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Pulumati A, Algarin Y, Jaalouk D, Latta S, Nouri K. Fillers impacting follicles: the emerging complication of filler-induced alopecia. Int J Dermatol 2024; 63:1131-1139. [PMID: 38615331 DOI: 10.1111/ijd.17169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Filler-induced alopecia is a transient alopecia characterized by localized hair loss and often attributed to vascular compromise following dermal filler injections in facial regions. Although an uncommon phenomenon, the rising incidence of filler-induced alopecia underscores the importance of understanding and managing this condition. We performed an extensive PubMed review of articles reporting filler-induced alopecia and summarizing the implicated filler types, injection areas, hair loss patterns, symptom onset, course progression, treatments, and prognosis. Hyaluronic acid injections were the most implicated in filler-induced alopecia cases, with calcium hydroxylapatite and autologous fat less frequently associated. No cases involved other dermal filler types. Although recovery times varied depending on the treatment, hyaluronidase (HAase) injections rapidly restored near-normal hair density within 3-4 months. Minoxidil and platelet-rich plasma play a more minor role in restoring hair growth but may be used as adjuncts with HAase to facilitate hair growth. Finally, alternative interventions like intralesional triamcinolone, warm compresses, and nitroglycerin warrant exploration, given limited robust clinical data. Our study promotes awareness of filler-induced alopecia's rising incidence and offers practical insights and evidence-based recommendations for effective management. By equipping dermatologists with this knowledge, our aim is to improve patient outcomes and reduce adverse events in filler-based procedures.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Yanci Algarin
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Dana Jaalouk
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Steven Latta
- Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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Miotti G, De Marco L, Quaglia D, Grando M, Salati C, Spadea L, Gagliano C, Musa M, Surico PL, Parodi PC, Zeppieri M. Fat or fillers: The dilemma in eyelid surgery. World J Clin Cases 2024; 12:2951-2965. [PMID: 38898854 PMCID: PMC11185368 DOI: 10.12998/wjcc.v12.i17.2951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024] Open
Abstract
The aging of the periocular region has always aroused great interest. A fresh, young, and attractive sight determined an ever-greater attention to surgical and non-surgical techniques to obtain this result. In particular, the change in the concept of a young look, considered then "full", led to the increasing use of surgical (fat grafting) or medical (hyaluronic acid) filling techniques. Eyelid rejuvenation became increasingly popular in the field of cosmetic treatments, with a focus on achieving a youthful and refreshed appearance. Among the various techniques available, the choice between using fat grafting or fillers presented a clinical dilemma. In particular, what surgery considered of fundamental importance was a long-lasting result over time. On the other hand, aesthetic medicine considered it fundamental not to have to resort to invasive treatments. But what was the reality? Was there one path better than the other, and above all, was there a better path for patients? The minireview aims to explore the physiopathology, diagnosis, treatment options, prognosis, and future studies regarding this dilemma. We analyzed the literature produced in the last 20 years comparing the two techniques. Current literature reveals advancements in biomaterials, stem cell research and tissue engineering held promise for further enhancing the field of eyelid rejuvenation. The choice between fat grafting and fillers in eyelid cosmetic treatments presented a clinical dilemma. Understanding physiopathology, accurately diagnosing eyelid aging, exploring treatment options, assessing prognosis, and conducting future studies were essential for providing optimal care to patients seeking eyelid rejuvenation.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Luca De Marco
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Davide Quaglia
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Martina Grando
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento 33078, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, Rome 00142, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna “Kore”, Enna 94100, Italy
- Eye Clinic Catania University San Marco Hospital, Viale Carlo Azeglio Ciampi, Catania 95121, Italy
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Km 7, Benin 300105, Nigeria
| | - Pier Luigi Surico
- Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, United States
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Cheng MH, Chang CW, Wang J, Bupphathong S, Huang W, Lin CH. 3D-Bioprinted GelMA Scaffold with ASCs and HUVECs for Engineering Vascularized Adipose Tissue. ACS APPLIED BIO MATERIALS 2024; 7:406-415. [PMID: 38148527 DOI: 10.1021/acsabm.3c00964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
The purpose of tissue engineering is to reconstruct parts of injured tissues and to resolve the shortage of organ donations. However, the main concern is the limited size of engineered tissue due to insufficient oxygen and nutrition distribution in large three-dimensional (3D) tissue constructs. To provide better support for cells inside the scaffolds, the vascularization of blood vessels within the scaffold could be a solution. This study compared the effects of different culturing systems using human adipose tissue-derived stem/stromal cells (ASCs), human umbilical vein endothelial cells (HUVECs), and coculture of ASCs and HUVECs in 3D-bioprinted gelatin methacrylate (GelMA) hydrogel constructs. The in vitro results showed that the number of live cells was highest in the coculture of ASCs and HUVECs in the GelMA hydrogel after culturing for 21 days. Additionally, the tubular structure was the most abundant in the GelMA hydrogel, containing both ASCs and HUVECs. In the in vivo test, blood vessels were present in both the HUVECs and the coculture of ASCs and HUVECs hydrogels implanted in mice. However, the blood vessel density was the highest in the HUVEC and ASC coculture groups. These findings indicate that the 3D-bioprinted GelMA hydrogel coculture system could be a promising biomaterial for large tissue engineering applications.
