to produce the desired augmentation of the gluteal region by autologous fat grafting in one stage, the patient should be advised that a secondary procedure may be needed to accomplish the desired result.

術後瘢痕声帯に対する音声改善手術の経験

[Introduction] It has been reported that satisfactory surgical treatment is difficult to accomplish on cases with post-operative vocal fold scarring where flexibility has decreased. In the present study, the primary goal was to attain voice improvement for a professional singer, who had undergone laryngeal micro-surgery repeatedly. We removed scar tissue and performed autologous fat augmentation thereby successfully improving the wave motion of mucosa during phonation. The result of our study on the changes of acoustical analyses are reported. [The Case and the Course] The patient was a 60-year-old female folk singer. She had a history of smoking and had undergone laryngeal micro-surgery for polypoid degeneration of the vocal folds several times in the past. Mucosal depression was noted on left vocal fold. Using a stroboscope, mucosal wave motion was determined to be partially lacking on the left, and a deficiency of glottal closure was seen. In order to repair the vocal fold defect, autologous fat augmentation was performed. After the operation, her daily conversation voice had improved; however, no improvement of her singing voice was noted and mucosal defect remained. The patient was a professional singer and had a strong desire for her voice to be improved further. Subsequently, using laryngeal microscope, we tried to remove the intra-mucosal scar tissue and to inject fat tissue. Post-operatively, mucosal defect had diminished almost completely and wave motion during phonation had improved.[Summary] The results of the study suggest that the removal of scar tissue and fat augmentation seem to be effective surgical treatments for vocal fold scarring.

Augmentation after microsurgical removal of vocal fold nodules

Innovative otolaryngologists, speech language pathologists, and voice scientists have continued to move forward in understanding the etiology and treatment of vocal nodules. The present article reviews the publications with respect to the advances in this area. There is support for the notion that there is a positive relationship between vocal nodules and the presence of a posterior glottic chink (PGC). Generalized tension in all the laryngeal muscle is often associated with the PGC due to persistent posterior cricoarytenoid muscle pull during phonation. This phenomenon leads to secondary mucosal change with formation of vocal nodules. Fat augmentation after microsurgical removal of vocal nodules can reduce both the occurrence of a PGC and posterior cricoarytenoid muscle activity and subsequently decrease vocal nodule recurrence. Therefore, the treatment efficiency and protocol are direct and fast. Finally, long-term outcomes studies have demonstrated improvements in vocal disability with both objective and subjective evaluation. Fat augmentation is an effective autogenous implant which may be considered in the management of patients after microsurgical removal of nodules.

Autologous Fat Augmentation of the Vocal Folds with Basic Fibroblast Growth Factor —Application in Clinical Cases—

はじめに：声帯内自家脂肪注入術は，いわゆる声門不全疾患に対するリハビリテーション手術として普及してきた。しかし，注入後の吸収による効果の減弱は避けられず，注入量の決定が困難であった。イヌを用いた動物実験において，低濃度の線維芽細胞増殖因子の投与により注入後の吸収による減量が軽減できることを確認したので，学内の臨床審査委員会の認定を経て臨床応用をおこなった。方法：塩基性線維芽細胞増殖因子を，自家脂肪組織に混合して2症例の声帯内に注入し，経時的に観察した。注入後の合併症の有無，効果の持続などについて検討した。症例1：33歳，声帯溝症症例2：62歳，男性，食道癌術後反回神経麻痺結果：現在，いずれの例も術後1年以上経過しており症状は安定している。注入後の脂肪組織の残存量は，脂肪組織のみを注入した従来の方法に比較して，CT画像上，脂肪組織の残存量が多かった。また，注入後に重篤な合併症は認められなかった。結論：線維芽細胞増殖因子を脂肪組織に混合して声帯内注入術を施行することによって，注入後に脂肪組織の残存率を改善させることができる可能性が示唆された。

Chronic Stress, Combined with a High‐Fat/High‐Sugar Diet, Shifts Sympathetic Signaling toward Neuropeptide Y and Leads to Obesity and the Metabolic Syndrome

