Local Plastic Surgery Research Articles

Гігієна порожнини рота після проведення внутрішньоротових оперативних втручань

Purpose. Prevention of early postoperative inflammatory complications after intraoral surgical interventions. Methods. It is proposed to use modern hygiene products, 45 patients were examined after intraoral surgical interventions: 24 patients after the removal of a retained late tooth in the lower jaw and 21 patients after a sparing maxillary sinusotomy with oroantral fusion plastic surgery. Results. In the case of the recommended treatment, early inflammatory complications in the postoperative period in the form of inflammatory infiltration of soft tissues were observed in 3 of 24 patients (12.5%) after atypical tooth extraction and in 4 of 21 patients (19.1%) after sparing maxillary sinus surgery with local plastic surgery of the palate. In the control group, early postoperative complications in the form of inflammatory infiltration of soft tissues were observed in 6 out of 24 patients (25.0%) after atypical tooth extraction and in 7 patients (33.3%) after sparing maxillary sinus surgery with local palatal plastic surgery. Conclusions. Hygienic oral care using our proposed method is more effective in patients after intraoral surgical interventions compared to traditional methods of hygiene. The use of our proposed method of hygienic oral care allowed us to reduce the number of postoperative inflammatory complications by almost 2 times. We recommend using these oral hygiene products after intraoral surgical interventions. Key words: upper jaw, lower jaw, atypical tooth extraction, sparing maxillary sinusotomy, oral hygiene, Listerine, methylene blue Ligor.

Building Sustainable Reconstructive Microsurgery in Countries with Limited Resources: The Rwandan Experience.

Reconstructive microsurgery practice has been well adopted in developed countries, but this has not been the same in low- and middle-income countries (LMICs). Injuries related to road traffic accidents are highest in these countries, with 93% of the world's fatalities on the roads occurring in LMICs. The objective of this study was to highlight the need for sustainable microsurgery in LMICs and share strategies undertaken in Rwanda. We review the contemporary literature about the needs and challenges facing reconstructive microsurgery in LMICs. We describe the strategies undertaken in Rwanda towards developing microsurgery. We also report the outcomes of the first ever microsurgery visiting professorship organized in the country and the steps taken towards achieving sustainable microsurgery practice in Rwanda. There is a huge unmet need for reconstructive microsurgery in LMICs. Most of the microsurgical operations in these countries are done in short term surgical mission setups. No data focusing on sustaining reconstructive microsurgery in LMICs has been described in the contemporary literature. There is a 2.5-fold increase in the number of trained plastic surgeons in Rwanda over the past 5 years, with increasing skills in microsurgery and opportunities for formal overseas fellowships. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable microsurgery services is possible in countries with limited resources. In our experience, the fly-in-fly-out microsurgical missions aimed at mainly providing surgical care to patients seem to have a limited long-term impact and sustainability. We recommend integrating these missions into planned microsurgical initiatives of pre-existing local plastic surgery training programs.

КОРРЕКЦИЯ ТЯЖЁЛЫХ РУБЦОВЫХ КОНТРАКТУР И ДЕФОРМАЦИЙ НИЖНИХ КОНЕЧНОСТЕЙ

Objective: To improve the outcomes of surgical treatment of severe contractures, deformities, and lower limb (LL) soft tissue defects using optical magnification and precision techniques. Methods: 54 patients with sequelae of traumatic injury underwent surgical repair of severe contractures, deformities, and soft tissue defects of the LL. Contractures were accompanied by extended cicatricial deformities and soft tissue defects of the LL. Traumatic injuries often lead to sequelae in children, as observed in 39 patients. The leading causes of burn injuries were boiling water and hot oil. Results: Various types of Z-plasty were used in 29 (53.7%) cases to correct contracture and toe and foot deformities. Tailored surgeries were performed for severe injuries and extended cicatricial deformities with residual defects covered with skin grafts. Optical magnification with precision technique contributed to adequately mobilizing the fasciocutaneous flaps and the neurovascular bundle (NVB) release. By using ultrasonic dopplerography (USDG), it was possible to determine how the degree circulatory disorders in the affected LL is dependent on the duration between injury and presentation at our center, the severity of the contracture, and the size and depth of the soft tissue damage. Purulent wound infection and superficial partial necrosis of the fasciocutaneous flaps occurred in 3 and 5 patients, respectively Conclusion: In managing concomitant injuries, including assessing their extent, appropriately evaluating the initial severity of the trauma is essential. The evaluation requires using additional diagnostic methods and selecting the optimal reconstruction method. Optical magnification and precision techniques enable the effective mobilizing of fasciocutaneous flaps while preserving their blood supply. This leads to adequate mobilization and decompression of the NVB, effectively preventing NVB iatrogenic damage. Keywords: Lower limb, burn, contracture, deformity, soft tissue defect, local plastic surgery.

