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Hoang Thanh T, Nguyen Kim T. A Simple Procedure of Fascia-Fat Grafting and Blepharoplasty as a Single-Stage Procedure for the Correction of Sunken Eyelids in Vietnamese Population. Ophthalmic Plast Reconstr Surg 2024; 40:453-459. [PMID: 38319189 DOI: 10.1097/iop.0000000000002624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
PURPOSES Upper sunken eyelids, which are characterized by the hollowness of the upper eyelids, often cause a poor aesthetic appearance. Herein, we present a simplified technique using fascia-fat grafts for volume augmentation combined with blepharoplasty as a single-stage procedure. METHODS From January 2021 to December 2021, 30 patients with sunken eyelids visiting our clinic for hollow eyelid treatment underwent a fascia-fat grafting derived from the inguinal crease combined with simultaneous eyelid reconstruction. A modified classification of sunken eyelids that was more suitable for the Asian population was proposed. RESULTS Postoperatively, edema and ptosis were transient and addressed thanks to proper massage and compresses. Two cases had scar fibers leading to a slight tension of upper eyelids at 6-month follow-up. This event was addressed by triamcinolone acetonide injections at 4-6-week intervals with satisfactory results. The orbital volume of all patients was satisfying and stable up to 12 months after the surgery. The satisfaction rate was 100% and 88.8% in group 1 and group 2, respectively, at 12-month follow-up. CONCLUSIONS Fascia-fat grafting combined with blepharoplasty as a single-stage procedure was a simplified method that did not require varied types of surgical tools but brought satisfactory results. This method facilitated the routine procedure and eased surgeons in the clinical practices.
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Affiliation(s)
- Tuan Hoang Thanh
- Plastic and Reconstructive Aesthetic Surgery Center, Viet Nam National Burn Hospital, Military Medical University, Hanoi, Vietnam
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Li G, Wang H. Novel Applications of Concentrated Growth Factors in Facial Rejuvenation and Plastic Surgery. Facial Plast Surg 2024; 40:112-119. [PMID: 36423628 DOI: 10.1055/a-1987-3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Concentrated growth factor (CGF), which is a third-generation platelet concentrate product, exhibits good potential for repair and regeneration of soft and hard tissues, and has gradually attracted attention in the field of cosmetic plastic surgery. The purpose of this review is to summarize the application and research of CGF in the field of facial rejuvenation and plastic surgery. A comprehensive review of the literature about the applications of CGF in facial rejuvenation and plastic surgery was conducted in PubMed, Ovid MEDLINE, and Web of Science. According to the inclusion and exclusion criteria, a total of 22 articles were included in this review. In recent years, CGF has been applied in many aspects in the field of facial rejuvenation and plastic surgery, including skin photoaging, repairment of soft-tissue defects, rhinoplasty, hair loss, autologous fat transplantation, and scars. In addition, no significant adverse reactions have been reported so far. CGF is rich in high-concentration growth factors, which has great potential and application prospects in facial rejuvenation and plastic surgery. However, the applications of CGF still have some problems, such as the mechanism, time of decomposition, and long-term efficacy and safety, which are needed to be resolved in future.
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Affiliation(s)
- Guo Li
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, Sichuan University West China Hospital of Stomatology, Chengdu, People's Republic of China
| | - Hang Wang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, Sichuan University West China Hospital of Stomatology, Chengdu, People's Republic of China
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Hajimortezayi Z, Daei N, Gholizadeh N, Zakeri M, Alhili F, Hasanzadeh S, Hormozi A, Ebrahimi F, Zamani M. Fat transplant: Amazing growth and regeneration of cells and rebirth with the miracle of fat cells. J Cosmet Dermatol 2023. [PMID: 38010992 DOI: 10.1111/jocd.16103] [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: 03/25/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUNDS AND OBJECTIVE During fat transplantation, adipose tissue is removed from the body and injected into different areas under the skin. The goal of this review article is to look into the efficacy and applicability of fat transplantation in regenerative medicine and rejuvenation, including Nanofat, Microfat, and Millifat. METHODS As a search strategy and study selection, we searched the PubMed and Medline databases until 2023 using related keywords (e.g., Nanofat, Microfat and Millifat, Regenerative Medicine, and Rejuvenation). RESULTS Autologous fat transplantation has no risk of an allergic reaction or rejection of the transplant by the individual. Autologous adipose tissue is considered an ideal filler for facial rejuvenation and is suggested as the most biocompatible and non-immunogenic skin filler. Adipose tissue transplant may have semi-permanent to permanent effects. According to recent reports, adipose tissues possess a high percentage of mature stem cells. The effect of regenerating adipose tissue and its intrinsic cells can be described as an obvious process. Variations in the sizes of adipose tissues can result in different results depending on the surgical site. Based on topographic assessment, graft fats are assigned depending on the anatomical locations and the size such as Millifat (2-2.5 mm), Microfat (1 mm), and Nanofat (500 μm or less). CONCLUSION Some characteristics of fat tissue increase its effectiveness, such as increasing stem cells, growth factors, cytokines, and compounds effective in repair, regeneration, and rejuvenation.
