Structural Fat Grafting Research Articles

Abdominoplasty Combined with Hip Expansion by Fat Grafting: An Evolution in Waistline Contouring.

Recent sociocultural trends show numerous patients requesting more curvaceous profiles. Abdominoplasty techniques had evolved into a combination of fascial plication with liposuction of the lateral torso, but often left patients with "boxy" profiles. The senior author performs 360-degree liposuction of abdomen and back, hip expansion with structural fat grafting, excision of redundant soft tissue, and wide plication of abdominal fascia to create the desired profile. Retrospective review of patient charts and CosmetAssure claims of female patients treated from January 2014 through May 2022 identified 1125 patients with a minimum 6-month follow-up who underwent abdominoplasty using 360-degree liposuction of waist, back, and flanks; wide plication of the rectus abdominis muscle; and hip expansion with fat grafting. Authors reviewed pre- and postoperative photographs to evaluate the technique's effectiveness. Hip expansion with fat grafting combined with abdominoplasty was successfully achieved in 1125 cases. Average age was 38 years. Average body mass index was 29 kg per m2. Average amount of aspirated fat was 1896 mL. Average amount of fat injected into the bilateral hips was 493 mL. Complication rates were comparable to those observed in similar abdominoplasty series reported in the literature. Abdominoplasty combining liposuction of the waist, back, abdomen, and flanks followed by wide fascial plication and expansion of the hips with fat grafting is a safe, reproducible technique for female patients. This technique prioritizes the hip anatomical area as an aesthetic consideration in abdominoplasty and facilitates creating a harmonious hip-to-waist ratio characteristic of a feminine figure.

Parry-Romberg Syndrome: Successful Result in a Single Procedure Combining Silicone Implant and Structural Fat Grafting for Severe Facial Deformity.

Parry-Romberg syndrome (PRS) is an enigmatic and acquired degenerative condition. It is characterized by a gradual and progressive facial hemiatrophy, after which facial deformities appear unexpectedly in a stable state. The degree of disfigurement depends on tissue involvement, illness onset, and duration. Nowadays, non-invasive treatments with lower morbidity, such as structured fat grafting (SFG) are preferred over traditional operations such as free flaps and bone grafts. However, for severe cases of PRS, multiple sessions of SFG are required. Despite the therapeutic failure that a 20-year-old lady had suffered after five previous conventional surgical procedures, the outcome was successful after only one surgical therapy employing a particular combination of SFG and malar silicone elastomers implant (SI). The author highlights the interest in a combination of non-invasive procedures using SFG and malar augmentation with SI to repair large volume loss while improving symmetry and skin texture. Otherwise, the role of adipose-derived stem cells in fat survival is crucial and should be the focus of future studies and the key to technological advancement.

Use of adipose derived stem cells in Treacher Collins syndrome.

Treacher Collins syndrome (TCS) is a rare congenital disorder of craniofacial development. TCS occurs with an incidence of 1:50,000, and more than 60% of TCS cases have no previous family history and arise as the result of de novo mutations. The high rate of de novo mutations, together with the extreme variability in the degree to which individuals can be affected, makes the provision of genetic counseling extremely complicated. Consequently, every case of TCS is unique and needs to be assessed individually. Patients with TCS frequently undergo multiple reconstructive surgeries from birth through adulthood, which rarely are fully corrective in the long-term. The nascent field of regenerative medicine offers the promise to improve some of these treatments. In particular, structural fat grafting (SFG) seems to be a good strategy not only to restore the normal volume and contour of the face, but also to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present genetical analyses of ADSC affected by TCS. ADSCs from were analyzed for their stemness properties and shared many characteristics with those of a healthy subject. Screening of the genome of the TCS patient using array-Comparative Genomic Hybridization allowed us to identify some chromosomal imbalances that are probably associated with TCS. We found that some alterations, involving the TIMELESS gene, were usually associated with embryonic stem cells. With the aim to improve the final results, we need to consider combining knowledge of genetic alterations and expression profiles as a fundamental step before starting with surgical procedures.