Ways and methods of closing tissue defects of the middle zone of the facial skull after removal of malignant tumors with intracranial spread (case from practice)

A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of ​​the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics. The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.

EP-584 An evaluation of plastic surgery operation note documentation in line with RCS standards

Abstract Aim To assess the extent to which operation note documentation had been completed accurately, in line with Royal College of Surgeons (RCS) standards, in a local plastic surgery department. Methods Using an RCS good surgical practice guideline, operation notes from cases in January 2021 were reviewed. A total of 112 procedures that were undertaken in both theatres and plastics dressing clinic were audited. The results were collated and analysed using Microsoft Excel. As a result of data analysis, interventions were created whereby results were presented at a local meeting and guidelines were disseminated via WhatsApp to members of the surgical team. A re-audit then occurred using all plastic surgery procedures in May 2021, totalling 112 patients again. Results The first cycle demonstrated that the majority of the guideline subsections were met well. This included a defined operative diagnosis (96% of notes) and operative findings (97% of notes). However, some guidelines including problems/complications (17% of notes) and DVT prophylaxis (0.01% notes) were not adhered to as appropriately. The re-audit concluded that nine subsections of the guideline improved from the first cycle. This included operative diagnosis (96% first cycle, 100% second cycle) and details of closure technique (81% first cycle, 95% second cycle). Notably problems/complications (17% first cycle, 41% second cycle) also improved. Conclusions Initially, the guideline was met to a reasonable standard, however, improvements were made following the intervention. This led to an improvement in the documentation of nine subsections of this guideline.

226 Management of Closed Fractures of the Hand; Single Centre Audit

Abstract Aim To compare current practice at the local Plastic Surgery Department to national Standard British Society for Surgery of the Hand BSSH guidelines recommend for closed hand fractures. Method Retrospective data collection All procedures done within one month June 2021, compare it to previous audit done in Feb 2021 and close the audit loop Electronic data records Results June 2021 (90.5 %) meet the standard of time to presentation compared to 76% in Feb 2021 June 2021 62% meeting the standard for time to surgery compared to 46% in Feb 2021 Main reasons for delay unavailable dedicated Plastic Surgery theatre lists, busy emergency theatre lists. Conclusions Documentation of delays in presentation/Management has improved. More theatre capacity is required to avoid cancelation and delayed management.

Leadership and Advanced Degrees: Evaluating the Association Between Dual Degrees and Leadership Roles in Academic Plastic Surgery.

There are increasingly prevalent formal educational programs for physicians who seek to be better trained to advance their fields. Although higher education and advanced degrees are not necessarily linked to leadership, we hypothesize that leaders in plastic surgery commonly have dual degrees. We sought to evaluate the prevalence of and association between additional advanced degrees in academic plastic surgery and plastic surgery leadership. Plastic surgery faculty from 96 academic training programs and all executive committee and board of directors' members from national, regional, and local plastic surgery societies were evaluated. Surgeons' institutional online profile pages, personal web pages, societal websites, and LinkedIn profiles were all evaluated for current/past leadership roles, as well as for advanced degree. Odds ratios (ORs) were used to determine if the presence of extra degrees increased their likelihood of leadership roles. A total of 1036 plastic surgeons were evaluated. Sixteen percent of academic faculty have a dual degree. Furthermore, 25.5% of plastic surgeons holding formal academic leadership roles have a dual degree (OR, 2.15; P = 0.043), as do 34.4% of those serving on the executive committee or board of directors in national plastic surgery societies (OR, 2.23; P = 0.026) and 29.2% of those serving in local/regional societal leadership roles (OR, 1.96; P = 0.043). Among all dual degrees, Masters in Business Administration has the highest association with leadership roles (OR, 3.45; P = 0.002). Academic plastic surgeons with dual degrees are approximately twice as likely to hold a formal academic or societal leadership role. Additional studies are needed to determine if causative relationships exist.

