Fat Injection Research Articles

Clinical Impact of Highly Condensed Stromal Vascular Fraction Injection in Surgical Management of Depressed and Contracted Scars.

Recent research on stromal vascular fraction (SVF) has demonstrated the presence of numerous growth factors that aid in tissue regeneration and suggest the potential for scar treatment. This study was conducted to clinically show that adding stem cells can improve the surgical outcomes of scar formation. Between March 2014 and February 2016, 17 patients underwent injections of fat and highly condensed SVF simultaneously with scar reduction surgeries and 15 patients received scar revision with or without simultaneous application of highly condensed SVF (4.90 × 107 stem cells/ml) at our institution. Clinical photographs were taken before and after surgery, and the scars were graded using the following standard scales: the Observer Scar Assessment Scale (OSAS), Stony Brook Scar Evaluation Scale (SBSES), Vancouver Scar Scale (VSS), and Visual Analog Scale (VAS). All patients showed improvement, registering significant increases in scar tissue scores (P < 0.05 in all four scoring systems). Patients in the SVF group showed more improved outcomes than patients in the non-SVF group for all scar tissue scores except the SBSES (OSAS, P = 0.029; SBSES, P = 0.281; VSS, P = 0.001; VAS, P = 0.021). Subcategories of these scales reflected more favorable outcomes in terms of height and pliability; however, there was no significant change in vascularity. SVF injections enhance tissue regeneration by contributing stem cells and growth factors to improve outcomes in scar revisions or tissue grafts. Harvesting the SVF through liposuction also provides a cosmetic benefit. Significant SVF-related gains in the scoring of scars indicate the merit of SVF as an aspect of conventional scar management. 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 .

Abstract: Fat Embolism in Gluteal Lipoinjection: Not Only a Matter of “Where” but Also of “What”

PURPOSE: Gluteal fat grafting became extremely popular during the last five years according to ASPS statistics.1 Parallel, there have been deaths reports following this procedure, usually associated with gluteal vessels damage and macroscopic fat embolism (MAFE).2 Some necropsies have failed to find macroscopic fat tissue in lungs or tore gluteal veins, but found oil in lung parenchyma in the microscopic evaluation, which has been called microscopic fat embolism (MIFE).3 Fat embolism is known to occur even without lipoinjection, in patients subjected only to liposuction.4 But all papers published so far about safety in gluteal fat transplantation focus only on MAFE pathophysiology, outlining buttocks areas, machinery, and techniques that are more prone to provoke a vessel wall damage. To date, there is no initiative discussing measures to avoid MIFE, therefore not contemplating all fatal cases that occur. METHODS and MATERIALS: MIFE pathophysiology, the interplay between vascular wall physiology and liposuction components, taking into account the effects of surgical metabolic response on vascular reactivity are discussed and correlated to clinical current practices. RESULTS: Fat injections into the muscular tissue are related to fat embolism not only because the presence of large vessels within its mass that can be damaged and suction the fat graft through the tearing but also because muscles have a higher overall vascularity and concentration of vessels compared to other tissues that allow more absorption of the free oil normally contained in the lipoaspirate through its lipophilic walls. CONCLUSION: Initiatives to develop fat tissue harvesting and processing machinery and techniques that avoid the presence of free oil in the graft material are pivotal to ensure maximal safety in autologous fat graft procedures.

The Expanding Role of Diagnostic Ultrasound in Plastic Surgery.

Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one's injection plane. The author's use of diagnostic ultrasound was evaluated from May 2017 to May 2018. Ultrasound scans were used routinely to detect deep venous thromboses. Patients undergoing abdominal liposuction and/or abdominoplasty were scanned for possible hernias. Other common applications included the evaluation of breast implants, breast masses, and seroma management. The device was used in surgery in 3 patients to assess the plane of buttock fat injection. One thousand ultrasound scans were performed during the 1-year study period. A distal deep venous thrombosis was detected in 2 patients. In both cases, the thrombosis resolved within 1 month, confirmed by follow-up ultrasound scans. A lateral (tangential) fat injection method was shown to safely deposit fat above the gluteus maximus fascia. Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Some of these applications are likely to improve patient safety. Early detection of deep venous thromboses is possible. Unnecessary anticoagulation may be avoided. Subclinical abdominal defects may be detected. Ultrasound may be used in the office to evaluate breast implants, masses, and seromas. In surgery, this device confirms the level of buttock fat injection.

