Long-term Outcomes of Temporal Hollowing Augmentation by Targeted Volume Restoration of Fat Compartments in Chinese Adults

Aesthetic Temporal Augmentation with the Pedicled Temporoparietal Fascia Flap

INDRODUCTION

The contour of the temple area can significantly influence the overall facial shape and proportions. To date, various methods and techniques have been used to augment the deficient temporal fossa; however, each of these approaches has certain inherent limitations. The present study aimed to transfer the temporoparietal fascia flap (TPFF) to the frontotemporal regions for aesthetic temporal augmentation.

METHODS

This was a retrospective study of 13 cases with temporal depression who underwent a TPFF procedure for aesthetic temporal augmentation. These cases were operated for three years, from January 1, 2020, to December 1, 2023, at Nanjing Second Hospital, Nanjing, China.

RESULTS

The data of bilateral temple width showed a measurement of 12.20 ± 0.53 cm (preoperative) and 14.36 ± 0.41 cm (postoperative), with a statistically significant difference (p < 0.001). There were no postoperative complications, including hematomas, infection, or facial nerve injuries. All patients were followed for 6 to 48 months (mean: 18 months) and exhibited cosmetic improvement. Overall, 10 patients were satisfied with the aesthetic results, while 3 were unsatisfied due to undercorrected depression. During the follow-up period, the temple volume was maintained. The frontal temple exhibited a smooth contour, and scalp baldness at the incision site was inconspicuous.

CONCLUSIONS

Compared with other methods, the pedicled TPFF flap transfer is a safe and effective technique for correcting depressions in the frontotemporal regions.

LEVEL OF EVIDENCE IV

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 .

Autologous fat grafting for cosmetic temporal augmentation: a systematic review

Background

Autologous fat grafting for temporal augmentation is increasingly popular in aesthetic surgery. However, its high absorption rate, unpredictable volume retention rate, and potential safety risks are significant drawbacks. Evaluation methods for the fat graft survival rate, especially volume retention in the temporal area, vary widely and tend to be more subjective than objective. Therefore, this systematic review aims to analyze the unpredictable volume retention rate, associated safety concerns, and the various assessment strategies following autologous fat grafting for cosmetic temporal augmentation.

Methods

We conducted a systematic review of manuscripts listed in the MEDLINE/PubMed database on autologous fat grafting for cosmetic temporal augmentation. Articles had to be available in full text and written in English. Studies not presenting human data or not discussing cosmetic indications were excluded. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Eight articles were included. The average fat volume injected into each temporal region was 10.69 ml (range 6-17.5) on the right and 10.64 ml (range 5.9-17.4) on the left side. All included articles utilized photographic documentation before and after treatment, along with various questionnaires and scales (37.5% Likert Scale, 12.5% Hollowness Severity Rating Scale, 12.5% Visual Analogue Scale, 12.5% Allergan Temple Hollowing Scale). For objective assessment, one article (12.5%) used computed tomography, and another (12.5%) employed a three-dimensional scanning system to objectively evaluate fat graft survival.

Conclusion

Autologous fat grafting effectively addresses temporal hollowness, with high patient satisfaction and a favorable safety profile. However, the variability in fat retention rates highlights the need for more controlled studies to establish reliable, validated methods for evaluating fat graft survival in the temporal area, and to further assess the safety of this procedure.

Ultrasound to Improve the Anatomic Approach to the Temple and a Retrospective Study on the Efficacy of Large-Volume Autologous Fat Grafting

BACKGROUND

Autologous fat grafting (AFG) has been used widely in temporal-hollowing augmentation, but its efficacy and safety are unclear. The authors examined the use of Doppler ultrasound (DUS) in large-volume lipofilling after performing an anatomic study of the temporal region.

METHODS

To clarify safe and stable levels of AFG of the temporal fat compartments, 5 cadaveric heads (10 sides) were dissected after dye was injected into targeted fat pads with DUS guidance. In addition, the authors retrospectively analyzed 100 patients with temporal fat transplantation, including groups with conventional AFG ( n = 50) and DUS-guided large-volume AFG ( n = 50).

RESULTS

The anatomic study revealed the approach of 5 injection planes and 2 fat compartments in the temporal region: the superficial and deep temporal fat pads. In the AFG study, all patients were female, and there were no statistically significant differences between the groups in age, body mass index, tobacco or steroid use, or previous filling history. Between the conventional AFG group and the DUS-guided large-volume AFG group, the average volume of temporal lipofilling per side was 10.55 ± 2.25 versus 22.32 ± 5.19 mL/side ( P < 0.001), surgeon Likert scale score was 2.86 ± 0.97 versus 4.24 ± 0.66 ( P < 0.001), and rate of satisfaction was 74% versus 92% ( P < 0.05) (statistically significant differences).