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Affiliation(s)
- Zahra Hajimortezayi
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Narges Daei
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Nasim Gholizadeh
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mana Zakeri
- Department of Biology, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Farah Alhili
- Medical Technical College, Al-Farahidi University, Baghdad, Iraq
| | - Sajedeh Hasanzadeh
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Arezoo Hormozi
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Faezeh Ebrahimi
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Majid Zamani
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Li R, Chen X, Sun H, Hao L, Luo S. Application of 3-Dimensional Technology for Evaluating Muscular Type and Muscle-Fat Pad Mixed-Type Nasolabial Folds With Botulinum Toxin-A Treatment. Aesthet Surg J 2023; 43:NP271-NP282. [PMID: 36536480 DOI: 10.1093/asj/sjac341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Botulinum toxin-A (BTX-A) is used in the treatment of nasolabial folds (NLFs). However, lighting and clinician subjectivity play a major role in evaluating the efficacy of this treatment. OBJECTIVES By applying 3-dimensional (3D) technology, this study aimed to quantitatively evaluate the effects of BTX-A injection on muscular (M) and muscle-fat pad mixed-type (MF) NLFs. METHODS BTX-A was injected into bilateral marked points on the NLFs, where the levator labii alaeque nasi, zygomaticus minor, and zygomaticus major pull the skin to form the NLF (2 U at each injection site). Pretreatment and posttreatment 3D facial images were captured with static and laughing expressions. The curvature, width, depth, and lateral fat volume of the NLFs were measured to compare the therapeutic efficacy for type M and MF NLFs. RESULTS Thirty-nine patients with type M and 37 with type MF NLFs completed the follow-up data. In these patients, the curvature, width, and depth of the NLF showed a significant reduction at 1 month and gradually recovered at 3 and 6 months after treatment, with more significant improvement when laughing than when static. Variations compared to the pretreatment values of type MF were greater than those of type M at each time point. The lateral fat volume of the type MF NLF was significantly reduced (P < .05). CONCLUSIONS 3D technology can quantitatively evaluate the effects BTX-A injection for treating type M and type MF NLFs. BTX-A is more effective on type MF than on type M NLFs. LEVEL OF EVIDENCE: 4
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Wang Z, Cheng R, Du Y, Chen X, Li R, Hao L, Luo S. The Retention-Rate Improvement of Stromal Vascular Fraction Gel in Prefrontal Filling With Botulinum Toxin-A Injection: A Retrospective Analysis. Aesthet Surg J 2023; 43:NP202-NP212. [PMID: 36495214 DOI: 10.1093/asj/sjac332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As a derivative of adipose tissues, stromal vascular fraction gel has been widely utilized in facial soft tissue filling, but it still does not achieve the expected effect in forehead filling. The reason may be related to the corrugator muscles movements. OBJECTIVES The authors aimed to evaluate the effect of botulinum toxin-A (BTX-A) on the retention rate of stromal vascular fraction gel by limiting the corrugator muscles movements and to provide a theoretical basis that short-term inhibition of movement in the affected area could improve the effects of the fat graft. METHODS From January 2019 to June 2021, patients with stromal vascular fraction gel facial filling (including frontal and temporal parts) were selected. According to whether or not BTX-A treatment was received, patients were divided into injected and the noninjected groups. A questionnaire and the Global Aesthetic Improvement Scale (GAIS) were administered to evaluate 2-dimensional photos. The retention rate and curvature were calculated with 3-dimensional images utilizing Artec Studio 13 Professional and MATLAB software. RESULTS The graft retention, forehead curvature, and GAIS scores were all higher in the injected group than the noninjected group (P < .01). On the questionnaire, the injected group also showed more satisfaction with the treatment effect and were more willing to recommend the treatment to their friends. CONCLUSIONS BTX-A injection can improve the retention rate of prefrontal stromal vascular fraction gel filling, with higher patient satisfaction and better postoperative effects. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Zhizhou Wang
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Rong Cheng
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Yuyang Du
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Xinyao Chen
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Rou Li
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Lijun Hao
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Sai Luo
- From the Plastic and Aesthetic Center, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