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

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

Abstract: A Retrospective Comparison of Two Techniques of Fat Grafting in Breast Reconstruction: Outcomes over 5 Years

BACKGROUND: Autologous fat grafting (AFG) has become a common method of contour modulation of breasts after post-mastectomy implant reconstruction since the lift of the ASPS ban in 2009. Standard methods involve multiple tedious steps: harvesting, collection (with various possible manipulations) and finally reinfusion to the recipient site, most frequently via manual syringe.1,2 We developed a novel technique condensing these steps into one closed-loop system. In this innovative method3,4 we used a continuous flow pump to reinfuse fat to the breast. Del Vecchio also recently showed safety and efficiency with this method.5 METHODS: We conducted a retrospective cohort review of patients receiving AFG for breast contouring either by the syringe or closed-loop method by a single surgeon. Time to infuse fat, complications, and outcomes were analyzed. The cohort included 19 syringe AFG procedures (34 breasts) and 25 closed-loop procedures (41 breasts) between 2013 and 2018. Both short term (infection, explant) and long-term complications (granulomas, cysts, biopsy) were analyzed. RESULTS: Average infusion time was 15 minutes (4–30) for the closed-loop technique. Clinical follow-up times ranged from 28 to 161 weeks (mean=88) for syringe and 0 to 130 weeks (mean=32) for the closed-loop method. There were 2 major and 6 minor complications out of 34 breasts in the syringe method (5.5%, 16.6%, overall 23.5%) versus 1 major and 5 minor complications out of 41 breasts in the closed-loop method (2.4%, 12.1%, overall 14.6%) [p-value major=0.49, minor=0.58, overall=0.33]. Syringe complications included 2 granulomas and 1 cyst (8.8%) while the closed-loop complications included 2 granulomas (4.9%) [p-value=0.50]. Average total volume transferred was 262cc (60–850) for syringe, and 334cc (80–795) for closed-loop method. Infusion rate for the closed-loop method ranged from 100 to 250 mL/min, most consistently at 125 ml/min. CONCLUSION: The study suggests the closed-loop technique significantly decreases time of fat transfer to an average of 15 minutes, a trend towards decreased overall complications, though not statistically significant, and good subjective fat retention beyond 12 months. This suggests the closed-loop method is safe, effective, and significantly decreases operating time. We continue to collect patients in the closed-loop cohort and are also analyzing variation in adipocyte viability between the two methods. REFERENCES: 1. Coleman SR, Saboeiro AP. Fat Grafting to the Breast Revisited: Safety and Efficacy. Plastic and Reconstructive Surgery. 2007;119(3):775–785. doi:10.1097/01.prs.0000252001.59162.c9. 2. Delay E, Garson S, Tousson G, Sinna R. Fat Injection to the Breast: Technique, Results, and Indications Based on 880 Procedures Over 10 Years. Aesthetic Surgery Journal. 2009;29(5):360–376. doi:10.1016/j.asj.2009.08.010. 3. Hayssen H, Hagarty SE. A Novel Closed-Loop Autologous Fat Grafting Technique for Breast Reconstruction. Annals of Plastic Surgery. Vol 78, April 2017. 4. US and International Patent Applications. (US20170312403) Simple Closed Loop System for Direct Harvest and Transfer for High Volume Fat GraftingApril 2016 and (WO2017189918) A CLOSED LOOP SYSTEM FOR DIRECT HARVEST AND TRANSFER FOR HIGH VOLUME FAT GRAFTING, PCT Patent Applications April 2016, April 2017. 5. Del Vecchio D, Wall S Jr., Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation. Plastic and Reconstructive Surgery. 2018 May;141(5):639e-649e. doi:10.1097/PRS.