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Affiliation(s)
- Ming-Huei Cheng
- Center of Lymphedema Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chien-Wen Chang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Jerry Wang
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Sasinan Bupphathong
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
- High-value Biomaterials Research and Commercialization Center, National Taipei University of Technology, Taipei 10608, Taiwan
| | - Wei Huang
- Department of Orthodontics, Rutgers School of Dental Medicine, Newark, New Jersey 07103, United States
| | - Chih-Hsin Lin
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
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Qari S, Bader M, Farran E, Borrah R, Khamis S, Alharbi Z. Combined Synergetic Effect of Lipoconcentrate Fat Grafting, Nanofat Transfer, Platelet-Rich Plasma, Microneedling, and CO2 Fractional Laser for Plastic Regenerative and Esthetic Surgery and Cosmetic Care. Cureus 2023; 15:e44035. [PMID: 37746505 PMCID: PMC10517633 DOI: 10.7759/cureus.44035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
The advancements in skin care methods and products show the rising interest in cosmetics. Recent studies emphasize the regenerative potential of fat grafting, platelet-rich plasma (PRP), microneedling, and carbon dioxide (CO2) fractional laser techniques. Combining these strategies into a protocol is yet to be explored. In this article, we demonstrate different types of fat grafts and their versatility in treating different facial problems found in our patient. This study evaluated the synergistic effect of lipoconcentrate and nanofat grafting, PRP, microneedling, and CO2 fractional laser to provide esthetic and regenerative facial skin care. This case report was conducted in Dr. Soliman Fakeeh Hospital, Saudi Arabia. Our case involved a 53-year-old woman who had traumatic facial injuries due to a car accident years ago that buried asphalt particles in her facial scars, causing bluish skin discoloration. She suffered from multiple deep atrophic scars in several areas on the left side of her face, causing asymmetry. She was treated using lipoconcentrate and nanofat grafting, followed by three PRP with microneedling sessions and then a final CO2 fractional laser session. The evaluation was based on the physician's clinical assessment, image documentation, and patient satisfaction, which revealed significant improvement in skin appearance with respect to texture, color, symmetry, and overall health of the skin over a period of four months. The potentiality and efficacy of the combination therapy of lipoconcentrate, nanofat, PRP, microneedling, and CO2 fractional laser for skin rejuvenation and scar treatment showed promising results in this case report.
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Affiliation(s)
- Sarah Qari
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Maryam Bader
- Plastic Surgery and Burn Unit, King Fahad General Hospital, Jeddah, SAU
| | - Eyas Farran
- College of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Renad Borrah
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Sherif Khamis
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
- Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ziyad Alharbi
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
- Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, SAU
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Jiang X, Chen W, Chen N, Wang Y, Lin J, Tian X, Wu H, Zhang Q. Comprehensive management for complex complications after periumbilical fat implantation into the upper eyelid. BMC Ophthalmol 2023; 23:306. [PMID: 37430215 DOI: 10.1186/s12886-023-02989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Recently, periumbilical fat (PF) mass, an autologous material with a high survival rate, has been transplanted to treat sunken or dissatisfactory double eyelids. However, the intricate complications of PF grafts and associated reconstructive strategies are infrequently discussed. METHODS During 3 years, 20 patients (33 eyes) with eyelid malformations caused by PF grafts into the orbital septum or on the surface of the levator aponeurosis underwent corrective blepharoplasty. We recorded patients' subjective feelings and identified deformities from crease abnormalities, bloated appearance, and problems with the eyelid's height. Then, we categorize them into three types based on their complexity: type I, swollen appearance; type II, obvious adhesion; type III, severe comprehensive damage. The relevant management included removing fat implants, releasing the adhesion, and rebuilding the physical structure according to the anatomic damage mechanism. The improvement effect was assessed with a satisfaction survey from patients and doctors at 6 months of follow-up. RESULTS The swollen appearance was observed in 26 eyes (78.8%), an unsmooth double-eyelid line was in 23 eyes (69.7%), and the incidence of adhesion was in 22 eyes (66.7%). Following a comprehensive evaluation, 15 eyes (45.5%) and 13 (39.4%) were classified as type I and type II respectively. After the 6-month follow-up, 22 eyes (66.7%) showed exceptional aesthetic results, whereas only 2 eyes as type III had a poor outcome. CONCLUSIONS The deformities emerging from periumbilical fat into the upper eyelid are associated with the shape of the fat and the adhesion in tissues. Graft removal, adhesion release, and restoration of the natural anatomic structure can have positive outcomes.