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Du Y, Ye Y, Wang Q, Li M, Chen X, Li R, Hao L, Luo S. Effect of Positional Changes on Skin Landmarks in Midface Filling. Aesthet Surg J 2022; 42:NP778-NP785. [PMID: 35667001 DOI: 10.1093/asj/sjac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The design lines for midfacial filling shift upward with a patient's position changes from upright to supine during operation. This will cause the actual filled part to deviate from the target area. OBJECTIVES This authors aimed to evaluate the effect of positional changes on midfacial landmarks and find the optimal body position for midface filling. METHODS The process involved the grading and evaluation stages. The midfacial laxity of each sample in the evaluation stage was graded into minimal, moderate, and severe by the system established in the grading stage. Measured through the 3-dimensional images in each grade, the vertical distances from landmarks C, D, and E (representing the region of the tear trough, infraorbital area, and nasolabial fat pad, respectively) to the horizontal line of the inner canthus and depth of nasolabial fold at an angle of 90° were separately compared with those from the other angles (60°, 45°, 30°, and 0°) of the operating table. RESULTS In the minimal midfacial laxity group, all 3 landmarks significantly moved upward when the angle decreased to 30°. However, landmark E of the moderate and severe and landmark D of the severe midfacial laxity groups both significantly moved upward when the angle decreased to 45°. The depth of the nasolabial fold at a 45° angle was significantly less than that at a 90° angle in the moderate and severe groups. CONCLUSIONS In midface filling, a patient's body position should be optimally selected according to the midfacial laxity and filling area.
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Affiliation(s)
- Yuyang Du
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Yajie Ye
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Qing Wang
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Meijia Li
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Xinyao Chen
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Rou Li
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Lijun Hao
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
| | - Sai Luo
- Center of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Harbin Medical University, Nangang District, Harbin City, Heilongjiang Province, P. R. China
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Huang H, Tang X, Li S, Huang D, Lu D, Wu F, Liu D, Li H. Advanced platelet-rich fibrin promotes the paracrine function and proliferation of adipose-derived stem cells and contributes to micro-autologous fat transplantation by modulating HIF-1α and VEGF. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:60. [PMID: 35282074 PMCID: PMC8848409 DOI: 10.21037/atm-21-6812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 01/01/2023]
Abstract
Background The micro-autologous fat transplantation (MAFT) technique has demonstrated its feasibility in multiple medical fields, such as facial rejuvenation. Advanced platelet-rich fibrin (APRF), an autologous platelet concentrated on a fibrin membrane without added external factors, has shown significant potential for tissue restoration. However, the role of APRF in the modulation of MAFT remains unclear. Here, we aimed to explore the effect of APRF on MAFT. Methods Adipose-derived stem cells (ASCs) were isolated from human gastric subcutaneous fat and treated with APRF. ELISA assays measured cytokines. The proliferation of ASCs was analyzed by CCK-8 assays. The levels of hypoxia-inducible factor-1α (HIF-1α), heat shock protein 70 (HSP70), insulin like growth factor 2 (IGF-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) were measured by ELISA assays, quantitative reverse transcription-PCR (qRT-PCR), and Western blot analysis. The effect of APRF/HIF-1α/VEGF on MAFT in vivo was analyzed in Balb/c nude mice. The BALB/c mice were subcutaneously co-transplanted with fat, APRF, and control shRNA, HIF-1α shRNA, or VEGF shRNA into the dorsal area. The serum and protein levels of the above cytokines were analyzed by ELISA assays and Western blot analysis. Lipid accumulation was measured by Oil Red O staining. The expression of CD34 was assessed by immunohistochemical staining. Results APRF continuously secreted multiple cytokines, including epidermal growth factor (EGF), FGF-2, insulin like growth factor 1 (IGF-1), interleukin-1beta (IL-1β), interleukin-4 (IL-4), platelet-derived growth factor alpha polypeptide b (PDGF-AB), platelet-derived growth factor beta polypeptide b (PDGF-BB), transforming growth factor-beta (TGF-β), and VEGF. APRF was able to promote the proliferation of ASCs. APRF dose-dependently activated the expression of HIF-1α, HSP70, IGF-2, IL-6, IL-8, and VEGF in ASCs. APRF regulated the paracrine function of ASCs by modulating HIF-1α and VEGF.APRF increased the survival of MAFT by modulating HIF-1α and VEGF in vivo. Conclusions APRF promotes the paracrine function and proliferation of ASCs and contributes to MAFT by modulating HIF-1α and VEGF. Our findings provide new insights into the mechanism by which APRF regulates MAFT.