Correction to: Discussion of Shue et al. "Fat Injection: A Systemic Review of Injection Volumes by Facial Subunit".

Dino Elyassnia was left off the original version of this article. The author line is correct here.

Autologous fat grafting for enhancement of breast reconstruction with a transverse myocutaneous gracilis flap: A cohort study

The transverse myocutaneous gracilis (TMG) flap is a viable option for the reconstruction of small- to moderate-sized breasts. The purpose of this series was to examine the outcomes of fat grafting to breast and donor site secondary to breast reconstruction with a TMG flap. A cohort study was conducted to identify all patients who underwent autologous fat grafting after breast reconstruction with a TMG flap at two institutions between January 2009 and October 2013. Data were collected regarding patient demographics, body mass index, and medical history as well as surgical details regarding TMG flap surgery and fat grafting. A total of 145 fat graftings were performed in 83 patients following TMG flap breast reconstruction to improve the contour, shape, and volume of breasts (98%, n = 142), donor site (9%, n = 13) or both (7%, n = 10), mainly after breast cancer surgery (83%). On average, 1.8 fat grafting sessions were performed with an average of 30cc fat per breast and 56.4cc fat per thigh. In 72% of patients, fat injection was performed by other pending reconstructive procedures. Fat was harvested by the tumescent technique, by using a filter syringe system, and injected without any further processing in multiple layers. Autologous fat grafting as a secondary procedure represents a powerful adjunct to enhance the aesthetic outcome of the reconstructed breast and donor site. It can be easily combined with other pending reconstructive procedures. With additional fat grafting, it may be possible to expand indications and offer autologous reconstruction with a TMG flap even in very lean patients.

Autologous Fat Grafting in the Treatment of Facial Scleroderma.

Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations of systemic sclerosis are extremely disabling and treatment options are limited. In this study, we aimed to assess the safety and efficacy of autologous fat grafting in the face of patients with systemic sclerosis. We enrolled 16 SSc patients suffering from facial sclerosis and limited mouth opening capacity. Autologous fat injection ranging from 15 to 40 ml was administered per patient, based on their face morphology. The patients were evaluated at baseline and 3 months after fat injection. Evaluations included mouth opening capacity, mouth handicap in systemic sclerosis (MHISS), Rodnan skin sclerosis score, skin biophysical properties using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT), volumizing and aesthetic effects based on pre- and posttreatment photographs, possible side effects, and global patient satisfaction. Clinical assessment showed autologous fat transfer significantly improved mouth opening capacity and the MHISS and Rodnan score of patients with facial scleroderma (p value <.001). The aesthetic and/or functional results of fat injection were satisfying to about 80% of the patients. The changes in CRRT values were not significant. Our findings support the possible therapeutic role of autologous fat grafting in improving facial scleroderma both in aesthetic and in functional aspects. This trial is registered with IRCT20180209038677N1.

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.

Rejuvenation of the centre of the face: a new paradigm. Endoscopic lifting with fat grafting

The ageing process starts in the centre of the face in the periocular region and around the mouth, with a combination of volume loss and tissue descent. It is a logical approach to assess all these problems at once. The combination of minimal incisions vertical endoscopic lifting combined with superficial enhanced fluid fat injection can be an integral approach to facial rejuvenation.

Role of Fractionated Fat in Blending the Lid-Cheek Junction.