Office-Based Structural Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.

Unilateral vocal fold paralysis (UVFP) is a common cause of incomplete glottic closure, leading to significant somatic and social disabilities. Office-based autologous fat injection laryngoplasty (AFIL) has been proposed as an effective treatment for glottic insufficiency but has not been well-studied for UVFP. We enrolled 23 patients who underwent office-based structural AFIL due to unilateral vocal paralysis at our institution between February 2021 and January 2022. In the procedure, autologous fat was harvested and injected into the vocal fold under the guidance of flexible digital endoscopy for structural fat grafting. The voice handicap index-10 (VHI-10) score and perceptual voice measurements were collected before the operation, 2 weeks postoperatively, and 3 months postoperatively. Twenty-two patients were followed-up for at least 3 months. The VHI-10 score improved significantly from 29.65 ± 8.52 preoperatively to 11.74 ± 7.42 at 2 weeks (p < 0.0001) and 5.36 ± 6.67 at 3 months (p < 0.0001). Significant improvements in grades of dysphonia (p < 0.0001), breathiness (p < 0.0001), and asthenia (p = 0.004) were also noted at 3 months postoperatively when perceptual measurements were investigated. Office-based structural AFIL is an effective treatment for improving voice-related disability for UVFP patients.

Regen Fat Code: A Standardized Protocol for Facial Volumetry and Rejuvenation.

Facial aging is a degenerative process that impairs contour and angle prominence. Rejuvenation is based on tissue replacement, volumization of the atrophic areas, and improving flaccidity and cutaneous photoaging. The aim of this study was to apply structural fat grafting to manage volumetric deficits of the face, following a new systematic protocol called "Regen Fat Code" (RF Code) that was created to standardize structural lipotransfer methods. This is a prospective clinical trial involving 80 healthy candidates for facial rejuvenation who were split into 2 groups. Group A underwent only structural lipotransfer; Group B underwent replacement of deep facial structures by face-lifting plus structural lipotransfer. Structural lipotransfer followed the protocol "RF Code" and 3 clinical tools were adopted for pre- and postoperative facial volumetric analysis. Total volume (mL) of lipotransfer in Groups A and B ranged between 1 and 20 mL (mean [standard deviation], 12 [5] mL), distributed to the different areas as follows: nasolabial fold, 3.32 [0.92] mL; superior lip, 2.0 [0.62] mL; inferior lip, 2.76 [0.71] mL; malar, 8.51 [5.25] mL; inferior eyelid, 1.2 [0.54] mL; and chin, 7.18 [1.99] mL. Areas with less mobility showed a lower absorption index than dynamic areas. The development of the RF Code protocol demonstrated the potential of grouping many parameters based on the lipotransfer method used to volumize and regenerate atrophic areas of the face. The protocol is easy to apply, and allows different volumizing and regenerative effects to be proposed, according to the demands of each surgical area.

New Trends In Treacher Collins Syndrome: Bony Reconstruction And Regenerative Therapy

Aim:Treacher Collins syndrome is a rare congenital disorder of craniofacial development with a highly variable pheonotype. This syndrome occurs with an incidence of 1:50,000, and more than 60% of the cases have no previous family history and arise as the result of de novo mutations. The disorder displays an intricate underlying dysmorphology. Affected patients may suffer life-threatening airway complications and functional difficulties involving sight, hearing, speech, and feeding. Deformation of facial structures produces a characteristic appearance that includes malar-zygomatic hypoplasia, periorbital soft tissue anomalies, maxillomandibular hypoplasia, and ear anomalies. Management requires a specialized craniofacial team, as comprehensive care starts at birth and may require life-long follow-up. Standard craniofacial procedures for bony and soft tissue reconstruction are used. This article outlines current treatment strategies and future concepts for surgical and regenerative management. Methods:The new field of regenerative medicine and therapy offers the promise to improve some of these treatments. In particular, Structural Fat Grafting (lipostructure) seems to be a good strategy to restore the normal volume and contour of the face, and to provide a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. In this work, we present the case of a young girl with Treacher Collins Syndrome who underwent serial sessions of fat grafting in addition to other surgical bony reconstructive techniques. ADSCs have been isolated from the patient’s lipoaspirate, and compared for their stemness properties with those of a healthy subject. Conclusion:Screening of the genome of the Treacher Collins patient using array-Comparative Genomic Hybridization (array-CGH) allowed us to identify some chromosomal imbalances that are probably associated with the syndrome.Correction of these imbalances and asymmetries by modulating ADSCs could be an innovative approach to improve and stabilize the results of the surgical treatment of Treacher Collin Syndrome.