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Affiliation(s)
- Xuewei Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Plastic Surgery, Mylike Medical Cosmetic Hospital, Shanghai, China
| | - Wei Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Chen
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Wang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jiayan Lin
- Department of Plastic and Reconstructive Surgery, The Frist Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xufeng Tian
- Department of Plastic and Reconstructive Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Hailong Wu
- Department of Plastic Surgery, NuoYa Stomatological Hospital, Siping, Jilin, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Ding F, Shen Y, Lu L, Sun D, Luo X, Liang X, Yang J, Jin R. Correction of Mild-to-Moderate Sunken Upper Eyelids of Asians with Stromal Vascular Fraction Gel. Ophthalmol Ther 2023; 12:535-548. [PMID: 36510031 PMCID: PMC9834495 DOI: 10.1007/s40123-022-00615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/06/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Fat grafting is an efficient and safe procedure for the correction of upper eyelid sulcus deepening. Stromal vascular fraction (SVF) gel has been proven to be an ideal fat derivative and can be widely used for facial augmentation. We aimed to determine the efficacy of SVF gel for the correction of a mild-to-moderate sunken superior sulcus among Asian patients. METHODS Patients with a mild-to-moderate sunken superior sulcus underwent SVF gel grafting of the sunken upper periorbital area. The primary result was the quantitative volume difference in the superior sulcus region before and after grafting. This was evaluated through three-dimensional VECTRA® imaging. The secondary results included the aesthetic quantitative evaluation results (upper lid area and pretarsal space ratio), global aesthetic improvement scale (GAIS) score, and complications. RESULTS Thirty-one patients with mild-to-moderate sunken upper eyelids were included in this study. The average unilateral injected amount was 1.235 mL (± 0.171 mL). The 1-year delta volume was 0.801 ± 0.086 mL, and the effective survival volume was 65.3% (± 6.1%). The median preoperative pretarsal space and upper lid area ratio was 1.010 (± 0.150). The median postoperative pretarsal space and upper lid area ratio at 1 year was 0.159 (± 0.031) (n = 62; P < 0.0001), indicating a significantly reduced sunken appearance. The average GAIS score was 2.174 (± 0.391). All patients were satisfied with their surgical outcomes. The reoperation rate was 12.9%. CONCLUSIONS SVF gel is safe and effective for the treatment of a mild-to-moderate sunken superior sulcus and is associated with satisfactory clinical outcomes and short recovery times.
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Affiliation(s)
- Feixue Ding
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yirui Shen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Lin Lu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xusong Luo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xiao Liang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Rui Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated With Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Jeyaraman M, Muthu S, Sharma S, Ganta C, Ranjan R, Jha SK. Nanofat: A therapeutic paradigm in regenerative medicine. World J Stem Cells 2021; 13:1733-1746. [PMID: 34909120 PMCID: PMC8641019 DOI: 10.4252/wjsc.v13.i11.1733] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/15/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Adipose tissue is a compact and well-organized tissue containing a heterogeneous cellular population of progenitor cells, including mesenchymal stromal cells. Due to its availability and accessibility, adipose tissue is considered a “stem cell depot.” Adipose tissue products possess anti-inflammatory, anti-fibrotic, anti-apoptotic, and immunomodulatory effects. Nanofat, being a compact bundle of stem cells with regenerative and tissue remodeling potential, has potential in translational and regenerative medicine. Considering the wide range of applicability of its reconstructive and regenerative potential, the applications of nanofat can be used in various disciplines. Nanofat behaves on the line of adipose tissue-derived mesenchymal stromal cells. At the site of injury, these stromal cells initiate a site-specific reparative response comprised of remodeling of the extracellular matrix, enhanced and sustained angiogenesis, and immune system modulation. These properties of stromal cells provide a platform for the usage of regenerative medicine principles in curbing various diseases. Details about nanofat, including various preparation methods, characterization, delivery methods, evidence on practical applications, and ethical concerns are included in this review. However, appropriate guidelines and preparation protocols for its optimal use in a wide range of clinical applications have yet to be standardized.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