In response to stress, some people lose while others gain weight. This is believed to be due to either increased beta-adrenergic activation, the body's main fat-burning mechanism, or increased intake of sugar- and fat-rich "comfort foods." A high-fat, high-sugar (HFS) diet alone, however, cannot account for the epidemic of obesity, and chronic stress alone tends to lower adiposity in mice. Here we discuss how chronic stress, when combined with an HFS diet, leads to abdominal obesity by releasing a sympathetic neurotransmitter, neuropeptide Y (NPY), directly into the adipose tissue. In vitro, when "stressed" with dexamethasone, sympathetic neurons shift toward expressing more NPY, which stimulates endothelial cell (angiogenesis) and preadipocyte proliferation, differentiation, and lipid-filling (adipogenesis) by activating the same NPY-Y2 receptors (Y2Rs). In vivo, chronic stress, consisting of cold water or aggression in HFS-fed mice, stimulates the release of NPY and the expression of Y2Rs in visceral fat, increasing its growth by 50% in 2 weeks. After 3 months, this results in metabolic syndrome-like symptoms with abdominal obesity, inflammation, hyperlipidemia, hyperinsulinemia, glucose intolerance, hepatic steatosis, and hypertension. Remarkably, local intra-fat Y2R inhibition pharmacologically or via adenoviral Y2R knock-down reverses or prevents fat accumulation and metabolic complications. These studies demonstrated for the first time that chronic stress, via the NPY-Y2R pathway, amplifies and accelerates diet-induced obesity and the metabolic syndrome. Our findings also suggest the use of local administration of Y2R antagonists for treatment of obesity and NPY-Y2 agonists for fat augmentation in other clinical applications.

Airway Resistance and Airflow Dynamics after Fat Injection into Vocal Folds

The aim of this prospective study was to verify whether vocal fold fat augmentation (VFFA) modifies upper airway patency. To the best of our knowledge, this is the first study analyzing the impact of VFFA on laryngeal resistance to airflow. Twenty-one consecutive patients 16 to 74 years of age underwent 24 VFFA operations because of glottic incompetence due to laryngeal hemiplegia (13 patients) or vocal fold tissue defects (8 patients). Flow-volume loop spirometry and body plethysmography were performed before and 1 to 6 months after surgery. There were no significant differences between preoperative and postoperative pulmonary volumes (FVC and FEV1), expiratory flows (PEF, FEF50), or inspiratory flows (PIF, FIF50), although a slight increase in inspiratory flows meant that FEF50/FIF50 slightly decreased. Specific airway resistance (sRaw) increased after VFFA, but not in a statistically significant manner (p = .078). None of the patients experienced postoperative stridor. One obese woman with laryngeal hemiplegia had postoperative effort dyspnea; her respiratory studies showed a reduction in inspiratory flows and an increase in sRaw, and demonstrated progressive improvement. Flow-volume loop spirometry showed that VFFA does not significantly modify respiratory airflows, although a slight increase of inspiratory airflows suggested an improvement in variable extrathoracic obstruction. Body plethysmography proved to be a sensitive procedure that highlighted the subtle increase in upper airway resistance. Hence, VFFA can be considered a relatively safe procedure for achieving vocal fold medialization, and spirometry and plethysmography can be useful for preoperative assessment and postoperative follow-up.