Assessment of Fat Grafting in Enhancing the Middle Eastern Buttocks

Background: Fat survival remains a challenge followingfat grafting and has been a subject of debate. The key tosuccessful fat grafting in buttock enhancement dictates familiaritywith the technique, knowledge of the gluteal topographyand aesthetics along with understanding of the patient's desiredneeds and goals. However, several areas still need to beresearched.Objectives: This study aims to describe the anthropometricmeasurements of the Middle Eastern female buttocks and toevaluate the post-operative volume changes of structural fatgrafting following gluteal enhancement procedures.Methods: This study included sixty adult healthy females.Candidates were classified into four main groups; controlgroup (30 candidates) for measuring anthropometrics ofMiddle Eastern buttocks with normal BMI, and other 30candidates were grouped into three surgical groups (10 candidatesfor each) according to the amount of fat grafting.Anthropometric measurements were obtained directly throughpatients' photos (posterior and lateral views) pre-operatively,3 and 6 months postoperatively. Pre-operative volume ofgluteal region in each quadrant was measured for the wholebuttock by using the ultrasound then compared to that of 3and 6 months post-operatively.Results: Control group (30 candidates) showed that roundshape buttocks was the dominant shape. Fat survival rate offat injected in subcutaneous plane decreased with increasingvolume of fat injected, while in the intramuscular plane thesurvival rate the same and was not affected significantly.Conclusion and Recommendations: Round shaped buttockis the dominant shape in Middle Eastern buttock; fat survivalrate is greater when injected intramuscular. We warn surgeonsfrom trying intramuscular fat injection without anticipatingproblems and also without taking in consideration precautionsand recommendations especially in large volume grafting.Also, we recommend authors to perform more studies inMiddle Eastern buttocks for more control cases to confirmthe anthropometric criteria of Middle Eastern buttocks.

A Study of Aesthetic and Functional Outcome Following Structural Fat Grafting for Facial Scars and Contour Deformity.

This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting. The aim of the present article is to highlight how fat grafting helps to improve aesthetic and functional outcome in facial scars and contour deformities. It also highlights the factors that need to be considered while planning autologous fat grafting to get better aesthetic results. This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity. The study was conducted from May 2014 to April 2019 in a tertiary care hospital. All the patients were followed up for a minimum period of 1 year from the date of surgery. Assessment of post-operative aesthetic outcome, in terms of satisfaction, was done using the Visual Analogue Scale (VAS), which ranges from 1 to 10 by the patient and operative surgeon. The mean age was 30.8 9.8 years. Out of 60 patients, 20 patients underwent additional procedure like dermabrasion and collagen dressing to improve aesthetic outcome. Among 60 patients, 24 patients had transient edema and 10 patients had bruising at the recipient site. There were no major donor site complications except pain which was managed conservatively. Mean patient satisfaction score is 7 and mean surgeon satisfaction score is 7.25. Despite the ongoing concerns about survival and longevity of fat grafts and also unpredictability of long-term outcomes, fat grafting has become a very useful surgical tool to improve the quality of facial scars and correct contour deformity. Our series shows excellent outcome both clinically as well as from the patient satisfaction. Future research is warranted in the fields of the adipocyte derived stem cells and to expand the clinical application of fat grafting.

Soft Tissue Reconstruction in Patients With Hemifacial Microsomia: A Systematic Review of the Literature.