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Affiliation(s)
- Hao Huang
- Department of Plastic and Aesthetic Surgery, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xike Tang
- Dermatology Department, The Affiliated Nanning Infectious Disease Hospital of Guangxi Medical University and the Fourth People's Hospital of Nanning, Nanning, China
| | - Shounan Li
- Department of Thoracic Surgery, the People's Hospital of Binyang County, Nanning, China
| | - Donglin Huang
- Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | | | - Fuzhi Wu
- Nanning Wilking Biological Technology Co., Ltd., Nanning, China
| | - Dalie Liu
- Department of Plastic and Aesthetic Surgery, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongmian Li
- Research Center of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, Nanning, China
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Abstract
Autologous fat grafting is commonly used for soft tissue augmentation and reconstruction, this technique is limited by a high rate of graft absorption. The stromal vascular fraction gel (SVF-gel) grafting for facial volume augmentation can exert a positive effect on skin rejuvenation, but its major limitation is the low rate of conversion of Coleman fat. The purpose of our study was to investigate a novel surgery using performing high-density fat in combination with SVF-gel in the treatment of hemifacial atrophy, or Romberg diseases. From October 2017 to October 2019, 13 patients with hemifacial atrophy underwent high-density fat transfer with SVF-gel injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules (FACE-Q conceptual framework: 1, Satisfaction with Facial Appearance; 2, Health-Related Quality of Life; 3, Negative Sequelae; 4, Satisfaction with Process of Care), which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. The excellent cosmetic results were observed during follow-up periods, with no adverse events was seen in the treatment group. All patients showed improvements in facial augmentation and contour. In patients with facial volume loss, high-density fat transfer with SVF-gel facial injection resulted in significantly higher improvement scores and better patient satisfaction. The patient-reported FACE-Q modules presurgery and postsurgery results showed statistically significant improvement (P < 0.05). This high-density fat in combination with SVF-gel is an effective method of correcting the facial volume loss that leave no complications during follow-up, having a satisfactory volumization effect. This could largely facilitate the clinical utilization of fat.
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Fan P, Fang M, Li J, Solari MG, Wu D, Tan W, Wang Y, Yang X, Lei S. A Novel Fat Making Strategy With Adipose-Derived Progenitor Cell-Enriched Fat Improves Fat Graft Survival. Aesthet Surg J 2021; 41:NP1228-NP1236. [PMID: 34387330 DOI: 10.1093/asj/sjab216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A low survival rate is one of the main challenges in fat grafting. OBJECTIVES This study aimed to evaluate whether microfat obtained by a novel strategy promoted the survival and retention of fat grafts. METHODS A 5-mm-diameter blunt tip cannula with large side holes (~30 mm2/hole) was used to obtain macrofat. A novel strategy based on a newly invented extracorporeal cutting device was then used to cut the macrofat into microfat, which was named adipose-derived progenitor cell enrichment fat (AER fat); Coleman fat was used as the control. Aliquots (0.5 mL) of both types of fat were transplanted into 10 nude mice and analyzed 10 weeks later. Western blotting, flow cytometry, and immunofluorescence were performed to assess the AER fat characteristics and underlying mechanisms. RESULTS The retention rate of fat grafts in AER fat-treated animals was significantly higher than that in the Coleman group (mean [standard deviation] 54.6% [13%] vs 34.8% [9%]; P < 0.05) after 10 weeks. AER fat contained more dipeptidyl peptidase-4-expressing progenitor cells (3.3 [0.61] × 103 vs 2.0 [0.46] × 103 cells/mL; P < 0.05), adipose-derived plastic-adherent cells (6.0 [1.10] × 104 vs 2.6 [0.17] × 104 cells/mL; P < 0.001), and viable adipocytes than Coleman fat. Moreover, histologic analysis showed that AER fat grafts had better histologic structure and higher capillary density. CONCLUSIONS AER fat transplantation is a potential strategy to improve the survival and long-term retention of fat grafts. AER fat contained more dipeptidyl peptidase-4-expressing progenitor cells.
