Fat Injection Research Articles

Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty.

While percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty. This study aims to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty. From May 2022 to December 2023, a consecutive cohort of 97 patients underwent this surgical technique. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes. Following a mean follow-up of 7.2 months (ranging from 6 to 17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < 0.05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < 0.05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0±19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision. External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, presenting a viable alternative to conventional fixation techniques.

Fat Embolism Does Not Alter Cardiac Structure or Induce Pathological Changes in a Rat Model

IntroductionFat embolism (FE) encompasses conditions in which fatty substance becomes embedded in a tissue/organ. Fat emboli most commonly affect the lungs in a trauma setting. This can lead to both significant pathology locally and systemically including changes in structure, inflammatory response, activation of the renin-angiotensin system, and subsequent hypoxia. In fact, changes in skin, brain, lungs, and kidneys have been noted in FE syndrome. Because there is an extensive record of pathology reports on this condition without evidence of direct cardiac involvement, as well as our studies showing apparent complete recovery after the acute embolism, we hypothesized that structural changes similar to the lung and at the same time course would not be observed in the heart. MethodsWe used a rat model of FE previously described by our group where we have documented significant lung pathology. In this study, we analyzed both pulmonary and cardiac structure, histology, and gene expression at 48 h and 10 wks post fat injection to mimic FE. ResultsDespite severe inflammatory evidence and structural changes to the lung and vasculature up to 10 wks after FE, we found no significant alterations to cardiovascular morphometry including lumen patency ratio, adventitia/media ratio, fibrosis content, and heart chamber/wall dimensions in stained histological sections. Additionally, genetic markers of cardiac pathological hypertrophy were not significantly elevated 48 h or 10 wks after fat treatment. Oil Red O staining showed increased fat droplet content within lung and aorta tissue, but not in the myocardium. ConclusionsOur study suggests that, in contrast to the lungs, the heart is more resistant to the inflammatory and remodeling responses that result from FE, possibly due to the organ-specific differences in fat retention.

Abdominal Etching-A Novel Classification Method for Surgical Approach.

The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. Sixty-two patients (42 male) with an average age of 36years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Modified blepharoplasty combined with autologous fat transplantation into the orbital septum for the correction of dermatochalasis and sunken eyelids

BackgroundPeriorbital aging typically manifests with dermatochalasis and depression of the upper eyelid. Blepharoplasty is a popular choice for addressing upper eyelid skin laxity but is not suitable for sunken eyelids. This study introduces an innovative approach for periorbital rejuvenation by addressing dermatochalasis and sunken upper eyelids concurrently in aging Asian women. MethodThe study involved 45 patients with upper eyelid dermatochalasis accompanied by moderate to severe depression. Subbrow blepharoplasty was performed in conjunction with upper eyelid granular fat grafting in the orbital septum for these patients. Preoperative measurements of the depth and volume of the upper eyelid depression were taken and the surgical outcomes were assessed at 3 and 6 months postoperatively using the GAIS score and the Antera 3D camera. ResultThe average depth of the upper eyelid depression before surgery was 6.501±1.473mm, and the average volume was 0.579±0.144 cm3. There were significant improvements in the depth and volume of the depression at 3 and 6 months after surgery compared to the preoperative measurements. The GAIS scores were also improved and postoperative outcomes were deemed satisfactory. ConclusionFor patients with dermatochalasis accompanied by moderate to severe upper eyelid depression, a standard blepharoplasty was unable to improve the sunken eyelid. This novel technique combines autologous granular fat injection into the orbital septum and blepharoplasty to effectively address periorbital aging, thereby promoting facial rejuvenation.