| | - Shilpa Sharma
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
| | - Charan Ganta
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Stem Cells and Regenerative Medicine, Kansas State University, Manhattan, United States 10002, United States
| | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
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Sharma S, Muthu S, Jeyaraman M, Ranjan R, Jha SK. Translational products of adipose tissue-derived mesenchymal stem cells: Bench to bedside applications. World J Stem Cells 2021; 13:1360-1381. [PMID: 34786149 PMCID: PMC8567449 DOI: 10.4252/wjsc.v13.i10.1360] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
With developments in the field of tissue engineering and regenerative medicine, the use of biological products for the treatment of various disorders has come into the limelight among researchers and clinicians. Among all the available biological tissues, research and exploration of adipose tissue have become more robust. Adipose tissue engineering aims to develop by-products and their substitutes for their regenerative and immunomodulatory potential. The use of biodegradable scaffolds along with adipose tissue products has a major role in cellular growth, proliferation, and differentiation. Adipose tissue, apart from being the powerhouse of energy storage, also functions as the largest endocrine organ, with the release of various adipokines. The progenitor cells among the heterogeneous population in the adipose tissue are of paramount importance as they determine the capacity of regeneration of these tissues. The results of adipose-derived stem-cell assisted fat grafting to provide numerous growth factors and adipokines that improve vasculogenesis, fat graft integration, and survival within the recipient tissue and promote the regeneration of tissue are promising. Adipose tissue gives rise to various by-products upon processing. This article highlights the significance and the usage of various adipose tissue by-products, their individual characteristics, and their clinical applications.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh 226010, India
| | - Sathish Muthu
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh 226010, India
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul, Tamil Nadu 624304, India
- Research Scholar, Department of Biotechnology, School of Engineering and Technology, Greater Noida, Sharda University, Uttar Pradesh 201306, India
| | - Madhan Jeyaraman
- Indian Stem Cell Study Group, Lucknow, Uttar Pradesh 226010, India
- Research Scholar, Department of Biotechnology, School of Engineering and Technology, Greater Noida, Sharda University, Uttar Pradesh 201306, India
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh 201306, India
| | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh 201306, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh 201306, India
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Yang F, Ji Z, Peng L, Fu T, Liu K, Dou W, Li J, Li Y, Long Y, Zhang W. Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis. PLoS One 2021; 16:e0248505. [PMID: 33793573 PMCID: PMC8016360 DOI: 10.1371/journal.pone.0248505] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background In recent years, autologous fat grafting (AFG), also known as fat transfer or lipofilling, has been widely performed for periorbital rejuvenation and defect correction, although the evidence regarding its efficacy and safety is still lacking. Besides, with respect to the periorbital region, it is invariably the earliest appearance area of the facial aging phenomenon. Therefore, a systematic review and meta-analysis is needed to evaluate the efficacy and safety of this technique. Methods A literature search was performed in PubMed, Embase, and the Cochrane library databases on November 20, 2020, adhering to the PRISMA guidelines, to identify all relevant articles. Then, a data extraction and standardization process was performed to assess all outcome data. Ultimately, the data were assessed using a random effects regression model with comprehensive meta-analysis software. Results Thirty-nine studies consisting of 3 cohorts and 36 case series with a total of 4046 cases were included. Meta-analysis revealed a relatively high satisfaction rate of 90.9% (95% CI, 86.4%–94.0%). Frequent complications in 4046 patients receiving AFG were edema, chemosis, and contour irregularity, with an overall complication rate of 7.9% (95% CI, 4.8%–12.8%). Conclusion This systematic review and meta-analysis showed that AFG for rejuvenation of eyelids and periorbital area provided a high satisfaction rate and did not result in severe complications. Therefore, AFG might be performed safely for periorbital rejuvenation and reconstruction.