CONCLUSIONS

The anatomic approach to the main temporal fat compartment is feasible. DUS-guided large-volume AFG is an effective and safe way to improve temporal hollowing augmentation.

Customized anterior temporal augmentation for treating anterior temporal hollowing (ATH) by 3D-printed cranioplasty

BACKGROUND

Anterior temporal hollowing (ATH) leads to unattractive facial asymmetry and significant distress for the patient. This study aimed to correct ATH by a prefabricated cranioplasty using soft-tissue volume augmentation created by 3D printing and to evaluate the esthetic improvement.

METHODS

This prospective study was conducted on 19 patients with ATH after brain surgery. Quantitative assessment used Materialized Mimics® and Images® to compare defect volume and quantitative measurement of the "defect value" pre- and post-PMMA implantation. Qualitative assessment was rated by patients on VAS pre- and 6 months post-surgery.

RESULTS

The mean defect value decreased significantly with the innovative PMMA implant, from 2.42 ± 0.57 cm to 0.57 ± 0.45 cm (p < 0.01). There was a statistically significant reduction between pre- and postoperative defect value: 1.85 ± 0.48 (p < 0.01; 95% CI 2.08-1.61). After PMMA cranial implantation, 100% of patients reported esthetic improvement, 79% (15 out of 20) rating their esthetic improvement with the highest possible VAS score: mean VAS rating, 0.84 ± 1.2 preoperatively, and 4.63 ± 0.83 postoperatively, for a significant mean improvement of 3.789 ± 1.273 (p < 0.01; 95% CI 3.176-4.403).

CONCLUSIONS

The innovative PMMA cranial implants created by advanced customized 3D technology successfully managed ATH. This could be a therapeutic alternative for correcting ATH and can be routinely employed in clinical practice.

Fat Grafting Reduces Skin Hyperpigmentation of Localized Scleroderma Patients: A Prospective Self-controlled Study

BACKGROUND

Localized scleroderma (LS) is characterized by skin fibrosis, hyperpigmentation and soft tissue atrophy. Fat grafting has been widely used to correct LS deformity.

OBJECTIVE

To investigate the effect of fat grafting on the skin pigmentation of LS lesions.

METHODS

A prospective self-controlled study was conducted. Skin melanin and erythema indexes were measured by Mexameter® MX18 before and 3 months after surgery. Differences between lesions and contralateral normal sites were compared to evaluate changes induced by fat grafting. Localized Scleroderma Cutaneous Assessment Tool and PUMC Localized Scleroderma Facial Aesthetic Index were used for clinical evaluation.

RESULTS

Fourteen frontal linear LS patients participated in the study. Before surgery, the melanin index of the lesions was significantly higher than the contralateral sites (p = 0.023), while the erythema indexes were not significantly different (p = 0.426). Three months post-operation, the melanin index of the lesions significantly decreased (p = 0.008). There was no significant change in the erythema index of the lesions before and after fat grafting (p = 0.322). The LoSCAT and PUMC LSFAI scores demonstrated improved disease condition and facial esthetics after surgery.

CONCLUSION

Fat grafting could alleviate skin hyperpigmentation and skin damage of LS lesions while having little effect on skin erythema and disease activity.

LEVEL OF EVIDENCE III

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 .

Contouring and augmentation of the temple using stromal vascular fraction gel grafting

Background

Hollowing temples are common in aging Asians. Stromal vascular fraction (SVF) gel is a novel, mechanically processed adipose-derived product containing condensed adipose-derived stem cells and native extracellular matrix, allowing improved fat grafting. The present study evaluated the effectiveness of SVF-gel treatment on temple hollowing.

Methods

This prospective, single-center study included an SVF-gel grafting group (n = 34) and a Coleman's fat grafting group (n = 29). Temple contour was assessed using preoperative and postoperative photographs. Temple augmentation was quantified using three-dimensional (3D) technology and an MVS-600 3D scanner system. Patient satisfaction was assessed postoperatively.

Results

At 12 months follow-up, the minimal forehead width/forehead width ratio and the width of the temporal peak were increased in both groups (p < 0.05).; and the retention rate (41.2% ± 8.4%) of the SVF-gel group was significantly higher than that of Coleman's fat group (32.6% ± 8.8%; p < 0.05). Moreover, patients in the SVF-gel group reported higher satisfaction scores than those in Coleman's fat group.