Fat grafting has been used extensively in plastic surgery in the past two decades. Here, the authors report the retrospective comparison of patients who underwent fractionated fat injection to blend the lid-cheek junction with those who had regular fat injection. After obtaining institutional review board approval, a retrospective review of patients who underwent lower blepharoplasty with fractionated fat injection for blending the lid-cheek junction from January of 2014 through October of 2015 was performed. The results were compared to those of lower blepharoplasty patients who did not have fractionated fat injected before January of 2014. Twelve prospectively selected patients underwent histopathologic and gene expression comparisons. A comparison of complications between the two groups revealed no significant differences. Furthermore, there was no significant difference between the two groups for sequelae of fractionated fat injection and regular fat injection. The gene expression analysis of the fractionated and regular fat did not show any difference between undifferentiated and differentiated cells. In addition, Oil Red O staining of the fractionated and regular fat after differentiation showed that cells from both fat groups differentiated equally well. Fractionated fat injection appears to be a safe addition in blending the lid-cheek junction in the five-step lower blepharoplasty. There is no fat nodule formation with injection of fractionated fat injection compared with injection of regular fat performed superficially in the tear trough area. Contrary to what has previously been shown, the presence of viable cells in fractionated fat was noted. Therapeutic, III.

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

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

Fat grafting of hairy areas of head and neck - comparison between lipofilling and nanofat grafting procedures in a cadaveric study

AimFat grafting has well-recognized effects in terms of volume gain, skin trophicity, relieving of post-wound nevralgia. Recent publications suggest a regenerative action on hair follicles. The objective of our study was to compare lipofilling and nanofat grafting in hairy areas of head and neck so as to determine a convenient fat injection technique for those areas in the prospect of treating alopecia. Material and methodsOur study compared lipofilling and nanofat grafting, in a cadaveric study involving one body. ResultsLipofilling was found easy to perform in the face, avoiding classical pitfalls, but was more difficult in the scalp areas. Nanofat grafting seemed particularly convenient to inject into the scalp, especially in Merkel's space, and hairy areas that required high precision injections. ConclusionAfter having compared lipofilling and nanofat grafting in hairy areas of the head and neck, we propose a combination of lipofilling (in hairy areas where a durable gain of volume is acceptable, in case of burn or scar) and nanofat grafting (in all hairy areas and in Merkel's space in scalp areas). This technique may be used either as a complement of hair follicle grafting or as a regenerative treatment of alopecia.

Characterization of the Tissue and Stromal Cell Components of Micro-Superficial Enhanced Fluid Fat Injection (Micro-SEFFI) for Facial Aging Treatment.

New microfat preparations provide material suitable for use as a regenerative filler for different facial areas. To support the development of new robust techniques for regenerative purposes, the cellular content of the sample should be considered. To evaluate the stromal vascular fraction (SVF) cell components of micro-superficial enhanced fluid fat injection (SEFFI) samples via a technique to harvest re-injectable tissue with minimum manipulation. The results were compared to those obtained from SEFFI samples. Microscopy analysis was performed to visualize the tissue structure. Micro-SEFFI samples were also fractionated using Celector,® an innovative non-invasive separation technique, to provide an initial evaluation of sample fluidity and composition. SVFs obtained from SEFFI and micro-SEFFI were studied. Adipose stromal cells (ASCs) were isolated and characterized by proliferation and differentiation capacity assays. Microscopic and quality analyses of micro-SEFFI samples by Celector® confirmed the high fluidity and sample cellular composition in terms of red blood cell contamination, the presence of cell aggregates, and extracellular matrix fragments. ASCs were isolated from adipose tissue harvested using SEFFI and micro-SEFFI systems. These cells were demonstrated to have a good proliferation rate and differentiation potential towards mesenchymal lineages. Despite the small sizes and low cellularity observed in micro-SEFFI-derived tissue, we were able to isolate stem cells. This result partially explains the regenerative potential of autologous micro-SEFFI tissue grafts. In addition, using this novel Celector® technology, tissues used for aging treatment were characterized analytically, and the adipose tissue composition was evaluated with no need for extra sample processing.

Enhancing Facelift With Simultaneous Submalar Implant Augmentation.