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Affiliation(s)
- Fan Yang
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhaohua Ji
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi’an, China
| | - Liwei Peng
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ting Fu
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi’an, China
| | - Kun Liu
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi’an, China
| | - Wenjie Dou
- Department of Plastic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jing Li
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuejun Li
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
- * E-mail: (WZ); (YL); (YL)
| | - Yong Long
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi’an, China
- * E-mail: (WZ); (YL); (YL)
| | - Weilu Zhang
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Xi’an, China
- * E-mail: (WZ); (YL); (YL)
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Copcu HE, Oztan S. Not Stromal Vascular Fraction (SVF) or Nanofat, but Total Stromal-Cells (TOST): A New Definition. Systemic Review of Mechanical Stromal-Cell Extraction Techniques. Tissue Eng Regen Med 2021; 18:25-36. [PMID: 33231864 PMCID: PMC7862455 DOI: 10.1007/s13770-020-00313-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/04/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022] Open
Abstract
The most important and greatest source in the body for regenerative cells is fat tissue. Obtaining regenerative cells from adipose tissue can be done in two ways: Enzymatic and mechanical. The regenerative cell cocktail obtained by the enzymatic method, including stem cells, is called Stromal vascular fracture (SVF). In the literature, there is no clear definition of regenerative cells obtained by mechanical method. We systematically searched the techniques and definitions for stromal cells obtained from adipose tissue by scanning different databases. To evaluate the mechanical stromal-cell isolation techniques and end products from adipose tissue. Systematic review of English and non-English articles using Embase, PubMed, Web of Science and Google scholar databases. Search terms included Nanofat, fragmented fat, mechanical stromal / stem cell, mechanical SVF, SVF gel. We screened all peer-reviewed articles related with mechanical stromal-cell isolation. Author performed a literature query with the aforementioned key words and databases. A total of 276 publications containing the keywords we searched were reached. In these publications, there are 46 different definitions used to obtain mechanical stromal cells. The term SVF is only suitable for enzymatic methods. A different definition is required for mechanical. The most used term nanofat is also not suitable because the product is not in both "fat" and in "nanoscale". We think that the term total stromal-cells would be the most appropriate definition since both extracellular matrix and all stromal cells are protected in mechanical methods.
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Affiliation(s)
- H. Eray Copcu
- Plastic and Reconstructive Surgery, MEST Medical Services, Cumhuriyet Bulv. No:161/A,1,2 Alsancak, Izmir, Turkey
| | - Sule Oztan
- Plastic and Reconstructive Surgery, MEST Medical Services, Cumhuriyet Bulv. No:161/A,1,2 Alsancak, Izmir, Turkey
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Bayat M, Bahrami N, Mesgari H. Rhinoplasty with Fillers and Fat Grafting. Oral Maxillofac Surg Clin North Am 2020; 33:83-110. [PMID: 33246548 DOI: 10.1016/j.coms.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonsurgical rhinoplasty is one choice for cases in which open surgery may be harmful, the deformity is not indicated to correct with open surgery, or in patients who have phobia of general anesthesia or any type of surgery. Autologous fat injection or fillers are most common materials currently available in the market. In this article, we explain the indications, contraindications, methods, and complications of this treatment.
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Affiliation(s)
- Mohammad Bayat
- Department of Oral & Maxillofacial Surgery, Shariati Hospital, Tehran University of Medical Sciences, north kargar ave, Tehran Iran.
| | - Naghmeh Bahrami
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, north kargar ave, Tehran Iran; Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Mesgari
- Facial Esthetic Surgery, Tehran University of Medical Sciences, north kargar ave, Tehran Iran
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Veronese S, Dai Prè E, Conti G, Busato A, Mannucci S, Sbarbati A. Comparative technical analysis of lipoaspirate mechanical processing devices. J Tissue Eng Regen Med 2020; 14:1213-1226. [PMID: 32598097 DOI: 10.1002/term.3093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/10/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022]
Abstract
Fat grafting is a well-established procedure in reconstructive, aesthetic, and regenerative medicine, in particular due to the presence in the adipose tissue of a high concentration of mesenchymal stem cells. The need to reduce fat processing times, for an immediate clinical use and regulatory restrictions on the degree of manipulation of human tissues, has led to the development of numerous devices for the mechanical, nonenzymatic processing of adipose tissue. The aim of this study is to describe the state of the art of mechanical devices used for fat processing, performing a technical analysis of the currently commercially available devices. This should facilitate the development of new devices that improve therapeutic results.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Elena Dai Prè
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Giamaica Conti
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Alice Busato
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Silvia Mannucci
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
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Mao X, Pei Y, Zhang L, Zhang Y, Jin R, Cheng L, Sun X, Zhang Y. A Novel Way for Upper Eyelid Rejuvenation by Combination of Local Fat-Fascia-Muscle Flap Repositioning for Middle-Aged Asian Women. J Plast Reconstr Aesthet Surg 2020; 73:1565-1572. [PMID: 32414704 DOI: 10.1016/j.bjps.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/13/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Upper eyelid aging is common among middle-aged Asians. Apart from skin aging, there has been an increasing recognition for the role of sunken eyelid playing in upper eyelid aging. Various methods have been developed to deal with the upper eyelid volume deflation. However, autologous fat tissue could not achieve stable and satisfying rejuvenation results, especially for middle-aged patients who have established extremely low adipose tissue survival rates. Therefore, efficient rejuvenation methods with consistent long-term improvement are needed, especially for middle-aged patients. METHODS A retrospective study was conducted of 248 middle-aged patients who underwent the upper eyelid tightening and local fat-fascia-muscle flap reposition for upper eyelid rejuvenation in our department between 2015 and 2017. A precise sunken upper eyelid calculation method was used to evaluate the patients' upper eyelid sunken volume prior to the operation for the guidance of sunken correction. The same method was also used to calculate the post-operation upper eyelid sunken volume to evaluate the operation efficiency. RESULTS The average age of the patients who underwent the surgery was 49.5±7 years-old. The fat-fascia-muscle flap was repositioned according to each patient's pre-operation sunken upper eyelid evaluation result, and precise and satisfying immediate sunken correction was observed after the surgery. Long-term consistent improvement was achieved. Compared to the pre-operation evaluation, the upper eyelid sunken correction ratio was nearly 90% in one year's follow-up, and no major complication occurred. CONCLUSIONS The fat-fascia-muscle flap reposition combined with sunken upper eyelid calculation has been proved efficient and consistent for middle-aged Asians upper eyelid rejuvenation.