Hemifacial microsomia is the most common congenital disorder of the face after cleft lip and palate. While treatment of the bony abnormalities has been well documented, less attention has been paid to correction of the soft tissue deformity. This study aimed to systematically review the literature addressing the techniques utilized to correct the soft tissue deformity in hemifacial microsomia. A comprehensive review of peer-reviewed literature regarding the management of soft tissue reconstruction in patients with hemifacial microsomia was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Odds ratio was used to assess differences in complication rates between reconstructions performed with free tissue transfer and fat grafting. The literature search yielded 38 articles that were fully reviewed for data extraction. Articles were grouped into one of 5 reconstructive modalities-pedicled flap, microvascular free tissue transfer, structural fat grafting, alloplastic implant, and functional reconstruction. Microvascular free tissue transfer had a complication rate of 27.1%, while structural fat grafting had a complication rate of 4.2% (odds ratio 6.7, P = 0.0003). Microvascular free tissue transfer likely provides greater volume than fat grafting at the cost of a higher complication rate. Mild to moderate soft tissue deformity can be corrected with serial fat grafting. However, severe soft tissue deformity is better corrected with microvascular free tissue transfer. When performing free tissue transfer, one should be prepared for recipient vessel anomalies. To provide adequate augmentation with isolated fat grafting, multiple sessions are likely required.

Autologous Fat Grafting in Cleft Lip and Palate.

Structural fat grafting is a technically simple procedure that has revolutionized the field of plastic surgery, with applications ranging from tissue regeneration to scar modulation to volume restoration. This technique has found applications in the treatment of cleft lip and palate, where it can be used to fill deficient midfacial volume and treat velopharyngeal insufficiency. In this article, the authors summarize the current literature supporting the use of fat grafting in patients with clefts. Evidence as to the safety, efficacy, longevity, and potential complications of the technique are discussed.

Anatomical Fat Grafting for Reconstruction of Frontotemporal Contour Deformities After Neurosurgical and Craniofacial Surgical Interventions: A Symmetry Outcome Study

Fat grafting has been described as an option to repair frontotemporal contour deformities (volumetric deficiency of bone and/or soft tissues) after neurosurgical/craniofacial surgical interventions. However, technical surgical descriptions have varied, with reports describing the bolus fat injection or the classical multilayer injection, but with no detailed descriptions concerning how and where the fat should be grafted. The purpose of this study was to assess the frontotemporal symmetry outcomes after a single fat-grafting procedure for postoperative frontotemporal contour deformity reconstructions using the anatomical fat-grafting approach. A prospective analysis was conducted of consecutive patients (n= 106) who underwent anatomical fat grafting (Coleman's structural fat grafting technique using anatomical facial subunit and fat compartment principles) to reconstruct frontotemporal contour deformities after neurosurgical/craniofacial surgical interventions. A subjective assessment by a panel of external surgical professionals and laypersons was obtained to grade the frontotemporal symmetry. Objective ultrasound symmetry assessment was blindly performed preoperatively and at 3- and 12-month follow-up. There were significant (all P < 0.05) postoperative subjective and objective frontotemporal symmetry enhancements (preoperative < postoperative) after anatomical fat grafting, with no differences (all P > 0.05) between the 3- and 12-month postoperative comparisons. Thirty-seven percent of patients required an additional fat grafting session for residual asymmetry after 12 months of follow-up. Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.

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.

A Novel Porcine Model for Future Studies of Cell-enriched Fat Grafting.