Midface Fat Augmentation Is Linchpin of Full-Face Rejuvenation

Midface Fat Augmentation Is Linchpin of Full-Face Rejuvenation

Fat Transplantation Using Fresh Versus Frozen Fat

BACKGROUND Autologous fat in both fresh and frozen forms has been used for many years as a filler for various dermatologic conditions. However, it is not clear whether fat that has been frozen survives as well as, and gives aesthetic results similar to, fresh fat. The efficacy of frozen fat has been debated in the literature. OBJECTIVE To evaluate the clinical aesthetic appearance and longevity of fresh fat versus frozen fat in a side-by-side two-hand comparison in the same patient. METHODS Ten patients underwent fat augmentation on their hands, utilizing 10 cc of fresh fat in one hand and 10 cc of frozen fat in the contralateral hand within 17 days of fresh fat placement. Follow-up evaluation was conducted at 1, 3, and 5 months in a randomized, double-blind comparison study. Physician-determined aesthetic preference, prominence of veins, and depth of metacarpal spaces were evaluated. Photographs were taken of both hands during each patient follow-up visit. RESULTS All three areas of physician-assessed gradation: aesthetics, vein prominence, and depth of metacarpal space were superior for the hand injected with frozen fat at 1-, 3-, and 5-month follow-up visits. CONCLUSIONS This pilot study supports the use of autologous frozen fat for equivalent to improved results regarding longevity and aesthetic appearance versus fresh fat at 1, 3, and 5 months for fat augmentation of aging hands.

Fat Transplantation Using Fresh Versus Frozen Fat: A Side-by-Side Two-Hand Comparison Pilot Study

Autologous fat in both fresh and frozen forms has been used for many years as a filler for various dermatologic conditions. However, it is not clear whether fat that has been frozen survives as well as, and gives aesthetic results similar to, fresh fat. The efficacy of frozen fat has been debated in the literature. To evaluate the clinical aesthetic appearance and longevity of fresh fat versus frozen fat in a side-by-side two-hand comparison in the same patient. Ten patients underwent fat augmentation on their hands, utilizing 10 cc of fresh fat in one hand and 10 cc of frozen fat in the contralateral hand within 17 days of fresh fat placement. Follow-up evaluation was conducted at 1, 3, and 5 months in a randomized, double-blind comparison study. Physician-determined aesthetic preference, prominence of veins, and depth of metacarpal spaces were evaluated. Photographs were taken of both hands during each patient follow-up visit. All three areas of physician-assessed gradation: aesthetics, vein prominence, and depth of metacarpal space were superior for the hand injected with frozen fat at 1-, 3-, and 5-month follow-up visits. This pilot study supports the use of autologous frozen fat for equivalent to improved results regarding longevity and aesthetic appearance versus fresh fat at 1, 3, and 5 months for fat augmentation of aging hands.

Fat transplantation for treatment of the senescent face

For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face.

Autologous Fat Augmentation for Voice and Swallow Improvement after Cordectomy

Surgery for the treatment of early-stage glottic carcinoma still remains a valid option. In most patients, newly formed neocord tissue preserves glottic functions, but in some patients an important glottic gap leading to glottic insufficiency may occur. In our study, 11 patients who had serious glottic insufficiency after endoscopic laser and laryngofissure cordectomy were treated with autologous fat injection (AFI) into the neocord tissue for voice and swallowing rehabilitation. One patient did not attend the first control visit and was excluded from the study. The remaining 10 patients were evaluated in the preoperative and postoperative periods for phonatory functions and efficacy of AFI by videolaryngostroboscopy and computerized acoustic analysis. Phonatory functions showed statistically significant improvement in the shimmer, noise-to-harmonic ratio, maximum phonation time and fundamental frequency. Perceptual ratings (GRBAS scale) also showed statistically significant improvement in all 5 parameters. Despite improvement in glottic closure, the mucosal wave deteriorated. Due to recurrence of symptoms of glottic insufficiency, AFI was repeated in 2 patients at the third and fifth months, respectively. One year later, the AFI resulted in successful rehabilitation of swallowing in all patients. The probability of resorption of autologous fat and the deterioration of the mucosal wave after AFI remain a problem, but re-injection can be done easily. As AFI is an easy, safe and cheap method, we concluded that it is a promising alternative procedure for managing voice problems after laser or laryngofissure cordectomy defects.