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Affiliation(s)
- Pengju Fan
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Man Fang
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jingjing Li
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dingyu Wu
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Wuyuan Tan
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Yongjie Wang
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Xinghua Yang
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Shaorong Lei
- Department of Burn and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
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Abstract
Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.
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Affiliation(s)
- Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
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11
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Abstract
BACKGROUND Because the anatomic mechanisms underlying the formation of the midcheek groove are unclear, treatments to date have resulted in unsatisfactory outcomes. OBJECTIVE This study investigated the anatomical foundation of the midcheek groove and evaluated appropriate treatment methods. MATERIALS AND METHODS Six cadaver hemifacial specimens were subjected to gross anatomic dissection and 6 to P45 sheet plastination. Based on the anatomic results, the area under the orbicularis oculi muscle (OOM) was selected for deep filling. Patients were evaluated by measuring 3D depth, regrading, and self-assessment. RESULTS The medial band was observed to be an important structure of the OOM, with the facial projection overlapping the midcheek groove trace. Two of the 6 P45 specimens were found to have compact fibroelastic bundles (CFBs) between the medial band and the dermis. Deep filling of the area under the OOM significantly reduced the depth of each section in all 34 patients (p < .001). Grades 3 and 4 midcheek grooves were downgraded distinctively. Most subjects expressed satisfaction with outcomes. CONCLUSION Formation of the midcheek groove is associated with the passage of CFBs. Deep filling of the area under the OOM effectively improves the midcheek grooves.
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Luo S, Zhang X, Dong H, Wen C, Hao L. Correction of the Tear Trough Deformity and Concomitant Infraorbital Hollows With Extracellular Matrix/Stromal Vascular Fraction Gel. Dermatol Surg 2021; 46:e118-e125. [PMID: 32187039 DOI: 10.1097/dss.0000000000002359] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The tear trough deformity is a sign of eye aging. Filling is an ideal choice for the tear trough accompanied by infraorbital hollows. OBJECTIVE To evaluate the efficacy and safety of stromal vascular fraction gel (SVF-gel) as a filler for the tear trough deformity which is combined with infraorbital hollows. MATERIALS AND METHODS From July 2017 to June 2018, 33 patients underwent autologous fat aspiration and were followed up successfully. Stromal vascular fraction gel was used to correct patients with bilateral Barton I/II; tear trough deformity and infraorbital hollows. Improvement was evaluated by measuring skin-periosteal depth, 3D volume, global aesthetic improvement scale (GAIS), and patient self-assessment. RESULTS Skin-periosteal depth improved significantly (p < .001). The volumetric increment of the tear trough and infraorbital regions increased 2.132 ± 0.671 mL, and the retention rate was excellent (72.87 ± 10.23%). The GAIS showed a high score (2.5 ± 0.5 points), with patient self-assessment showing satisfactory results for all 7 questions on the questionnaire. CONCLUSION The high retention rate of SVF-gel suggests that it can provide an effective solution to tear trough deformity accompanied by infraorbital hollows.
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Affiliation(s)
- Sai Luo
- All authors are affiliated with the Center of Plastic and Aesthetic Surgery of the First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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13
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Gruber RP. Invited Discussion on: Concentrated Growth Factors Extracted from Blood Plasma used to Repair Nasal Septal Mucosal Defect After Rhinoplasty. Aesthetic Plast Surg 2020; 44:517-518. [PMID: 31624893 DOI: 10.1007/s00266-019-01504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald P Gruber
- Departments of Plastic and Reconstructive Surgery, Stanford University, Stanford, USA.