A comparison of surgical scar treatment using various combinations of autologous fat, hyaluronic acid and resurfacing with the 1540 nm non-ablative Erbium laser – a prospective pilot study

ABSTRACT Scars can cause aesthetic or functional disturbance. Several interventions had been described to improve their appearance. We propose that the combination of some of those treatments can synergize their effects on the scar. We designed a prospective pilot study with ten patients using the patient as their own control to compare different interventions. In each patient, the scar was divided into four parts treated differently: 1. No treatment (control), 2. Fat grafting only, 3. Fat grafting and Hyaluronic Acid (HA), 4. Fat grafting, HA and with a non-fractional laser. Each part of the scar was evaluated by the Patient and Observer Scar Assessment Scale (POSAS). Treatment of the scar with the combination of the three modalities showed better results in the observer scale. In addition, a combination of fat injection, HA, and subsequent skin resurfacing with non-ablative laser showed better outcomes for all parameters on the Observer Scale except vascularity, while on the Patient Scale thickness, relief, pliability, surface area, and overall measurement were better. The combination of all three treatments tends to improve scarring results and appears to be safe and effective. However, further studies with larger samples are needed to explore the potential use of this combined treatment.

Correction of Post-Surgical Temporal Hollowing with Adipo-Dermal Grafts: A Case Series.

Background: Surgical dissection and partial detachment of the temporalis muscle during neurosurgical procedures might result in a temporal depression known as "temporal hollowing". Reconstructive procedures to correct this condition include the implantation of synthetic materials (e.g., hydroxyapatite, methacrylate or polyethylene), injection of autologous fat or fillers as well as the use of flaps (e.g., temporo-parietal local flap and latissimus dorsi free flap). However, none of these techniques proved to be an ideal option due to a high complication rate or need for invasive and complex surgery. Adipo-dermal grafts are autologous; the resorption rate seems to be limited and the complexity of the procedure is minor. Moreover, autologous fat grafting can be performed to enhance the final outcome by correcting residual contour deformities. Methods: In this series of five patients, an institutional experience is presented using multi-layered adipo-dermal grafts harvested from the supra-pubic area for the restoration of volume and contour in post-surgical temporal hollowing. During the last follow-up, patients were asked to express their satisfaction, which was assessed by a survey. Results: this approach demonstrates a marked improvement in temporal hollowing associated with a low complication rate and good patient satisfaction. Conclusions: the aim of this consecutive case series is to emphasize the effectiveness of this surgical technique as one of the options to address temporal hollowing.

Guided SEFFI and CaHA: A Retrospective Observational Study of an Innovative Protocol for Regenerative Aesthetics.

Background/Objectives: This retrospective observational study sought to determine the efficacy and safety of an innovative combined treatment protocol using guided Superficial Enhanced Fluid Fat Injection (SEFFI) and calcium hydroxylapatite (CaHA) in facial rejuvenation. Methods: A total of 158 patients (149 females and 9 males) underwent the combined treatment of guided SEFFI and diluted/hyperdiluted CaHA. The study evaluated treatment outcomes at 30, 90, and 150 days post-treatment using the Global Aesthetic Improvement Scale (GAIS) and three-dimensional photogrammetric analysis. Results: The combined treatment demonstrated consistent enhancement in skin quality and facial volume across temporal, malar, zygomatic, and jawline regions. At 90 days post-treatment, substantial improvements were observed, with the GAIS scores reflecting significant enhancements in both skin quality and volume, which were sustained or slightly improved by 150 days. Minor complications, predominantly ecchymosis at the injection sites, resolved within a week, confirming the treatments' safety. Conclusions: The integration of guided SEFFI and CaHA resulted in significant improvements in skin quality and facial volume with minimal complications. Further research is recommended to consolidate these findings and explore long-term outcomes.