Local Plastic Surgery Volunteering: A Department Chair Survey.

Local Plastic Surgery Volunteering: A Department Chair Survey.

598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown

AimThe COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period.MethodRetrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed.ResultsFifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes.ConclusionsDespite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.

Rapid redesign and effect on clinical workload of a supra-regional burns and plastic surgery service during the COVID-19 pandemic

IntroductionIn March 2020, South Wales experienced the most significant COVID-19 outbreak in the UK outside of London. We share our experience of the rapid redesign and subsequent change in activity in one of the busiest supra-regional burns and plastic surgery services in the UK.MethodsA time-matched retrospective service evaluation was completed for a 7-week “COVID-19” study period and the equivalent weeks in 2018 and 2019. The primary aim of this study was to evaluate plastic surgery theatre use and the impact of service redesign. Comparison between study periods was tested for statistical significance using two-tailed t-tests.ResultsOperation numbers reduced by 64% and total operating time by 70%. General anaesthetic cases reduced from 41% to 7% (p<0.0001), and surgery was mainly carried out in ringfenced daycase theatres. Emergency surgery decreased by 84% and elective surgery by 46%. Cancer surgery as a proportion of total elective operating increased from 51% to 96% (p<0.0001). The absolute number of cancer-related surgeries undertaken was maintained despite the pandemic.ConclusionRapid development of COVID-19 SOPs minimised inpatient admissions. There was a significant decrease in operating while maintaining emergency and cancer surgery. Our ringfenced local anaesthetic Plastic Surgery Treatment Centre was essential in delivering a service. COVID-19 acted as a catalyst for service innovations and the uptake of activities such as telemedicine, virtual MDTs, and online webinars. Our experiences support the need for a core burns and plastic service during a pandemic, and show that the service can be effectively redesigned at speed.

Evaluating and Comparing Emotional Intelligence and Improvement Mindset of Plastic Surgery Residents

BackgroundEmotional Intelligence (EI) has been linked to burnout, job satisfaction, and work performance among resident physicians. Individuals with a growth mindset believe intelligence and ability are traits that can be increased or improved upon through learning. EI and mindset have yet to be studied among plastic surgeons in the United States. Materials and MethodsAn online survey was distributed to plastic surgery residents and general surgery residents at a single institution containing a validated EI survey tool (TEIQue-SF). Second, a survey was sent to all plastic surgery residents in the United States containing the TEIQue-SF and a validated survey tool to assess mindset (ITIS). ResultsThe response rate for the local study was 82% (plastic surgery) and 75% (general surgery). Only 7.8% of plastic surgery residents had any prior formal EI training or education. Mean global EI scores of local plastic surgery residents were higher than the normative population sample (P <0.0001). Plastic surgery and general surgery residents had similar EI scores. Integrated residents and junior plastic surgery residents had higher Well-Being scores compared to independent (P = 0.04) and senior residents (P = 0.04). Sixty-four plastic surgery residents completed the national survey. No correlation was found between EI and ITIS scores among the national plastic surgery resident cohort. ConclusionDespite different work profiles, general surgery and plastic surgery residents may have similar EI profiles. Mindset does not appear to correlate to EI domains. Future studies will focus on how EI and mindset may develop over the course of residency training and their relationship to overall resident wellness.