- University of California (SF), San Francisco, USA.
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14
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Abstract
BACKGROUND Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue-derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this "skin rejuvenation" effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality. METHODS The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications. RESULTS Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue-derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported. CONCLUSION Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue-derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.
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Abstract
BACKGROUND Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes. METHODS Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis. RESULTS Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as "satisfactory" by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results. CONCLUSIONS Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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16
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Schultz KP, Raghuram A, Davis MJ, Abu-Ghname A, Chamata E, Rohrich RJ. Fat Grafting for Facial Rejuvenation. Semin Plast Surg 2020; 34:30-37. [PMID: 32071577 DOI: 10.1055/s-0039-3402767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
For optimal results, facial rejuvenation procedures should address both the tissue laxity and volume deflation associated with facial aging. The lift-and-fill face lift, in which fat grafting provides volumetric rejuvenation to the face while surgical lift effectively repositions and removes ptotic and redundant tissue, has revolutionized the plastic surgeon's approach to the aged face. An understanding of the intricate anatomy of distinct facial fat compartments and a systematic method to assess areas of fat atrophy and volume depletion are keys to provide patients with a natural and youthful result. Fat grafting may be used to improve contour in any area treatable by nonautologous injectable fillers, including the temples, forehead, upper and lower orbit, cheeks, perioral region, nasolabial fold, jawline, and chin-with the benefit of a more natural contour and integration with native tissue.
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Affiliation(s)
- Kelly P Schultz
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas
| | - Anjali Raghuram
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas
| | - Matthew J Davis
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas
| | - Edward Chamata
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas
| | - Rod J Rohrich
- Department of Surgery, Division of Plastic Surgery, Michael E. DeBakey, Baylor College of Medicine, Houston, Texas.,Dallas Plastic Surgery Institute, Dallas, Texas
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Upper Lip Fat Grafting Using the Anatomical Subunit and Fat Compartment Principles Improves Lip Cant and Symmetry in Patients With Unilateral Upper Lip Asymmetries. Ann Plast Surg 2019; 84:163-172. [PMID: 31688118 DOI: 10.1097/sap.0000000000002027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Micro-Autologous Fat Transplantation Combined With Platelet-Rich Plasma for Facial Filling and Regeneration: A Clinical Perspective in the Shadow of Evidence-Based Medicine. J Craniofac Surg 2019; 30:672-677. [PMID: 30688814 DOI: 10.1097/scs.0000000000005122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Despite the popularity of lipofilling procedures in recent years, the presence of older habits still in fat graft harvesting and processing seems to be the biggest obstacle to the final better outcome of fat grafting. Our study is aimed to highlight some strategies what should be done in fat grafting in the shadow of evidence-based medicine and patient-reported outcomes which might be of interest to the clinicians. Between 2015 and 2017, 14 patients were included who underwent facial micro-autologous fat transplantation with platelet-rich plasma injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules, which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. Surveys conducted were modules of satisfaction with facial appearance, satisfaction with cheeks, satisfaction with skin, psychological function, social function, aging appearance appraisal, and satisfaction with the outcome. All patients were followed up minimum 9 months. No major complications were recorded. The patient-reported FACE-Q satisfaction and FACE-Q quality-of-life presurgery and postsurgery results showed statistically significant improvement (<0.001). Overall satisfaction with the outcome was 87.6 ± 16.8 (range 55-100). A combination of platelet-rich plasma and micro-fat grafting with soft harvesting and processing could be seen a good surgical technique to restore volume and enhance skin quality in facial soft tissue augmentation. The authors believe that with minimum detrimental effect on fat grafting while harvesting, processing, and with the addition of platelet-rich plasma while applying may increase the surgeon's and patient's satisfaction with the outcome.
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Platelet-Rich Plasma and Platelet-Rich Fibrin Enhance the Outcomes of Fat Grafting. Plast Reconstr Surg 2019; 143:1201e-1212e. [DOI: 10.1097/prs.0000000000005624] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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