Volumetric Effect and Patient Satisfaction after Facial Fat Grafting

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.

Effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value

Facial fat grafting is a popular cosmetic procedure, and experts are increasingly endorsing the use of high-density fat with adipose stem cell glue for better results. This study aims to explore the effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value. We conducted a randomized trial with 100 patients who underwent facial fat transplantation between August 2020 and August 2022. They were divided into two groups: a control group receiving traditional Coleman fat transplantation and an observation group receiving high-density fat with adipose stem cells. In the observation and control groups, the excellent and good rate was 98.00 and 80.00%. After 3 months of treatment, the thickness of frontal subcutaneous fat and temporal subcutaneous fat in the observation group was higher (P < 0.05). Observation group retention of fat transplantation was noticeably higher 3 months after treatment (P < 0.05). Three months after treatment, the VISIA (facial imaging system) scores of facial color spots, facial pores and facial wrinkles in the observation group were lower (P < 0.05). After treatment, both groups indicated noticeable improvements in physiological functions, health status, social function, mental health, and somatic diseases compared to before treatment. Notably, the observation group had higher scores (P < 0.05). The observation group had a lower complication rate (4.00% vs. 22.00%) and higher satisfaction rate (98.00% vs. 86.00%) than the control group. Using high-density fat combined with adipose stem cell glue for facial fat grafting yields superior results, reduces complications, and boosts patient satisfaction compared to traditional methods. We have complied with all relevant ethical regulations with regard to the use of stem cells.

In Vitro Characterization of Fat Grafts Processed Using the REVOLVE ENVI System versus Decantation

Background

This preclinical study evaluated benchtop/in vitro properties and fat viability and activity of grafts processed using the REVOLVE ENVI 600 system compared with decantation and evaluated properties of REVOLVE ENVI waste.

Methods

Lipoaspirate from six donors was processed using REVOLVE ENVI or decantation. The composition of each graft, hematocrit/red blood cell content, fat particle size/macrostructure, viable adipocyte count, and adipocyte activity were analyzed. Stromal vascular fraction was analyzed for viable progenitor cell count and colony-forming units.

Results

REVOLVE ENVI grafts had a higher mean (±SD) fat content at 85.6% ± 6.1% than decanted grafts at 72.1% ± 4.0% (P < 0.001), with negligible free oil (0.4% ± 1.1%) and cellular debris (<0.1%), whereas REVOLVE ENVI waste contained primarily aqueous fluid (91.0% ± 2.2%) with negligible viable fat. REVOLVE ENVI grafts had significantly lower hematocrit levels (P < 0.001) and contained significantly more large fat globules (P < 0.001) than decanted grafts or REVOLVE ENVI waste. The percentage of tissue particles of more than 1000 µm was highest for REVOLVE ENVI grafts at 61.6% ± 9.2% (decantation: 52.5% ± 13.4%; REVOLVE ENVI waste: 0.49% ± 1.50%), and the percentage of particles less than 200 µm was lowest for REVOLVE ENVI grafts at 15.7% ± 2.6% (decantation: 32.2% ± 8.9%; REVOLVE ENVI waste: 97.9% ± 4.5%). REVOLVE ENVI grafts contained 145.2% ± 36.0% more viable adipocytes, 145.7% ± 46.2% greater activity, 195.5% ± 104.2% more progenitors in SVF, and 363.5% ± 161.2% more SVF colony-forming units than decanted grafts.

Conclusion

Fat grafts processed using REVOLVE ENVI demonstrated greater viability and activity than decanted grafts in vitro.

Best Practices for FACE-Q Aesthetics Research: A Systematic Review of Study Methodology

BACKGROUND

The FACE-Q Aesthetics module is a validated patient-reported outcome measure (PROM) that evaluates perspectives on facial aesthetic treatments. Improper administration and poor study methodology can compromise the validity and interpretation of this PROM.

OBJECTIVES

This systematic review sought to evaluate the administration and scoring of the FACE-Q Aesthetics scales within the literature.

METHODS

A search of Ovid Medline, Embase, Cochrane, and Web of Science was performed on December 20, 2022, with the assistance of a health-research librarian (CRD42022383676). Studies that examined facial aesthetic interventions using the FACE-Q Aesthetics module as a primary or secondary outcome measure were included for analysis.

RESULTS

There were 114 studies included. The Face Overall (n = 52, 45.6%), Psychological (n = 45, 39.4%), and Social (n = 43, 37.7%) scales were most frequently reported. Errors in FACE-Q administration were identified in 30 (26.3%) studies. The most common error was the presentation of raw ordinal scores rather than the converted Q score (n = 23). Most studies reported a time horizon for their primary analysis (n = 76, 66.7%); however, only 4 studies provided a rationale for this selection. Sample size calculations for the primary outcome were rarely performed (n = 9, 7.9%).

CONCLUSIONS

There continues to be limitations in PROM administration and the quality of articles that report FACE-Q Aesthetic scale data. The authors suggest that future investigators using the FACE-Q refer to the User's Guide regarding administration and scoring of this scale, report a rationale for the study time horizon, and provide an a priori sample size calculation for the primary outcome of interest.