Multidisciplinary approach to surgical treatment and rehabilitation of patients with defects of the anterior tracheal wall

Theobjectivewas to improve the results of treatment of patients with persistent defects of the anterior tracheal wall and soft tissues of the neck.Methods and materials. 220 patients with tracheal cicatrical stenosis were treated, of which 120 patients had defects of the anterior tracheal wall of various sizes. In 70% of cases, PCT was postintubation/posttracheostomy. Men predominated – 89 (74.2 %), women – 31 (25.8 %). After a routine examination, including endoscopic examination, MSCT of the chest with the capture of the cervical region, and general clinical diagnostic methods, all patients underwent surgical treatment.Results.According to the nature of the elimination of the defect of the anterior tracheal wall, patients were divided into several groups. Both local plastic surgery and the elimination of the tracheal defect with the use of microsurgical techniques were used. Circular resection of the trachea with the elimination of the defect was performed in 5 cases. In 2 cases, in the presence of a large persistent defect of more than 6 cm in size, a composite pre-fabricated deltopectoral skin-fascial-cartilage flap was used.Conclusion.The choice of a method for eliminating a persistent open defect of the anterior tracheal wall is determined individually in each case, it depends on its size, the depth of the airway lumen, and the condition of the surrounding tissues. The use of displaced skin-fascial flaps on the vascular pedicle for closing the tracheal defect allows to restore the mucous membrane of the tracheal defect area without using the surrounding scar tissue and close the defect with a second flap without straining the edges of the wound.

783 Brachial Plexopathy Secondary to Prone Position Used in The Treatment of a Ventilated Patient With COVID-19: A Case Report and Service Improvement Recommendations

IntroductionProne position has been recommended by many authorities as part of the management of ventilated patients with COVID-19. However, proning with concurrent use of sedation and muscle relaxants carries the hypothetical risk of brachial plexus injuries, thought to be due to stretch and compression of the abducted shoulder.CaseWe report the case of a long-stay critical care patient who required frequent proning due to SARS-CoV-2 infection, and who presented with new right upper limb weakness. This case was referred to our local plastic surgery service and an injury to the upper trunk of the right brachial plexus was confirmed on nerve conduction studies.RecommendationsFollowing this case, we made adaptations to our local practice and modified our prone-specific SSKIN bundle (originally created to prevent pressure sores) to include a section on ‘Nerves’, with an accompanying diagram. We dubbed this the SSKINN bundle. This ensured safe prone positioning. We encourage other hospitals to put in place similar interventions.ConclusionsWe present this as a pathology to consider in patients proned during the COVID-19 pandemic; and recommend checking for signs of focal neurological deficits of the upper limb upon removal of paralysis and sedation, with early referral of suspected cases.

Management of Massive Tibial Bone Defect Using Unifocal Bone Transport with Ilizarov Apparatus: A case study

Introduction: Ilizarov technique is one of the excellent methods used for bony lengthening. The current literature states that the maximum possible amount of tibial lengthening by bifocal transport of an Ilizarov apparatus was 22 cm, while the maximum amount of tibial lengthening by unifocal transport of an Ilizarov apparatus was 14.5 cm.Case report: 40 years old Saudi teacher was presented with an open fracture at the right tibia of type 3B. The second debridement was done and ended up with 21.49 cm bone loss of the middle Tibial segment. Local flap plastic surgery was done to cover the skin defect and the bone transport was done at a rate of 1mm/day. The overall healing was excellent, and the patient returned to his pre-injury functional activity and rejoined his job as a teacher.Conclusion: Thus, the current case report is a unique new record of 21.49 cm of tibial lengthening achieved by the Ilizarov apparatus using unifocal transport. This will be a treatment hope for patients with excessive bone loss.

Global Burden of Craniofacial Disorders: Where Should Volunteering Plastic Surgeons and Governments Focus Their Care?

Approximately 11% of the global burden of disease is surgically treatable. When located within the head, face, and neck region, plastic surgeons are particularly trained to treat these conditions. The purpose of this study was to describe the etiology, disability, and barriers to receiving care for diseases of the head, face, mouth, and neck region across 4 low-and-middle-income countries. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cluster randomized, cross-sectional, national survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies demographic characteristics, etiology, disease timing, proportion seeking/receiving care, barriers to care, and disability. Across the 4 countries, 1413 diseases of head, face, mouth, and neck region were identified. Masses (22.13%) and trauma (32.8%) were the most common etiology. Nepal reported the largest proportion of masses (40.22%) and Rwanda reported the largest amount of trauma (52.65%) (P < 0.001). Rwanda had the highest proportion of individuals seeking (89.6%) and receiving care (83.63%) while Sierra Leone reported the fewest (60% versus 47.77%, P < 0.001). In our multi-variate analysis literacy and chronic conditions were predictors for receiving care while diseases causing the greatest disability predicted not receiving care (ORa .58 and .48 versus 1.31 P < 0.001). The global volunteering plastic surgeon should be prepared to treat chronic craniofacial conditions. Furthermore, governments should address structural barriers, such as health illiteracy and lack of access to local plastic surgery care by supporting local training efforts.