Freeze the Fat

Numerous techniques have been described for prolonging the duration of correction in autologous fat transplantation, and both fresh and frozen fat have been used in the augmentation of dermatologic defects. In this side-by-side, blinded comparison study, investigators measured the effectiveness of frozen fat versus fresh fat in aesthetic improvement. Ten patients underwent autologous fat augmentation of the dorsal side of both hands. Fresh fat was implanted in one hand and frozen fat …

難治性声門閉鎖不全疾患に対する声帯内脂肪注入術

難治性声門閉鎖不全疾患に対する声帯内脂肪注入術

An Unusual Case of Self-Injected Bovine Fat in Liquid Form to the Face for Cosmetic Reasons

A 45-year-old woman injected bovine fat in liquid form in to her periorbital area and nasolabial folds near the lip margin and glabellar area to look younger. She was influenced by a TV program about fat augmentation of the aging face and collagen injection to the wrinkles. Major depression had been diagnosed for this woman 5 years previously, after which she used antidepressants and hypnotics irregularly. The prolonged edema of her face subsided within 3 months, along with the erythema, itching, and firmness at the injection sites. No liposuction of the injected material was planned because it had changed to solid form as soon as it was injected. Additionally, it was thought that surgical excision of the fat would not be effective and could harm the facial nerve branches because magnetic resonance imaging showed diffuse enlargement of subcutaneous tissue. Therefore, a conservative approach, such as medical treatment with close follow-up evaluation was preferred. The reported case is presented not only to add an interesting self-injection case to the literature, but also to show that patients with psychological problems may harm themselves by using inappropriate methods for cosmetic reasons under the effect of inaccurate information obtained from TV programs, press, family, and friends.

Technical considerations in fat augmentation for patients with glottic insufficiency

Technical considerations in fat augmentation for patients with glottic insufficiency

Facial Volume Restoration With the Fat Autograft Muscle Injection Technique

Background Fat augmentation of the aging face has been a popular cosmetic procedure for decades. Many consider fat the ideal filler because it is natural, nonallergenic, and readily available. However, longevity and symmetry of the fat graft have been unpredictable. In addition, when large volumes are injected for panfacial correction, prolonged edema for months may result. OBJECTIVE Roger E. Amar has developed a new technique that is known as fat autograft muscle injection (F.A.M.I.) for fat augmentation. We present our experience in 100 patients who underwent this new method. METHODS One hundred patients underwent the F.A.M.I. procedure in which fat was injected within the muscles of facial expression. The fat was harvested in an atraumatic and sterile manner. Centrifuged fat was then injected with specific blunt-tipped cannulae for different muscle groups. The majority of patients underwent a partial- versus full-face procedure. RESULTS Patients were injected with volumes ranging from 3 to 63 cc of centrifuged fat in a single session. There were no complications, and downtime was 5 to 7 days. Patient satisfaction was high. Patients were followed postoperatively for 3 to 6 months. CONCLUSIONS Facial volume restoration with the F.A.M.I. technique is an artistic and systematic approach for facial volume restoration. It offers the potential for symmetric, long-term results.

Facial volume restoration with the fat autograft muscle injection technique.

Fat augmentation of the aging face has been a popular cosmetic procedure for decades. Many consider fat the ideal filler because it is natural, nonallergenic, and readily available. However, longevity and symmetry of the fat graft have been unpredictable. In addition, when large volumes are injected for panfacial correction, prolonged edema for months may result. Roger E. Amar has developed a new technique that is known as fat autograft muscle injection (F.A.M.I.) for fat augmentation. We present our experience in 100 patients who underwent this new method. One hundred patients underwent the F.A.M.I. procedure in which fat was injected within the muscles of facial expression. The fat was harvested in an atraumatic and sterile manner. Centrifuged fat was then injected with specific blunt-tipped cannulae for different muscle groups. The majority of patients underwent a partial- versus full-face procedure. Patients were injected with volumes ranging from 3 to 63 cc of centrifuged fat in a single session. There were no complications, and downtime was 5 to 7 days. Patient satisfaction was high. Patients were followed postoperatively for 3 to 6 months. Facial volume restoration with the F.A.M.I. technique is an artistic and systematic approach for facial volume restoration. It offers the potential for symmetric, long-term results.