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Affiliation(s)
- Xiyuan Mao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yunkun Pei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ying Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Rong Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Liying Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaoming Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yuguang Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Pelle-Ceravolo M, Angelini M. Properly Diluted Fat (PDF): An Easy and Safe Approach to Periocular Fat Grafting. Aesthet Surg J 2020; 40:19-33. [PMID: 30753276 DOI: 10.1093/asj/sjz039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The main challenge of periocular fat grafting is the risk of contour irregularities, especially in the lower eyelid. Injection of diluted fat can decrease the likelihood of poor contour. OBJECTIVES The authors developed a simple method of periocular fat grafting in which the fat was harvested through unconventional cannulas and diluted before the injection to avoid the risk of contour irregularities. METHODS A retrospective study was conducted on 200 patients who underwent fat grafting to the periocular region. Lipoaspirate was obtained through a 0.5-mm multiple-hole cannula and then was centrifuged. A solution of 70% fat was prepared (ie, properly diluted fat [PDF]) with saline and infranatant fluid as the diluent. The recipient site was tunnelized with a 1.2-mm cannula, and PDF was transferred utilizing a 1.2-mm cannula containing a single 1-mm hole. Aesthetic improvement was ascertained from pre- and postoperative photographs evaluated by 3 examiners. RESULTS A total of 164 (82%) patients received follow-up 6 months postoperatively, and 83 of these patients (41.5%) returned for monitoring 1 year postoperatively. Nearly all patients had improvement in periocular contour, but variable loss of volume was observed by 1 year. Patients who presented initially with scleral show often had noticeable improvement. At 1 year, only 3 patients experienced contour irregularities comprising soft bulges, similar to fat hernias. Two patients showed fat accumulation after substantial weight gain later than 1 year postoperatively. CONCLUSIONS Preparation and periocular delivery of PDF by the described techniques yield good contour with a low risk of visible masses occurrence. LEVEL OF EVIDENCE: 4
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Pourang A, Rockwell H, Karimi K. New Frontiers in Skin Rejuvenation, Including Stem Cells and Autologous Therapies. Facial Plast Surg Clin North Am 2019; 28:101-117. [PMID: 31779934 DOI: 10.1016/j.fsc.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.
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Affiliation(s)
- Aunna Pourang
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA
| | - Helena Rockwell
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kian Karimi
- Rejuva Medical Aesthetics, 11645 Wilshire Boulevard #605, Los Angeles, CA 90025, USA.
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Larsson JC, Chen TY, Lao WW. Integrating Fat Graft with Blepharoplasty to Rejuvenate the Asian Periorbita. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2365. [PMID: 31772873 PMCID: PMC6846325 DOI: 10.1097/gox.0000000000002365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contemporary periorbital rejuvenation is undergoing a paradigm shift to an approach that prioritizes volume preservation and/or augmentation. However, the technical difficulties of using traditional fat grafting techniques in this area and the distinct ethnic features make periorbital rejuvenation in Asians especially challenging. Here, the authors present their approach to enhance the periorbita and outcomes. METHODS A retrospective chart review was performed for 33 consecutive patients who underwent microautologous fat transplantation (MAFT) to the periorbita using the MAFT gun device combined with excisional blepharoplasty. Additionally, preoperative and postoperative photographs were analyzed by external evaluators to grade the aesthetic outcomes and fat resorption rates. RESULTS Three months after surgery, patients looked on average 5.4 ± 3.4 years younger, and the aesthetic result was graded 7.4 ± 2 in a one-to-ten scale. The fat resorption rate was 19.6% ± 3.5% at 3 months and 32.2% ± 3.9% after 12 months (range: 12-24 months; P = 0.007). The overall morbidity rate was 12% (4 patients), including 1 visible lump (3%), an overcorrection case (3%) in the lower eyelid, and 2 palpable lumps in the upper eyelid (6%) which were not visible. One case of lower eyelid hollowness required secondary fat grafting. CONCLUSIONS Traditional blepharoplasty procedures can be combined with fat grafting techniques to address volume loss and tissue descend while keeping ethnic identity. A fat injection device like the MAFT gun is safe and effective and provides long-term predictable outcomes for fat grafting around the periorbital thin skin.