Hybrid Chin Advancement: Combining Fat and Sliced Cartilage Grafts for Chin Augmentation During Rhinoplasty

BackgroundFacial balance significantly impacts aesthetics, particularly in the middle and lower thirds. Patients with chin retrusion often benefit from sagittal plane chin advancement in rhinoplasty, enhancing surgical outcomes and satisfaction.ObjectivesThis article presents a method for analyzing chin deformities and discusses a hybrid treatment approach to harmonize facial features, complementing rhinoplasty.MethodsThe chin positions of patients treated by the senior author were assessed. A retrospective analysis included 49 patients with chin retrusion of 2.5–6 mm. Among them, 22 patients initially offered chin implants declined, leading to planned chin augmentation. Fat grafting was exclusively performed for 20 patients lacking sufficient cartilage. The "Hybrid Chin Advancement" technique involved supporting tissues beneath muscles with nasal septum cartilage and fat injections and tissues above muscles with fat injection alone.ResultsPre- and postoperative Legan angle measurements and chin advancements were compared across three groups. While preoperative Legan angles were statistically similar, postoperative Legan angles and advancement changes were significantly higher in the implant group (p < 0.0001). Comparing hybrid chin advancement and fat grafting groups, postoperative Legan angles and advancement changes were significantly higher in the hybrid chin group (p < 0.0001).ConclusionsFat grafting suffices for mild advancements (~ 2 mm), while the hybrid chin method is effective for moderate advancements (~ 4 mm). For advancements exceeding 6 mm, implants or osseous genioplasty are optimal. Our study’s hybrid approach offers an easy, safe, and reliable method for achieving facial harmony in the lower two-thirds without compromising patient expectations.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Role of Autologous Micro-Fragmented Adipose Tissue in Osteoarthritis Treatment.

Osteoarthritis (OA) is the most common complex musculoskeletal disorder, resulting from the degeneration of the articular cartilage and characterized by joint pain and dysfunction that culminate in progressive articular cartilage loss. We present our experience in the management of hip and knee OA by means of the intra-articular injection of fat micrograft, describing our approach, which was developed from the belief in the powerful reparative effect of autologous fat graft on damaged tissue, as well as its natural lubricating effect on the joints. Inclusion criteria were as follows: men and women, aged 20 to 80 years, that referred articular pain of the hips and/or knees, showing initial-stage degenerative OA. From October 2018 to July 2023, a total of 250 patients underwent treatment with the Sefficare® device (SEFFILINE srl, Bologna, Italy). The Superficial Enhanced Fluid Fat Injection device was used to perform autologous regenerative treatments in a safe, standardized, easy, and effective way on 160 women, 64%, and 90 men, 36%. A total of 190 procedures (76%) involved the knees, with 20 patients who were bilaterally treated, while 60 procedures, all unilateral, involved the hips (24%). The mean age at treatment was 52.4 years. Before treatment, each patient had undergone X-rays and Magnetic Resonance Imaging (MRI) of the painful hip/knee to evaluate and grade the articular OA. Postoperatively, each patient was assessed after one, three, six, and twelve months. The donor site postoperative course was uneventful other than minimal discomfort. Clinically, the ROM (range of motion) of the treated knee/hip increased an average of 10 degrees 3 months after treatment, but the stiffness was reduced, as reported by the patients. The VAS (Visual Analog Scale) was submitted at 3, 6, and 12 months, demonstrating a progressive reduction of pain, with the best score obtained at six months postoperatively. In total, 85% of patients were satisfied one year after treatment, with a considerable improvement in pain and quality of life. The satisfactory outcome of this minimally invasive procedure indicates that the intra-articular injection of fat micrograft can replace or considerably delay the need for the classical major joint replacement surgery, thanks to its impact on the quality of life of patients and financial cost.

Surgical Management of Headache Disorders - A Systematic Review of the Literature.

This review article critically evaluates the latest advances in the surgical treatment of headache disorders. Studies have demonstrated the effectiveness of innovative screening tools, such as doppler ultrasound, pain drawings, magnetic resonance neurography, and nerve blocks to help identify candidates for surgery. Machine learning has emerged as a powerful tool to predict surgical outcomes. In addition, advances in surgical techniques, including minimally invasive incisions, fat injections, and novel strategies to treat injured nerves (neuromas) have demonstrated promising results. Lastly, improved patient-reported outcome measures are evolving to provide a framework for comparison of conservative and invasive treatment outcomes. Despite these developments, challenges persist, particularly related to appropriate patient selection, insurance coverage, delays in diagnosis and surgical treatment, and the absence of standardized measures to assess and compare treatment impact. Collaboration between medical/procedural and surgical specialties is required to overcome these obstacles.