Cell-enriched fat grafting has shown promising results for improving graft survival, although many questions remain unanswered. A large animal model is crucial for bridging the gap between rodent studies and human trials. We present a step-by-step approach in using the Göttingen minipig as a model for future studies of cell-enriched large volume fat grafting. Fat grafting was performed as bolus injections and structural fat grafting. Graft retention was assessed by magnetic resonance imaging after 120 days. The stromal vascular fraction (SVF) was isolated from excised fat and liposuctioned fat from different anatomical sites and analyzed. Porcine adipose-derived stem/stromal cells (ASCs) were cultured in different growth supplements, and population doubling time, maximum cell yield, expression of surface markers, and differentiation potential were investigated. Structural fat grafting in the breast and subcutaneous bolus grafting in the abdomen revealed average graft retention of 53.55% and 15.28%, respectively, which are similar to human reports. Liposuction yielded fewer SVF cells than fat excision, and abdominal fat had the most SVF cells/g fat with SVF yields similar to humans. Additionally, we demonstrated that porcine ASCs can be readily isolated and expanded in culture in allogeneic porcine platelet lysate and fetal bovine serum and that the use of 10% porcine platelet lysate or 20% fetal bovine serum resulted in population doubling time, maximum cell yield, surface marker profile, and trilineage differentiation that were comparable with humans. The Göttingen minipig is a feasible and cost-effective, large animal model for future translational studies of cell-enriched fat grafting.

Structural Fat Grafting to Improve Outcomes of Vocal Folds' Fat Augmentation: Long-term Results.

Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and <.001). The results achieved 1 year postoperatively remained stable at 3 and 10 years. Videolaryn-gostroboscopy showed improved glottic closure in all patients despite a limited amount of fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.

Abstract: Autologous Pedal Fat Grafting: A Randomized Cross-Over Clinical Trial

INTRODUCTION: Pedal fat pad atrophy impacts function, pain, and appearance. We previously published clinical trial data demonstrating that pedal fat grafting improves pain and quality of life, despite loss of grafted fat.1 Benefits of fat grafting may be attributed to resultant changes in fat pad or dermal thicknesses.2,3 We hypothesize that these changes may account for the prolonged improvement in pain and quality of life in patients with pedal atrophy following fat grafting. METHODS: Patients with pedal atrophy were enrolled in a randomized cross-over clinical trial. Group 1 underwent fat grafting upon enrollment with 2-year follow-up. Group 2 was managed conservatively for 1 year then crossed-over into the fat grafting group with 1-year follow-up. Fat was harvested and injected into each forefoot. Patients followed-up with ultrasounds at 1, 2, 6, and 12 months post-injection, with Group 1 continuing to 18- and 24-month follow-up. Additionally, the Manchester Foot Pain and Disability Index, a validated survey assessing foot pain and function, was administered to patients. RESULTS: 3 men and 20 women were enrolled with an average age of 63 ± 6 years. The average BMI was 26.0 ± 4.6 kg/m2. 26 and 17 feet were injected in Groups 1 and 2 respectively. There was no variance in BMI or age between groups. In Group 1, fat pad thickness returned to baseline by 12 months post-injection (p<0.05). In Group 2, fat pad thickness returned to baseline by 2 months post-injection, though fat pad thickness decreased prior to injection (p<0.05). In Group 1, dermal thickness increased by 6 months post-injection (p<0.05). This increase persisted through 24 months. In Group 2, dermal thickness decreased prior to injection, but increased to baseline after injection through 12-month follow-up (p<0.05). Group 1 had improved pain and function by 1 month post-injection that was maintained through 24 months (p<0.05). Group 2 had improvement in these measures by 2 months post-injection that was maintained through 12 months (p<0.05). CONCLUSION: In both groups, fat grafting for pedal atrophy positively impacted pain and function. These measures demonstrated a persistent improvement, though fat volume returned to baseline. This finding may be attributed to the observed increase in dermal thickness. Together, these results suggest that fat grafting may thicken or stabilize the dermis, contributing to improved clinical outcomes despite loss of grafted fat. Reference Citations: 1. Gusenoff JA, Mitchell RT, Jeong K, Wukich DK, Gusenoff BR. “Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial.” Plastic and Reconstructive Surgery Journal. 2016. 138: 1099–1108. 2. Coleman SR. “Structural Fat Grafting: More Than a Permanent Filler.” Plastic and Reconstructive Surgery Journal. 2016. 118: 108-120S. 3. Mojallal A, Lequeux C, Shipkov C, et al. “Improvement of Skin Quality after Fat Grafting: Clinical Observation and an Animal Study.” Plastic and Reconstructive Surgery Journal. 2009. 124: 765–774.