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Affiliation(s)
- Juan C. Larsson
- From the Department of Plastic and Reconstructive Surgery, Sanatorio Allende, Córdoba, Argentina
- Department of Orthopedic Surgery, Sanatorio Allende, Córdoba, Argentina
| | - Tai-Yuan Chen
- Department of Medical Education, Taipei Veteran General Hospital, Taipei, Taiwan
| | - William W. Lao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taoyuan, Taiwan
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Maamari RN, Massry GG, Holds JB. Complications Associated with Fat Grafting to the Lower Eyelid. Facial Plast Surg Clin North Am 2019; 27:435-441. [PMID: 31587763 DOI: 10.1016/j.fsc.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fat grafting is effectively used in the lower eyelid and periorbital area for rejuvenation of the aging face. Several complications may occur with fat grafting, including volume undercorrection or overcorrection, contour irregularities, prolonged bruising and swelling, infection, granulomas and inflammation, and vascular embolization with visual loss or stroke. In many cases, complications can be effectively treated, although permanent and serious injury can occur. Appropriate surgical techniques help to prevent most of these complications. An understanding of how and why complications of fat grafting of the lower eyelid occur aids in the avoidance and treatment of these complications.
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Affiliation(s)
- Robi N Maamari
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8096, St. Louis, MO 63110, USA.
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, 150 N. Robertson Boulevard, Suite 314, Beverly Hills, CA 90211, USA
| | - John Bryan Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc.,12990 Manchester Road, Suite 102, Des Peres, MO 63131-1860, USA
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[Secondary surgeries in eyelid and orbital surgery]. ANN CHIR PLAST ESTH 2019; 64:440-458. [PMID: 31383625 DOI: 10.1016/j.anplas.2019.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/23/2022]
Abstract
If eyelid and orbital surgery is very often particularly rewarding, it can also be deceiving. Moreover, a dysfunction can be added to the aesthetic result, leading to a secondary surgery. Secondary surgeries at the orbital level will mainly relate to problems of volume (container - content), whereas at the eyelid level, it will be problems of position that will be met. These eyelids wrong positionings result from an imbalance of dynamic forces that could have preexisted to the first surgery or is a consequence of that surgery. And it's the clinical trial that will be key, allowing the prevention of complications in the first surgery and that in secondary surgery will do for the diagnostic and will lead to the repairing operation. Several examples will be presented and discussed.
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Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1606. [PMID: 29632784 PMCID: PMC5889440 DOI: 10.1097/gox.0000000000001606] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/24/2017] [Indexed: 12/25/2022]
Abstract
Background Parallel to the steady decline in surgical aesthetic procedures to the face, dermal fillers seem to have gained a more prominent place in facial rejuvenation over the last couple of years. As a dermal, facial filler, autologous fat transfer (AFT) seems to have real potential because of the biocompatibility of adipose tissue besides being a procedure with few and primarily minor complications. This systematic review aims to evaluate the available evidence regarding the safety and effectiveness of AFT for facial rejuvenation. Method A systematic review after the Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analysis (PRISMA) statement was conducted. MEDLINE, Embase, and Cochrane Library were searched up to December 2016, with no language restrictions imposed. Case series, cohort studies, and randomized controlled trials (RCTs) reporting on relevant outcomes were included. Results Eighteen clinical articles were included, reporting on 3,073 patients in total over a mean follow-up period of 13.9 months. Meta-analysis showed an overall complication rate of 6% (95% CI 3.0-14.0), with hematoma/ecchymosis (5%), fat necrosis/oil cysts (2%), and irregular fat distribution and scars (both 2%) being among the most reported. No major complications were reported, and the overall patient satisfaction rate was 81%. Conclusion Although the evidence in this systematic review is still limited and plagued by heterogeneity between studies, AFT seems to be a promising method in facial rejuvenation with fewer complications than other fillers and high patient satisfaction rates. Further large-cohort, preferably multicenter, RCTs should substantiate these results through quantifiable volumetric assessment tools and validated patient questionnaires, while adhering to predetermined nomenclature in terms of complications.
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Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 2017; 20:49-60. [PMID: 28702187 PMCID: PMC5491488 DOI: 10.1016/j.amsu.2017.06.059] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. PATIENTS AND METHODS Literature review of publications concerning autologous fat grafting. RESULTS Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. CONCLUSIONS Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.