Clinical Implications of Fat Grafting in the Posterior Calf: A Dynamic Cadaver-based Study.

Intramuscular fat grafting in extremity muscles, especially the gastrocnemius, has become increasingly popular. However, while safety in truncal muscle fat grafting has been well-studied, research on extremity muscles is lacking. In this study, we aimed to explore the anatomy of the gastrocnemius muscle and adjacent structures as intramuscular and subcutaneous recipient sites. Additionally, we sought to analyze pressure-volume relationships and fat migration patterns during posterior calf grafting. Eight cadaveric lower extremities were examined. A prosection was performed to better understand the vascular complex around the gastrocnemius. Ultrasound-guided fat injections were then performed into both the subcutaneous and intramuscular layers; dynamic pressures were measured with a manometer. Last, dyed-injectant was injected subcutaneously to better elucidate subcutaneous anatomy. Anatomic prosection demonstrated the proximity of the gastrocnemius muscle to the popliteal venous system that arborized (>1 mm) intramuscularly. In the 3 specimens that underwent intramuscular fat grafting, the peak intramuscular pressures plateaued at 21 mmHg (19.5-23 mmHg); there was no observed extrafascial migration of the injectant. With subcutaneous injectant in 1 specimen, pressures in the subcutaneous space increased (125 mmHg) with additional injectant (240 mL) while pressures in the intramuscular space remained relatively constant (4 mmHg). Intramuscular gastrocnemius fat grafting should be done with caution: its proximity to critical veins and sustained increased intramuscular pressures following grafting increases risks of embolus and thrombosis, respectively. Subcutaneous injection may be safer in that increased pressures are not communicated to deep structures. Last, we present a novel description of posterior calf subcutaneous compartments that may better allow surgeons to direct and predict subcutaneous injectant.

An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency: A Review and Integrated Data Analysis.

Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature. This systemic review examined the evidence of AFG for VPI treatment over the past decade (2013-2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications. The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases. Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.

Autologous Fat Breast Reconstruction with Implant Completion-Experience with 29 Consecutive Cases and 33 Breasts.

Implant-based breast reconstruction is the most prevalent form of breast reconstruction. Autologous fat grafting (AFG) was conceptualized as an alternative to implant-based breast reconstruction and was found to be a reliable reconstruction modality. However, usually, a few grafting rounds are required to create the desired shape and size of the breast. Current literature describes ample experience with AFG as an adjunct to implant-based breast reconstruction for improving appearance. However, the utilization of breast implants following initial AFG has been sparingly described. The primary advantage of this study is the creation of new fat tissue as a breast mound. The reconstruction is then concluded by inserting an implant into this new mound. This approach reduces the overall number of fat injections needed to achieve the desired outcome, as well as the total volume of the implant. This IRB-approved retrospective study was conducted between January 2015 and December 2021. All women who underwent delayed breast reconstruction with AFG during this timeframe and wanted to complete it with a silicone implant as a last stage were included in the study. A total of 29 patients (33 breasts) underwent delayed breast reconstruction with AFG and a silicone implant as the final stage. In all cases, the results were satisfying without any major complications. Minor complications were observed with one patient and included an infection. The findings of this study have demonstrated the effectiveness of this procedure together with patient satisfaction, thus highlighting the potential advantages that this approach offers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Healing and Aging-related Properties of Adipose Tissue Fragments Obtained through the Guided SEFFI Procedure’s Mechanical Fragmentation are Facilitated by the Exosomes Present in the Final Injection