Conclusions

SVF-gel is effective for temple contouring and augmentation., with increased efficacy compared with Coleman's fat.

Volumetric Effect and Patient Satisfaction after Facial Fat Grafting

BACKGROUND

Facial fat grafts decrease in volume after transplantation. This observation is based on overall facial three-dimensional analyses, because there is sparse information on volume changes in well-defined aesthetic areas. The authors aimed to assess the overall and, more specifically, the local volumetric effects of facial fat grafting and relate these effects to patient satisfaction up to 1 year after treatment.

METHODS

All consecutive adult female patients who were scheduled for facial fat grafting without additional surgical procedures were asked to participate. All patients underwent the same fat grafting method. An algorithm-based personalized aesthetic template was applied to define specific aesthetic areas on the preoperative three-dimensional image. Objective outcome parameters [i.e., three-dimensional volume differences, patient satisfaction (FACE-Q questionnaire)] were measured at baseline and at 6 weeks, 6 months, and 12 months after fat grafting.

RESULTS

Of 33 female patients who underwent a facial fat graft procedure, 23 patients had complete three-dimensional data and were eligible for analysis. The highest volume gain was observed 6 weeks after grafting and was followed by a gradual loss thereafter. Overall and in the zygomatic area, a substantial gain in volume was still present 1 year after grafting, whereas this effect was lost in the lip area. FACE-Q scales Satisfaction with Facial Appearance Overall and Satisfaction with Cheeks improved too, whereas scores for Lines: Lips returned to baseline levels. The improvement in FACE-Q scales was in agreement with the objective change in volume.

CONCLUSION

Gain in overall and local volumetric effects is accompanied by comparable changes in patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Temporal Hollowing Causes, Classifications, and Treatment Options: A Systematic Review

BACKGROUND

Recent developments in surgical techniques and grading schemas to treat temporal hollowing necessitate critically assessing their efficacy. This systematic review presents the currently available protocols for temporal hollowing, aimed toward improving the clinical approach, for the benefit of the surgeon and patient.

METHODS

A search was conducted in Pubmed, Embase, and Google Scholar in September 2021 using the key words "temporal hollowing" and "temporal augmentation." Inclusion criteria were English written articles published in peer-reviewed journals that reported an outcome relating to the cause, classification, or procedure used to prevent or correct hollowing in humans.

RESULTS

Of the 413, 966 publications retrieved, 24 met the study inclusion criteria. Twenty-one publications discussed the etiology of temporal hollowing, 12 discussed a classification or grading system for temporal hollowing, and 19 discussed a procedure to prevent or correct temporal hollowing. The most commonly reported etiology for temporal hollowing was iatrogenic (63%). For classifying temporal hollowing severity, visual analogue scales (25%) were most commonly used. Mesh (26%) and autologous fat grafts (26%) were the most popular procedures used to prevent or correct temporal hollowing.

DISCUSSION

We presented the spectrum of temporal hollowing grading schemas and treatment modalities currently published in the field. The use, by a majority of publications, of a grading system based on the subjective judgement of the examiner (either alone or adjunct to imaging results) suggests the need for a more standardized measurement tool. Future studies should investigate a universally-applicable temporal hollowing classification system and its impact on treatment outcomes.

Clinical Application of Stromal Vascular Fraction Gel in Temple Augmentation Using Deep Injection and Shallow Pave Filling

BACKGROUND

Temporal hollowing is an early sign of aging, and many techniques comprising the injection of fillers into the temporal fossa to correct this hollowing have been described.

OBJECTIVE

To assess the safety of a new technique in which stromal vascular fraction gel is used for temporal hollowing.

METHODS

Thirty-three patients with temporal hollowing were corrected with the aforementioned gel using deep injection and shallow pave filling at the Department of Plastic and Reconstructive Surgery, Guangdong Women and Children Hospital, China, between January 2017 and April 2021. This gel was injected into the double plane via a needle and cannula by the same cutaneous access points to prevent severe vascular injury. Improvement was evaluated by self-assessment, the Hollowness Severity Rating Scale (grade range, 0-3; lower grades represent minimal hollowness), and a satisfaction survey.

RESULTS

Self-assessment questionnaire (6 questions) results were satisfactory; 44 temples (67%) demonstrated more than 2 grades of magnitude of clinical improvement. Thirty-one patients (94%) were satisfied with their outcomes; the complaint ratio was low.