Proposed A New Multidimensional Face Recognition For Surgically Altered Faces In Security Surveillance

From previously carried out review results, authors have proposed a new multidimensional face recognition approach and applied on the sample database of sensitive medical images. The basic idea is to differentiate an individual’s identity with its own core features extracted from local or global plastic surgery. Features are being highlighted to match pre-to-post or post-to-pre surgery face images. The procedure may affect different face recognition algorithms working on linear or non-liner variations approach and that’s what multidimensional approach is meant. Hence it proves that the performance of verified rank accuracy ratio has increased in face recognition for security surveillance.

Face Recognition using Probabilistic Model for Locally Changed Face

Face recognition is an attention-grabbing area in research field due to various challenges like aging, pose variation, facial expression, and illumination problem. Now-a-days, plastic surgery is a standout amongst the above mentioned exciting issues of face recognition. Local plastic surgery is a type of plastic surgery in which any one feature of the face is changed instead of all features of face. In this paper, the face recognition on local plastic surgical faces using probabilistic approach is presented, where a probabilistic approach like Naive Bayes Classifier, Neural Network Classifier are used to recognize the faces with local plastic surgery from the database. Naive Bayes classifier is fused with Expectation Maximization Algorithm (EMA) for better recognition of the faces from the database. Finally, Results of Naive Bayes Classifier, Naive Bayes Classifier with EMA is evaluated on standard Plastic Surgery Database(PSD). Similarly, Neural network classifier is also been tested on PSD database, which will aid to decide which classifier is efficient for recognizing plastic surgical faces. The motive of this paper is give increase in recognition rate with the help of effective classifier.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОСЛЕОЖОГОВЫХ РУБЦОВЫХ ДЕФОРМАЦИЙ ЖЕНСКОЙ ГРУДИ

Objective: Improving the results of surgical treatment of post-burn cicatricial deformities of the woman’s breast . Methods: The results of surgical treatment of 17 women with post-burn scar deformities of the mammary gland are analyzed. The average age of the patients was 21.6±3.2 years. Burns were obtained: with a flame in 9 (52.94%) cases, a hot stove in 2 (11.76%) observations, an electric stove in 3 cases (17.65%), hot fluid food in 2 cases (11.76%) and boiling water in 1 case (5.88%). The duration of the burn was from 3 to 36 years and was on average 14.0±2.0 years. Unilateral breast deformity was observed in 12 (70.6%) women (in 6 cases on the left and in 6 cases on the right). Five (29.4%) women had the post-burn cicatricial deformity of both breasts. In 6 (35.3%) cases, the nipple-areola complex (NAC) of the mammary gland was absent. As a result of a tightening scar on 11 mammary glands noted dystopia of NAC, caudally (n=4), laterally (n=4), caudally-laterally (n=2), cranially (n=1). The total area of scars ranged from 180 cm2 to 2400 cm2, averaging 694.4±39.6 cm2. Results: In the case of low-tightening scars of the mammary glands, local-plastic. Results: In the case of low-tightening scars of the mammary glands, local-plastic surgery, modified multi-patch Z-plastics methods were used, which, if necessary, were supplemented by auto-motive transplants. In patients with extensive tightening scars, the way of the resistant band was used (n=1) or fasciocutaneous flaps (n=2). Due to the dissatisfaction with the results of surgical treatment of post-burn cicatricial deformities of the woman’s breast, we developed and successfully introduced into clinical practice a method of subcutaneous rotation of NAC, which was used in the treatment of 5 patients. Complications in the early postoperative period were observed in 2 (11.7%) patients in the form of seroma around the displaced mammary gland (n=1) and marginal necrosis of scar-modified skin in the outer quadrant of the operated breast (n=1). These complications have prolonged the healing period of postoperative wounds without the need for additional surgical interventions. Long-term results in terms from 6 months to 15 years after surgery were tracked in 14 (82.3%) patients. In all cases, there was no need for additional corrective operations. When comparing the applied methods of surgical interventions, the best results were observed when using the NAC subcutaneous rotation method. Conclusion: Choosing of the method of surgical treatment of post-burn cicatricial deformities of the woman breast depends on the clinical options and the prevalence of tightening scars. The method of subcutaneous rotation of the mammary gland with a transposition of the NAC significantly expanded the possibilities of surgical treatment of these patients promotes symmetry of the mammary glands and their natural position. Keywords: Post-burn contracture of the mammary gland, deformation of the woman’s breast, nippleareola complex.