The Injection of autologous Adipose-Derived Stem Cells (ADSCs) and Stromal Vascular Fraction (SVF) into dermal and subdermal layers can improve skin volume and rejuvenation. The SEFFI (Superficial Enhanced Fluid Fat Injection) technique, which involves minimal manipulation of autologous microfragmented adipose tissue, was utilized for harvesting and re-injection, using the SEFFILLER™ disposable medical device. Mechanical fragmentation of adipose tissue is a well-established surgical technique that stimulates tissue regeneration, filler, and biological activity. The study evaluated the biological properties (regenerative and anti-aging) of different harvest and processing fat graft methods among which the fragmented adipose tissue, specifically focusing on the presence of exosomes. Exosomes, nanometer-sized vesicles produced by cells for cellular communication, were found to contain miRNAs with anti-inflammatory, regenerative, and vascular content. The products’ contained exosomes were confirmed in the study through electron microscopy, Western Blotting, gene expression, and sequencing of miRNA content.

P130 Unmet needs and treatment preferences concerning digital ulcers in patients with systemic sclerosis

Abstract Background/Aims Digital Ulcers (DU) affect around half of systemic sclerosis (SSc) patients and are associated with significant pain and difficulties in daily life. Despite available treatment options, DUs are often recalcitrant and recurrent. Our aim was to examine the patients’ perspectives concerning the unmet needs and treatment of SSc-DUs. Methods SSc patients with past DU were invited through international patient associations/social media to participate in an online English-language survey. The survey was launched on 31st January 2023 and open for four weeks. Results A total of 358 evaluable responses were collected from 11 countries, mainly from USA (65.6%), UK (11.5%) and Canada (4.5%). 81,6% of respondents were aged 30-70 years and 93% were female. Almost all (96.1%) had &amp;gt;1DU during the course of their disease (46% &amp;gt;10 DUs), mainly localised on the fingertips (84.9%). DUs have broad-ranging impacts: activities of daily living (79% ‘agreed’ or ‘strongly agreed’), work activities (73% ‘agreed’ or ‘strongly agreed’), future planning (64% ‘agreed’ or ‘strongly agreed’), and interpersonal relationships and/or social activities (59% ‘agreed’ or ‘strongly agreed’). Only one quarter (26.2%) of respondents were satisfied with currently available treatments, or treatment efficacy on main ulcer symptoms such as pain (24%). Half (51.7%) of respondents received wound/ulcer care, with only a third (31.4%) via a dedicated rheumatological/wound care clinic. The most frequent DU interventions were: wound cleaning (58.9%), ulcer dressing (63.2%) and debridement (27%), while botulinum (8.1%), fat injection (1.6%), sympathectomy (10.3%), and surgery (16.8%) were less frequent. Among respondents, the majority (71.3%) were ‘likely’ or ‘very likely’ to consider local DU treatment, 68.4% oral therapy, 43.8% intravenous treatments and 30.4% surgical approach. Figure 1 presents respondents perceived factors that may delay DU healing (1A), reasons to seek healthcare professional advice (1B), and reasons to change treatment (1C). Education about tDU complications is limited (34.1%), including recognition (30.8%), and actions to be taken (25%). Conclusion DUs have significant broad-ranging impacts there are many unmet needs have emerged. Local wound care is not standardized across specialist centers and patient education is often neglected. Dedicated treatment recommendations are urgently needed to optimise the therapeutic strategy, including non-pharmacological interventions. Disclosure G. Bandini: None. A. Alunno: None. B. Ruaro: None. I. Galetti: None. B. Alcacer-Pitarch: None. F. Oliveira Pinheiro: None. G. Campanaro: None. J. Jade: None. L. Muir: None. A. Moggi Pignone: None. Z. McMahan: None. K. El Aoufy: None. M. Matucci Cerinic: None. M. Hughes: None.

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.

New autologous fat implantation technique for face lifting: A pilot study.