CONCLUSION

The high satisfaction rate of patients treated using the stromal vascular fraction gel by deep injection and shallow pave filling suggests that this technique is simple, effective, and safe.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Liposuction of the Zygomatic Arch Area: A Novel Concept to Improve the Midface Contour

BACKGROUND

An ovoid, slender face with a smooth contour is preferred in oriental esthetics. We developed a novel concept to achieve a slimmer and harmonious midface contour by liposuction of the projection area of the zygomatic arch.

METHODS

A cadaver study including anatomical dissection and histologic examination were conducted to better understand the soft tissue structure of the projection area of the zygomatic arch and the vital technique for liposuction. For the clinical evaluation, 49 patients with midface hypertrophy who underwent liposuction of the zygomatic arch area from January 2016 to June 2021 were retrospectively reviewed.

RESULTS

Cadaver study showed that abundant fatty tissue existed in the subcutaneous layer of the zygomatic arch area. The liposuction manipulation was precisely limited to the subcutaneous fat layer, and nerve branches were observed in the deeper loose areolar tissue plane. Of the 49 patients enrolled in this study (including 98 zygomatic arch areas), the median fat removal volume per zygomatic arch area was 3.0 (2.0, 5.0) mL. The subcutaneous fat thickness was significantly decreased postoperatively [median 9 (6, 10) mm vs. 1 (1, 2) mm per zygomatic arch area, P < 0.001]. All patients were satisfied with their postoperative outcomes. Only three patients underwent slight depression of the liposuction area during making facial expression after surgery and subsequently recovered.

CONCLUSIONS

Liposuction of the zygomatic arch area is effective in improving midface hypertrophy and achieving a harmonious facial contour with a low risk of complications.

LEVEL OF EVIDENCE IV

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 .

Autogenous Fat Transplantation and Botulinum Toxin Injection Into the Masseter Muscle to Create an Ideal Oval Face

BACKGROUND

East Asian faces vary in shape but only oval faces seem to be considered attractive. Many patients with wide faces seek removal of part of the mandibular angle and/or zygoma to achieve an ideal facial contour, but the procedure is high risk and the recovery period is relatively protracted.

OBJECTIVES

We sought to achieve ideal facial contours through the use of autologous fat grafting (AFG) combined with masseter botulinum toxin (BTX) injection for patients with wide faces and masseter hypertrophy.

METHODS

Fourteen patients with wide faces underwent AFG of the forehead, temporal region, cheeks, zygomatic body, nose, nasolabial fold, tear trough, and chin; and BTX injection into the masseter muscles. Each patient was photographed more than 6 months after the operation. The pre- and postoperative ratios pertaining to the facial aesthetics of the face were calculated. The Hollowness Severity Rating Scale (HSRS) and Ricketts's E-line were used to evaluate the photographs. Patient satisfaction was also investigated.

RESULTS

All patients received AFG and 1 to 3 BTX injections. The face length:bizygomatic breadth, bigonial breadth:bizygomatic breadth, and lower-face height:middle-face height ratios improved greatly after treatment. The mean HSRS score decreased from 2.214 preoperatively to 1.071 postoperatively. The chin and nose became more prominent than before. Facial swelling persisted for an average of 11.929 days. All patients were satisfied with the treatment outcome.

CONCLUSIONS

A combination of AFG and BTX injection was able to achieve an ideal oval face in East Asian patients with wide faces and masseter hypertrophy, with very few complications. Recovery was rapid and patient satisfaction was high.

LEVEL OF EVIDENCE: 4

Volume Retention After Facial Fat Grafting and Relevant Factors: A Systematic Review and Meta-analysis

BACKGROUND

Autologous fat grafting is common in facial reconstructive and cosmetic surgeries; the most important drawbacks are the high absorption rate and unpredictable volume retention rate. Surgeons usually make clinical judgements based on their own experience. Therefore, this study aimed to systematically and quantitatively review the volume retention rate of facial autologous fat grafting and analyse the relevant influencing factors.

METHODS

A systematic literature review was performed using the Medline, EMBASE, Cochrane Library, and Web of Science databases in October 2019 for articles that reported objectively measured volume retention rates of facial fat grafting. Patient characteristics, fat graft volumetric data, and complications were collected. A meta-analysis using a random-effects model was conducted to pool the estimated fat retention rate. Relevant factors were analysed and reviewed on the basis of subgroups.