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Affiliation(s)
- Francesco Simonacci
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele Pio Grieco
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Tepavcevic B, Radak D, Jovanovic M, Radak S, Tepavcevic DK. Vascular Age as a Predictor of Side Effects After Facial Lipofilling. Aesthetic Plast Surg 2017; 41:729-737. [PMID: 28378184 DOI: 10.1007/s00266-017-0852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vascular age (VA) represents chronological age adjusted for an individual's atherosclerotic burden. Keeping in mind the fact that facial vascularization could influence the success of esthetic interventions, we aimed to investigate the predictive value of VA in development of side effects following facial lipofilling. METHODS In the period from October 1, 2014, to October 1, 2015, 106 consecutive subjects who underwent a facial lipofilling were included in the study. The VA was calculated using two approaches: Systematic Coronary Risk Evaluation (SCORE) project equations and means of vascular parameters assessed by color duplex sonographic examinations. The data regarding facial lipofilling-related complications (pain, edema and/or hematoma) have been collected during the regular checkups over 2 weeks after intervention. RESULTS The average chronological age of the participants was 50.9 ± 9.4 years. Estimation of VA using vascular sonographic parameters revealed the value of 45.4 ± 29.1 years, whereas the assessment of VA using SCORE equations showed that the mean age was 53.7 ± 12.7 (p = 0.006). The total frequency of these complications was as follows: 6.6% for hematoma, 15.1% for edema (13.2% mild edema and 1.9% severe edema) and 20.8% for local facial pain (17.0% mild pain and 3.8% severe pain). The multivariate logistic regression models showed that VA had statistically significant (p < 0.01) independent prognostic value for facial lipofilling-related appearance of hematoma and pain. CONCLUSIONS The results of our study revealed that advanced VA has an independent predictive role in the appearance of complications following facial plastic surgery. 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 .
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Bois E, Celerier C, Belhous K, Maulet M, Leboulanger N, Garabedian N, Denoyelle F. Velopharyngeal insufficiency managed by autologous fat grafting in patients with aberrant courses of internal carotid arteries. Int J Pediatr Otorhinolaryngol 2017; 96:135-139. [PMID: 28390603 DOI: 10.1016/j.ijporl.2017.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Velopharyngeal insufficiency (VPI) is usually managed, besides speech therapy, by performing a velopharyngoplasty. An alternative approach is autologous fat grafting (AFG) of the posterior pharyngeal wall. About 5% of the population has internal carotid arteries (ICA) with an aberrant course. This anatomic variation can be responsible for surgical difficulties while when performing a velopharyngoplasty, and therefore lead surgeons to only consider a speech reeducation of VPI. However, AFG is does not bear such surgical morbidity. OBJECTIVE The aim of this study is to retrospectively determine AFG efficiency on VPI in patients with aberrant ICA's courses who cannot benefit from a velopharyngoplasty, by comparing pre- and postoperative Borel Maisonny score (BMS) and intelligibility (Intell). METHODS We conducted a retrospective study in 2 centers, including children with VPI and aberrant ICA's courses who underwent an AFG of the posterior pharyngeal wall from 2004 to 2015, in addition to speech therapy. RESULTS Nine patients (4-11 years old) underwent the surgical procedure, 8 of them presenting a 22q11 microdeletion. All improved their VPI by AFG of the pharyngeal wall according to BMS and Intelligibility after a 10 months follow-up. The effect was stable after 3 years of follow-up. No severe complication (apnea, vascular injury) occured. CONCLUSION AFG of the pharyngeal wall, associated with speech therapy, seems to be a safe procedure for patients with VIP and aberrant ICA's courses. Multiple procedures are possible if needed.
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Affiliation(s)
- Emilie Bois
- Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France.
| | - Charlotte Celerier
- Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France.
| | - Kahina Belhous
- Radiology Department, Necker Enfants Malades Hospital, Paris, France.
| | - Michel Maulet
- Speech Therapist, Necker Enfants Malades Hospital, Paris, France
| | - Nicolas Leboulanger
- Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France.
| | - Noël Garabedian
- Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France.
| | - Françoise Denoyelle
- Otolaryngology-head and Neck Surgery Department, Necker Enfants Malades Hospital, Paris, France.
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Autologous Fat Grafting for Treating Blepharoplasty-induced Lower Eyelid Retraction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1190. [PMID: 28293531 PMCID: PMC5222676 DOI: 10.1097/gox.0000000000001190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 12/05/2022]
Abstract
Autologous fat grafting for blepharoplasty-induced lower eyelid retraction offers potential for a long-term solution while avoiding the morbidity associated with posterior lamellar spacer grafts. By combining traditional methods of lifting the retracted lower eyelid with autologous fat grafting, both functional and aesthetic concerns can be successfully addressed in these patients.
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