PRS Global Open's Evolution: Logo, Growth, and Mission.

PRS Global Open's Evolution: Logo, Growth, and Mission.

Periorbital Lipogranuloma after Autologous Fat Injection for Forehead Augmentation.

Dear Editor: Autologous fat injection (AFI) for facial augmentation has become a popular cosmetic procedure at local plastic surgery clinics. It is considered safe, with no severe adverse reactions, compared with synthetic filler injection. However, we encountered a patient with a periorbital lipogranuloma, a rare side effect of AFI for forehead augmentation. A 46-year-old woman presented with swelling on the left upper eyelid that was present for 3 weeks. She had received cosmetic AFI on her forehead at local plastic surgery clinics twice, 7 and 4 months previously. She stated that fat was harvested from her thighs during the first injection and stored frozen for the second injection. On physical examination, erythematous swelling with a palpable mass was noted on the left upper eyelid (Fig. 1A, B). Histopathologically, a foreign body reaction with lipid vacuoles, multinucleated giant cells, and fibrosis was observed in the subcutaneous layer (Fig. 1C). The patient was diagnosed with lipogranuloma following AFI for forehead augmentation and referred to the department of plastic surgery for surgical removal. Fig. 1 (A, B) Erythematous swelling on the left upper eyelid. (C) Histopathologically, a foreign body reaction with lipid vacuoles, multinucleated giant cells, and fibrosis is observed at the subcutaneous layer (H&E, ×200). Autologous fat is an easily accessible, renewable resource that can be harvested from multiple sites with little morbidity. When transferred to recipient site, autologous fat serves as a non-allergenic, well-tolerated, supple implant material1. Also, it does not have the potential risks of allogeneic fillers. Complications of AFI include visible lump, uneven contour, and hematoma. Rare, serious, and potentially fatal complications, such as skin necrosis, infection, central retinal artery occlusion, and cerebral infarction, have also been reported2. Granuloma formation is a well-known complication after synthetic filler injection, with 0.01%~0.1% incidence3. However, it occurs less frequently after AFI and is usually at the injection site. Lipogranuloma on the eyelid following AFI of the forehead has rarely been described. AFI generally requires repeated injections because of the high rate of volume loss, which is up to 70% after fat transfer4. To avoid repeated harvesting, cryopreservation of harvested fat at -20℃ is widely performed3. During cryopreservation, ice crystals form inside the adipocytes, causing viability loss. Nonviable adipocytes may illicit a foreign body reaction and failure of engraftment2,3. In the case series of Sa et al.3, 7 of 9 patients developed lipogranuloma after the second injection using cryopreserved autologous fat. The characteristic location of the lipogranulomas, the upper eyelid, is ascribed to the musculo-aponeurotic system. The galea is connected to the retro-orbicularis fascia to facilitate mobility of the frontalis muscle in the forehead. Therefore, fat injected into the forehead could move down to the upper eyelid along the galea. This could be exacerbated by gravity, massage, or facial muscle movement2,3. Conservative treatments, such as cooling with ice, anti-inflammatory drugs, topical and intralesional steroids, diuretics, and antibiotics may have some therapeutic effects. However, in most cases, surgical excision is needed2,5. To our knowledge, only 13 cases of periorbital lipogranuloma after AFI for forehead augmentation have been reported in ophthalmology and plastic surgery literature1,2,3,5. None have been reported in the dermatologic literature. Dermatologists should know that, periorbital lipogranuloma can occur after AFI for forehead augmentation.