RESULTS

We included 27 studies involving 1011 patients with facial fat grafting. The volume retention rate varied from 26 to 83%, with a mean follow-up of 3-24 months. The overall pooled retention rate was 47% (95% CI 41-53%). The volume measurement method significantly influenced the reported retention rate. A trend towards better retention was found for secondary fat grafting procedures and patients with congenital deformities. Only 2.8% of all patients had complications.

CONCLUSION

The exact percentage of facial fat grafts retained is currently unpredictable; the reported rate varies with different estimation methods. This review analysed studies that provided objectively measured volume retention rates, the pooled average percentage of facial fat graft retention (47%, 95% CI 41-53%), and relevant factors.

LEVEL OF EVIDENCE III

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 .

Differences in Temporal Volume between Males and Females and the Influence of Age and BMI: A Cross-Sectional CT-Imaging Study

BACKGROUND

 The temple has been identified as one of the most compelling facial regions in which to seek aesthetic improvement-both locally and in the entire face-when injecting soft tissue fillers.

OBJECTIVE

 The objective of this study is to identify influences of age, gender, and body mass index (BMI) on temporal parameters to better understand clinical observations and to identify optimal treatment strategies for treating temporal hollowing.

METHODS

 The sample consisted of 28 male and 30 female individuals with a median age of 53 (34) years and a median BMI of 27.00 (6.94) kg/m². The surface area of temporal skin, the surface area of temporal bones, and the temporal soft tissue volume were measured utilizing postprocessed computed tomography (CT) images via the Hausdorff minimal distance algorithm. Differences between the investigated participants related to age, BMI, and gender were calculated.

RESULTS

 Median skin surface area was greater in males compared with females 5,100.5 (708) mm² versus 4,208.5 (893) mm² (p < 0.001) as was the median bone surface area 5,329 (690) mm² versus 4,477 (888) mm² (p < 0.001). Males had on average 11.04 mL greater temporal soft tissue volume compared with age and BMI-matched females with p < 0.001. Comparing the volume between premenopausal versus postmenopausal females, the median temporal soft tissue volume was 46.63 mL (11.94) versus 40.32 mL (5.69) (p = 0.014).

CONCLUSION

 The results of this cross-sectional CT imaging study confirmed previous clinical and anatomical observations and added numerical evidence to those observations for a better clinical integration of the data.

Efficacy and Safety of Subcutaneous Temporal Autologous Micro-fat Augmentation

BACKGROUND

Autologous fat grafting is a rapidly developing soft tissue filling technique that has been playing an increasingly important role in facial contouring and rejuvenation surgeries. However, this technique is accompanied by many side effects and risks. In particular, there is still much room for improvement in regard to the surgical method of temporal augmentation with autologous fat, which is highly popular among Chinese people. Better surgical methods can achieve better outcomes while curbing surgical risks.

DESIGN AND METHODOLOGY

We reviewed 39 patients who consecutively underwent subcutaneous temporal autologous micro-fat argumentation surgery at Peking University People's Hospital from February 19, 2016, to May 13, 2019, to correct temporal hollowness. Each patient's Visual Analogue Scale (VAS) satisfaction score and Hollowness Severity Rating Scale (HSRS) score before and after surgery were precisely recorded, and any complaints about perioperative complications were meticulously collected to assess the efficacy and safety profile of the novel technique.

RESULTS

All 39 patients included in this study were female. We performed 86 subcutaneous temporal autologous micro-fat argumentation surgeries, with an average follow-up of 20.4 ± 9.6 months. The average fat filling volume in the right temporal region was 6.29 ± 2.55 mL, and that in the left temporal region was 6.34 ± 2.71 mL. The average VAS satisfaction score increased from 4.44 ± 1.33 before the surgery to 8.08 ± 0.77 after the surgery, and the average HSRS score dropped from 1.82 ± 0.72 before the surgery to 0.36 ± 0.49 after the surgery. Four patients were encountered with minor complications of intraoperative bleeding and congestion, which were all completely ameliorated after conservative therapies.

CONCLUSION

In the present study, we found that the reported surgical method of subcutaneous temporal autologous micro-fat augmentation successfully improved the temporal hollowness of the patients, boasting good surgical results and high patient satisfaction with minimal short- and long-term complications, illustrating that it is an effective, safe and promising novel surgical technique worthy of wider clinical application.

LEVEL OF EVIDENCE IV

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 .