Abstract: Analysis of Proinflammatory Markers in Lipofilled Breast Microenvironment in a Murine Model

INTRODUCTION: Fat grafting to the breast has a questionable oncologic risk according to laboratory reports on adipose tissue. One possible reason for this is the theoretical chronic inflammation due to adipokynes released by the grafted white adipose tissue (WAT).1–4 Thus, a translational study was designed to analyze inflammatory activity in lipofilled breast through proinflammatory markers. METHODS: Fifty-four paired-breasts of female rats were divided into three groups (control, grafted with autologous WAT of subcutaneous, and of omentum). The procedures of WAT preparation and grafting were performed as described previously.1–5 Briefly, a piece of WAT was harvested from omentum or subcutaneous and manually chopped with a scalpel into very small pieces and then placed into a 10-ml syringe. The WAT was then transferred into another 10-ml syringe through an emulsifier; in this way, the samples were homogeneously fragmented. Next, the samples were centrifuged at 3,000 rpm for 3 minutes. The lower and uppermost levels were discharged, such that only the middle layer (containing viable cells) was transferred into a 1-ml syringe. Finally, 0.2 ml of prepared autologous WAT (from omentum or subcutaneous tissue) was grafted through a 0.9-mm diameter cannula with a blunt tip into each of the 6 thoracic breasts of each rat. The rats were euthanized at 8 weeks post-operatively, and their breasts were harvested for analysis of gene quantification (via real-time PCR) for Mcp-1, F4/80, Cox-2 and IL-6. Statistical analyses were performed using paired t-tests, analysis of variance (ANOVA, one way) and Tukey’s test (post hoc). RESULTS: The markers Mcp-1, F4/80 and Cox-2 were similarly expressed among the groups (respectively p=0.422, p=0.143 and p=0.209). The expression of IL-6 marker was different between samples of breast grafted with WAT of omentum and subcutaneous (p=0.015), but not between samples of control and omentum (p=0.752), and control and subcutaneous (p=0.056). CONCLUSION: The difference in fold-change for IL-6 only between groups of lipofilled breasts, but not with control, certainly resulted from the different concentration of WAT of omentum and subcutaneous (they are from different embryological origin) in the breast composition in each group. Our results showed that no inflammation activity was identified in the lipofilled breast microenvironment, this illustrates that the tumorigenic potential of WAT reported for the mammary gland (regarding chronic inflammation) was not identified in our study. Reference Citations: 1. Claro, F., Jr., Moreira, L. R., Morari, J., et al. Assessment of the Cancer Risk of the Fat-Grafted Breast in a Murine Model. Aesthet Surg J 2016. 2. Gutowski, K. A., Force, A. F. G. T. Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force. Plast Reconstr Surg 2009;124:272–280. 3. Claro Jr, F., Figueiredo, J. C. A., Zampar, A. G., Pinto-Neto, A. M. Applicability and safety of autologous fat for reconstruction of the breast. British Journal of Surgery 2012;99:768–780. 4. Manabe, Y., Toda, S., Miyazaki, K., Sugihara, H. Mature adipocytes, but not preadipocytes, promote the growth of breast carcinoma cells in collagen gel matrix culture through cancer–stromal cell interactions. Journal of Pathology 2003;201:221–228. 5. Coleman, S. R. Structural fat grafting. St. Louis: Quality Medical Publishing; 2004.