Autologous fat injection techniques are specially performed to restore the lack of face volume. However, no reports have focused on the effect of sides of injection on the sagging appearance improvements and facial lifting. This study aimed to evaluate face lifting using the autologous fat injection in to sides of the face as a new technique. Ten patients with aging face were involved in this study. The procedure was done in an anaerobic method. To improve the method, to make patients more satisfied and gain better cosmetic outcomes autologous fat was injected on the sides of the face. To give a lifting effect to the face, the fat was injected on the hairline in the temple area, next to the ear, the angel of the jaw and the angel of the mandible leaning behind the ear to cause face lift. The patients were appraised clinically and photographically. The results showed that this autologous fat injection technique has significant improvement in face lifting. This new fat injection technique in sides of the face can create superior results on face lifting without any adverse side effects.

"Longitudinal Experience Using Pedicled Buccal Fat Pad Flaps in Cleft Palatoplasty: Mitigating Velopharyngeal Insufficiency Risk and Severity".

Cleft palatoplasty commonly results in denuded maxillary bone in the lateral gutter(s) and a posterior void between oral and nasal closures. Bony exposure of the anterior palate subjects the maxilla to scarring and growth restriction, while scar contracture of the posterior void may result in velopharyngeal insufficiency (VPI) and fistula formation. Utilization of the buccal fat pad flap (BFPF) at the time of palatoplasty provides vascularized tissue over these critical areas, thereby reducing the rate of secondary surgery for speech and fistula revision. A single-center, retrospective review identified patients who underwent palatoplasty with or without BFPF between 1995-2015. Data collected included cleft type, surgical technique, follow-up duration, and complications. Outcomes included rate of speech surgery and palatal fistula development. Veau phenotype index was computed on a scale of 2-4 as a weighted mean to reflect the frequency of cleft type (Veau II-IV) in BFPF and non-BFPF groups. Charts of 866 patients were reviewed; 212 met inclusion criteria. Of these, 101 received a BFPF. Mean follow-up duration was 11.4 years. Despite a selection bias for more severe clefts, the BFPF group had lower incidence of speech surgery (9.9% vs. 36.9%, p=0.0072). The BFPF group had more mild cases treatable with fat injection (7.9% vs. 2.7%, p=0.0346) and developed fewer fistulas (6.9% vs. 18.0%, p=0.0280). Despite the presence of more severe clefts, the BFPF group had a significantly lower rate of speech surgery. The BFPF is a valuable adjunct in primary palatoplasty, reducing VPI and fistula formation.

(019) Penile Augmentation by Division of the Suspensory Ligament of the Penis and Autologous Fat Injection

Abstract Introduction Penile size dissatisfaction is a problem which is more prevalent than what is perceived, it is not taken seriously by healthcare professionals. It is reported that 45% of men are unhappy with their penile size. Most men are too ashamed to seek professional help so they go to online sites that promote fake pills, creams, lotions, or try to solve the problem themselves (DIY Penile enlargement) which causes significant complications or undergo high risk procedures without proper counselling. Objective The aim of this study was to evaluate the outcome of penile augmentation surgery by division of the suspensory ligament of the penis with insertion of silicon buffer for flaccid length enhancement plus liposuction and autologous fat injection for penile girth enhancement. Methods A retrospective audit of patient outcomes after surgical Penile Augmentation (PA) at one centre, over a 5.5 year period. 560 patients had division of the suspensory ligament of the penis with insertion of silicon buffer with liposuction and autologous fat injection. The following data was collected: - Pre and post-operative flaccid penile length and girth. - Patient reported satisfaction rates. - Complications. Results 560 patients were included in this study, the mean patient age was 38 (24–72). The Mean follow up duration was 6 (3-12) months. The mean increase in flaccid length was 3.8 (1.5-6) cm. The mean increase in girth was 4.2 (2.5-5.5) cm. The patient reported satisfaction rates were 85%. No serious adverse events were encountered; the following complications were recorded: partial fat absorption occurred in 120 patients (21.4%) and was managed by fat top up. Phimosis occurred in 20 patients (3.5%) and was manged conservatively in all but 2 patients who required a circumcision, hard fat lumps occurred 30 patients (5.3%) and was managed by in office needling. Migration of fat in the scrotum occurred in 40 patients (7.1%) and was managed conservatively in all but 5 patients who required surgical removal of the fat lumps, infection of the silicon buffer occurred in 6 patients (1.07%) and was managed by removal of the silicon buffer, discomfort from the silicon buffer occurred in 5 patients (0.89%) and was managed by removal of the silicon buffer. Conclusions Penile enlargement by division of the penile suspensory ligament and injection of autologous fat is a safe and effective procedure which is associated with high patient-satisfaction rates. Disclosure No.

Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS Surgeons

Background: The demand for gluteal fat grafting (colloquially known as Brazilian butt lift [BBL]) has seen a dramatic increase in the past decade. Brazilian butt lift has been the fastest-growing cosmetic procedure in the United States for several years. During this time, the incidence of pulmonary fat embolisms (PFEs) associated with this procedure has raised safety concerns. Several professional organizations have responded to these concerns with investigational reports to identify the causes and provide recommendations to decrease the mortality associated with this popular cosmetic procedure. Awareness and implementation of these safety recommendations have been a cornerstone to decreasing the mortality rate associated with gluteal fat grafting. Objectives: To provide a comparison of current technical approaches and a mortality update on gluteal fat grafting among surgical members from the American Board of Cosmetic Surgeons (ABCS) within the last 6 years. Also, to determine if specific technical changes in the manner this procedure is performed are improving safety. Methods: An online (emailed) survey regarding perioperative gluteal fat grafting techniques and postoperative outcomes performed by ABCS surgeons within the previous 3 years was collected in 2 different 3-year time frames. Initial data were collected in 2019 for the preceding 3 years 2016-2019. The survey was again repeated in 2022 to collect similar data as before from ABCS member years 2019-2021. The data, which included the total # of BBLs performed, incidence of major infection or fat emboli, cannula size, and injection methods details was compared for each 3-year period. Both sequential studies provided a comparison of the techniques employed as well as morbidity and mortality outcomes. Results: Sixty-four ABCS surgeons who reported performing BBLs responded to the survey in 2019 and reported performing a total of 22 800 (BBLs) gluteal fat grafting cases in a previous 3-year window from 2016 to 2018. More surgeons used a closed system peristaltic pump in the second part of the study as compared to the first (51% vs 22%) ( P &lt; .01). Two cases required in-hospital treatment of infection in the first survey while zero cases were reported for the second survey period ( P = .07). Twenty-five of 64 (39%) reported injecting fat at least into superficial gluteal muscle during this earlier time frame. In this earliest study, there were 3 total cases of PFE reported (2 fatal PFEs and 1 nonfatal PFEs). In 2022, 85 ABCS surgeons who reported performing BBLs responded to the survey. Around 12 172 gluteal fat grafting cases were reported in the second 3-year study from 2019 to 2021 compared to 22 800 in the first study ( P &lt; .01). There was a total of 34 972 BBLs during the entire 6-year study. Most surgeons (82 of the 85) in the second-phase 3-year study reported injecting fat “exclusively” above the muscle ( P &lt; .01). There were no fatal and non-fatal PFEs reported in the follow-up 3-year study in 2022 of ABCS member data from 2019 to 2021 ( P = .03). Conclusions: The mortality report associated with gluteal fat grafting from this survey among surgical members of the ABCS suggests using the current safety recommendations proposed, including injection of fat in the subcutaneous layer only, have led to a decreased risk of PFEs associated with gluteal fat grafting. The mortality rate was zero (0 out of 12 800) when 96% were injecting above muscle only compared to a mortality rate of 1:11 400 (2 of 22 800 cases) when 39% of 22 800 BBLs performed had fat injected into muscle. While there were more BBLs performed during the earlier 3-year study ( P = .07). The mortality rate significantly decreased in the years when only a small minority of cases had fat injected into the muscle. This study adds to other existing literature from professional organizations’ reports on the safety of gluteal fat grafting using the proper safety measure and recommendations.