Temporal Fat Grafting in Children With Craniofacial Anomalies

BACKGROUND

Fat grafting is a common adjunct procedure used to treat temporal fat hollowing in children with craniofacial anomalies. The goal of this study was to assess the surgical and aesthetic outcomes of this procedure.

METHODS

We retrospectively reviewed patients who underwent temporal fat grafting at a single tertiary pediatric craniofacial center. The surgical outcome was assessed based on intraoperativeand 30-day postoperative complication rates. The aesthetic outcome was assessed by 3 independent investigators using a 3-point grading scale for preoperative temporal hollowing severity (1 = mild, 2 = moderate, 3 = severe) and a 5-point scale for postoperative improvement (0 = no, 1 = mild, 2 = moderate, 3 = significant, and 4 = complete improvement).

RESULTS

Forty-three patients met inclusion criteria. Twenty-seven (63%) were male, 39 (91%) had a history of craniosynostosis, and 18 (42%) had associated syndromes. The mean age at fat grafting was 9.9 years (2.7-20.4, SD = 5.5) with an average follow-up time of 1.6 years (0-5.8, SD = 1.8). The average volume of fat grafted was 8.6 mL (0-30, SD = 5.9) to the right temporal region and 8.6 mL (0-30, SD = 5.8) to the left. There were no intraoperative or postoperative complications. The mean improvement score was 2.9 (1-4, SD = 0.7), demonstrating that most patients experienced moderate to significant improvement. Multiple linear regression analysis demonstrated that syndromic status had a negative impact on the aesthetic outcome (P < 0.001).

CONCLUSIONS

These findings demonstrate that fat grafting is an effective method to treat temporal hollowing in children with craniofacial anomalies with no perioperative complications.

"Not Above, Not Below: Right in the Middle!"-Novel Filler Technique for Temporal Augmentation and Rejuvenation

The temporal region is challenging to treat due to its thin skin, which has the propensity toward showing irregularities. The literature on temporal hollowing augmentation suggests placing the filler either into the subcutaneous space or within the temporalis muscle. However, these techniques have been based upon opinion rather than supporting anatomical and clinical data. We introduce a novel injection technique to avoid complications and achieve lasting results. This novel technique was confirmed with a cadaver model, in vivo model, and application to a human subject. The anatomical layers of the temporal region were highlighted: the skin, subcutaneous tissue, temporoparietal fascia (superficial temporal fascia), deep temporal fascia, superficial temporal fat pad, and temporalis muscle. Particular emphasis was placed on identifying the frontal branch of the superficial temporal artery to avoid vascular complications. We believe the potential space between the temporoparietal fascia and the deep temporalis fascia is the safest, most efficacious plane to inject the temporal region with a 27-gauge cannula. Our future goal is to recruit and present a larger series of patients receiving this injection.

Facial aesthetic fat graft retention rates after filtration, centrifugation, or sedimentation processing techniques measured using three-dimensional surface imaging devices

OBJECTIVE

How to increase the long-term retention rate of autologous fat grafting has been widely discussed. This study aimed to evaluate long-term fat graft retention rates for the most widely used fat processing methods in the area of facial esthetic surgery, including centrifugation, filtration, and sedimentation, using three-dimensional (3D) imaging.

DATA SOURCES

PubMed, Embase, Wiley/Cochrane Library, and Web of Science databases were comprehensively searched from inception to July 2018 according to the guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.

STUDY SELECTION

Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, follow-up devices, fat grafting techniques, and clinical outcomes. Patient cohorts were pooled, and fat graft retention rates were calculated. Complications were summarized according to different clinical characteristics.

RESULTS

Of 77 articles, 10 clinical studies met the inclusion criteria and reported quantified measurement outcomes with 3D imaging which provide precise volumetric data with approximately 2% standard deviation compared to real volumes. Data of 515 patients were included. Fat grafting retention varied from 21% to 82%. We found filtration and centrifugation techniques could result in better retention outcomes. However, retention varied within each processing technique, with no significant difference among the 3 techniques. Twenty-two complications were reported among 515 patients, including donor-site hematoma (1 case), mild post-operative erythema (2 cases), mild volumetric asymmetries (2 cases), chronic edema (2 cases), overcorrection (2 cases), skin irregularity (6 cases), and headache or dysesthesia (7 cases).

CONCLUSIONS

Filtration and centrifugation techniques may result in better fat grafting retention outcomes than gravity sedimentation; however, more accurate statistical evidence is needed. Controversies continue to exist with respect to the performance of the different fat-processing techniques in fat graft retention.