The midface is particularly prone to the senescent changes of soft tissue ptosis and volume loss, which in individuals with aging or low adiposity can manifest as submalar hollowing. Facelift alone in those with submalar hollowing inadequately addresses the volume loss and may result in a gaunt appearance postoperatively. Submalar implant augmentation is a powerful tool for permanent midface volume restoration for a more youthful and natural contour, as opposed to soft tissue fillers that diminish over time. When performed together, submalar augmentation and facelift synergistically enhance facial rejuvenation results. Determine the long-term safety and efficacy of submalar implant augmentation as an adjunct to facelift. Retrospective review evaluating results and complications in all consecutive patients who had submalar implant augmentation with SMAS-plication facelift in a single surgeon private practice setting from January 1, 1991, to December 31, 2017. Forty-eight patients underwent submalar augmentation with simultaneous facelift with an overall satisfaction rate of 95.7%. Complications included 2.1%transient infraorbital hypoesthesia, 1.1% prolonged swelling, and 1.1% capsular contraction that required a minor adjustment under local anesthesia. No infection, implant migration, or extrusion or facial nerve injury occurred. Submalar implant augmentation is a safe and effective means of enhancing facelift results through midface volume restoration, subperiosteal release, and improved soft tissue suspension in a more favorable vector. Submalar implant augmentation performed simultaneously with facelift may be an attractive alternative to repeated soft tissue filler or fat injections for patients with submalar hollowing who are interested in facial rejuvenation surgery.

Micro-fragmented fat injection reduces sepsis-induced acute inflammatory response in a mouse model

BackgroundSevere sepsis has a high mortality rate. There is increasing evidence that human mesenchymal stem cells possess immunomodulatory properties in sepsis, particularly those from adipose tissue. We hypothesised that micro-fragmented human fat, obtained with minimal alteration of the stromal vascular niche, attenuates the inflammatory response and improves outcome in a murine model of sepsis. MethodsMicro-fragmented fat, lipoaspirate, or saline was administered intraperitoneally 2 h after caecal ligation and puncture (CLP) in C57Bl/6RJ ketamine–xylazine anaesthetised mice. The primary endpoint was the inflammatory score. Secondary endpoints included survival, physiological, histological, and biological parameters. ResultsIn CLP mice, micro-fragmented fat administration significantly decreased the median (range) inflammatory score compared with saline [17 (14–20) vs 9 (8–12), P=0.006]. Secondary endpoints were also significantly improved in micro-fragmented fat-treated compared with saline-treated CLP mice. Improvement in inflammatory score and in survival was suppressed when micro-fragmented fat was co-administered with liposomes loaded with clodronate (macrophage toxin) or NS-398 (cyclo-oxygenase 2 inhibitor), but not with SC-560 (cyclo-oxygenase 1 inhibitor). ConclusionsIn a murine model of severe sepsis, micro-fragmented fat improved early inflammatory status and outcome, at least in part, by a cyclo-oxygenase-2-mediated mechanism. The potential therapeutic value of micro-fragmented fat in severe sepsis warrants further investigation.

Serial Injections of Cryopreserved Fat at -196°C for Tissue Rejuvenation, Scar Treatment, and Volume Augmentation.

Background:Fat grafting has become popular since the first report of structural fat grafting in 2001. Fat grafting is effective not only for volume augmentation but also for tissue revitalization. However, fat harvesting is necessary before fat grafting can be performed. Therefore, the performance of serial fat injections is very challenging when treating such patients.Methods:From August 2015 to March 2017, we investigated 219 patients who underwent fat grafting using the fat that had already been cryopreserved at −196°C.Results:Follow-up ranged from 3 months to 2 years. No complications occurred, and all outcomes were satisfactory. Three representative cases were also reviewed.Conclusions:The cryopreserved fat at −196°C could be served as a useful method for serial fat grafting for clinical use; however, further research involving longer follow-up and pathological findings are needed.

Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Frontal Headache, Migraine Surgery, and Cosmetic Temple Filler Injection.

Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection. A retrospective review of 113 patients who underwent frontal migraine decompression surgery with the senior author at the University of Texas Southwestern Medical Center from July of 2012 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve. This frontotemporal nerve (FTN) was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. The identification and proper avulsion neurectomy of this newly described sensory FTN may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

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

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

Bicyclist's vulva: Diagnostic and therapeutic aspects

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