Effectiveness of Autologous Fat Grafting in Scaring After Augmentation Rhinoplasty:

Autologous Shuffling Lipo-Aspirated Fat Combined Mechanical Stretch in Revision Rhinoplasty for Severe Contractures in Asian Patients

BACKGROUND

A severely contracted nose is a common occurrence. Intraoperative expansion is not sufficient to soften the severely constricted nasal envelope, which poses challenges in revision rhinoplasty. In recent years, adjuvant therapies, including nasal fat grafting and cell component injection, are applied before revision rhinoplasty to soften the nasal envelope. Herein, autologous shuffling lipo-aspirated fat and manual mechanical stretch were combined as adjuvant therapy before revision rhinoplasty.

METHODS

A total of 24 patients with severe nasal contracture were included in this study. Of these, 8 received autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty (comprehensive therapy), 8 underwent mechanical stretch and revision rhinoplasty, and 8 patients underwent only revision rhinoplasty. The objective and subjective outcome assessment was processed in the follow-up period of 6 months. Nasal length, nasal tip projection, nasofrontal angle, and nasolabial angle were measured, and potential complications were assessed.

RESULTS

All 24 patients underwent a successful revision rhinoplasty. In the comprehensive therapy group, no patient had postoperative wound infection and defect of the nasal column mucous. The comprehensive treatment group had the most significant improvement in nasal length and nasal tip projection, and the nasolabial angle was the closest to 90°, which indicated the most effective nasal revision and aesthetic contour.

CONCLUSIONS

The adjuvant therapy combines autologous shuffling lipo-aspirated fat and manual mechanical stretch before revision rhinoplasty could effectively improve the surgical outcome and decrease the postoperative complications regarding severe nasal contractures.

LEVEL OF EVIDENCE IV

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Autologous Fat Injection for Augmentation Rhinoplasty: A Systematic Review

BACKGROUND

Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections.

OBJECTIVES

This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections.

METHODS

The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet.

RESULTS

The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%.

CONCLUSIONS

Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications.

LEVEL OF EVIDENCE 4

Our experience with lipofilling in secondary rhinoplasty, into a new era

Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining popularity. Given the characteristic of lipofilling to rejuvenate and improve skin texture, fat grafting can be used to reshape the nose in secondary rhinoplasty. Fat was injected in 27 patients with a mean age of 42 years. Volume of fat ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months, and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evaluation questionnaire and plastic surgeons' evaluation. After 1 year follow up, 20 patients were satisfied with the results at 1 year. The aesthetic outcome was noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of the patients had an improvement in skin texture with trophic effect on the skin. No complications were seen in our series According to this study, nasal lipofilling is a safe and efficacious filler in secondary rhinoplasty. However, more studies are needed to assess the indications and limitations of nose lipofilling.