Fat Injection: A Systematic Review of Injection Volumes by Facial Subunit

Fat grafting to the aging face has become an integral component of esthetic surgery. However, the amount of fat to inject to each area of the face is not standardized and has been based mainly on the surgeon's experience. The purpose of this study was to perform a systematic review of injected fat volume to different facial zones. A systematic review of the literature was performed through a MEDLINE search using keywords "facial," "fat grafting," "lipofilling," "Coleman technique," "autologous fat transfer," and "structural fat grafting." Articles were then sorted by facial subunit and analyzed for: author(s), year of publication, study design, sample size, donor site, fat preparation technique, average and range of volume injected, time to follow-up, percentage of volume retention, and complications. Descriptive statistics were performed. Nineteen articles involving a total of 510 patients were included. Rhytidectomy was the most common procedure performed concurrently with fat injection. The mean volume of fat injected to the forehead is 6.5mL (range 4.0-10.0mL); to the glabellar region 1.4mL (range 1.0-4.0mL); to the temple 5.9mL per side (range 2.0-10.0mL); to the eyebrow 5.5mL per side; to the upper eyelid 1.7mL per side (range 1.5-2.5mL); to the tear trough 0.65mL per side (range 0.3-1.0mL); to the infraorbital area (infraorbital rim to lower lid/cheek junction) 1.4mL per side (range 0.9-3.0mL); to the midface 1.4mL per side (range 1.0-4.0mL); to the nasolabial fold 2.8mL per side (range 1.0-7.5mL); to the mandibular area 11.5mL per side (range 4.0-27.0mL); and to the chin 6.7mL (range 1.0-20.0mL). Data on exactly how much fat to inject to each area of the face in facial fat grafting are currently limited and vary widely based on different methods and anatomical terms used. This review offers the ranges and the averages for the injected volume in each zone. 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 .

Structural Fat Grafting to Improve Reconstructive Outcomes in Secondary Cleft Lip Deformity.

To describe the technique and results of structural fat grafting in cleft lip revision, including patient satisfaction and aesthetic outcome. Retrospective case series. Multidisciplinary cleft care center. All patients who underwent structural fat grafting between June 2006 and September 2012 for cleft lip revision, with appropriate photographic follow-up included. Twenty-two cases were reviewed; 18 had sufficient data to be included. Patients underwent structural fat grafting for cleft lip revision, most commonly injecting fat under deficient philtral columns, the nostril base, and upper lip. Blinded observers rated outcomes using the Asher-McDade nasolabial appearance rating scale. Patients completed questionnaires assessing their satisfaction. A paired Student's t-test was used to test outcomes for significance (alpha = 0.05). Patients were an average of 16 years old (range: 6-43); average length of follow up was 11.7 months. Overall symmetry and aesthetics were improved based on the nasal form (P = 0.006) and vermillion border (P = 0.04) when rated using the Asher-McDade scale. No complications were recorded. Patients were significantly happier with their appearance after fat grafting (P < 0.001) and were uniformly positive when questioned about the ease of the surgery and rate of recovery. Structural fat grafting is a safe and effective way to improve symmetry and enhance facial proportions in patients with cleft lip. Given the high degree of patient satisfaction, few complications, and durable results, fat grafting offers many advantages in cleft lip revision.

A Simple, Reliable, and Inexpensive Intraoperative External Expansion System for Enhanced Autologous Structural Fat Grafting

External volume expansion of the recipient site by suction has been proposed as a way of improving fat graft survival. The objective of this study was to present an innovative and simple intraoperative external expansion system to enhance small-volume autologous fat grafting (40–80 mL) and to discuss its background and its mechanism of action. In this system, expansion is performed using a complete vacuum delivery system known as the Kiwi VAC-6000M with a PalmPump (Clinical Innovations). The recipient site is rapidly expanded intraoperatively 10 times for 30 seconds each with a negative pressure of up to 550 mm Hg before autologous fat injection. During this repetitive stimulation, the tissues become grossly expanded, developing macroscopic swelling that regresses slowly over the course of hours following the cessation of the stimulus. The system sets various mechanisms in motion, including scar release, mechanical stimulation, edema, ischemia, and inflammation, which provide an environment conducive for cell proliferation and angiogenesis. In order to maintain the graft construct in its expansive state, all patients are encouraged postoperatively to use the Kiwi three times daily for one minute per session over the course of three days. The handling of this system is simple for both the patients and the surgeon. Satisfactory clinical outcomes have been achieved without significant complications.

Siliconomas of the lower limb: Tumour-like excision and reconstruction.

Background:Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications.Objectives:The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone.Methods:Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn’t referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a “staging” of siliconoma.Results:Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh's profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared.Conclusions:Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.