1
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Jeong W, Choi K, Choi J, Kim J, Son D, Jo T. Exploring the transcriptomic and metabolomic profiles of adipose tissues: Insights and implications for fat grafting. J Plast Reconstr Aesthet Surg 2024; 98:91-99. [PMID: 39243716 DOI: 10.1016/j.bjps.2024.08.066] [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: 03/17/2024] [Revised: 07/14/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Expanding on previous research on murine fat grafts' metabolic shift, this study delved deeper into the metabolic profiles of human adipose tissues, specifically the superficial subcutaneous adipose tissue (SSAT) and deep subcutaneous adipose tissue (DSAT). METHODS Utilizing RNA sequencing, metabolomics, and metabolic flux analyses, SSAT and DSAT samples obtained during deep inferior epigastric perforator flap breast reconstructions were examined. Transcript data underwent unsupervised hierarchical clustering and Gene Set Enrichment Analysis. Metabolomics involved analyzing samples for cationic and anionic metabolites via capillary electrophoresis time-of-flight mass spectrometry, followed by principal component analysis (PCA) and heat map generation. Primary adipocytes from SSAT and DSAT were assessed using the Seahorse® extracellular flux analyzer. RESULTS PCA and heat map analyses highlighted distinct transcriptomic and metabolomic differences between SSAT and DSAT. SSAT predominantly upregulated genes linked to adipogenesis [false discovery rate (FDR) q < 0.0001], oxidative phosphorylation (FDR q < 0.0001), fatty acid metabolism (FDR q < 0.0001), and glycolysis (FDR q = 0.001). In contrast, DSAT showed a significant upregulation in inflammatory response genes (FDR q < 0.05). Metabolite analysis revealed an abundance of glycolytic metabolites in SSAT, whereas DSAT was rich in metabolites associated with fatty acid metabolism and oxidative phosphorylation. Cellular flux analysis further confirmed SSAT's elevated glycolysis and spare oxidative phosphorylation capacities. CONCLUSION Results highlighted the metabolic uniqueness of SSAT and DSAT in humans, with SSAT exhibiting superior metabolic flexibility. The implications of these metabolic differences, especially in fat grafting procedures, necessitate further research and exploration in future studies.
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Affiliation(s)
- Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Kyehoon Choi
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Jaehoon Choi
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Junhyung Kim
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Daegu Son
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Taehee Jo
- Department of Plastic and Reconstructive Surgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
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2
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Van Roey VL, Irvine WF. Optimal Diagnostic and Treatment Practices for Facial Dysostosis Syndromes: A Clinical Consensus Statement Among European Experts. J Craniofac Surg 2024; 35:1315-1324. [PMID: 38801252 PMCID: PMC11198962 DOI: 10.1097/scs.0000000000010280] [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] [Received: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
Facial dysostosis syndromes (FDS) are rare congenital conditions impacting facial development, often leading to diverse craniofacial abnormalities. This study addresses the scarcity of evidence on these syndromes about optimal diagnostic and treatment practices. To overcome this scarcity, European experts from ERN CRANIO collaborated to develop a clinical consensus statement through the Delphi consensus method. A systematic search of Embase, MEDLINE/PubMed, Cochrane, and Web of Science databases was conducted until February 2023. The quality of evidence was evaluated using various tools depending on the study design. Statements were subsequently formed based on literature and expert opinion, followed by a Delphi process with expert health care providers and patient representatives. In total, 92 experts from various specialties and three patient representatives were involved in the Delphi process. Over 3 voting rounds, consensus was achieved on 92 (46.9%), 58 (59.2%), and 19 (70.4%) statements, respectively. These statements cover the topics of general care; craniofacial reconstruction; the eyes and lacrimal system; upper airway management; genetics; hearing; speech; growth, feeding, and swallowing; dental treatment and orthodontics; extracranial anomalies; and psychology and cognition. The current clinical consensus statement provides valuable insights into optimal diagnostic and treatment practices and identifies key research opportunities for FDS. This consensus statement represents a significant advancement in FDS care, underlining the commitment of health care professionals to improve the understanding and management of these rare syndromes in Europe.
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Affiliation(s)
- Victor L. Van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders, Rotterdam, The Netherlands
| | - Willemijn F.E. Irvine
- Department of Pediatric Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Evidence-Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
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3
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Murta F, Guevara GF, Hyer JN, Ezra DG. Quantitative Assessment of Periocular Autologous Fat Transfer Survival Using 3D Stereophotogrammetric Imaging. Ophthalmic Plast Reconstr Surg 2024; 40:55-60. [PMID: 38241618 DOI: 10.1097/iop.0000000000002504] [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: 01/21/2024]
Abstract
PURPOSE To assess periocular autologous fat transfer (AFT) survival by assessment of volume change with sequential 3D VECTRA imaging. OBJECTIVE Little is known about the patterns of graft survival of AFT in the periorbital region, especially in cases involving prior radiotherapy or trauma. The aim of this pilot study was to characterize fat survival following AFT in patients with a broad range of clinical indications, with and without a history of prior radiotherapy, for both periocular and orbital AFT, and in a subgroup of patients with an anophthalmic socket. METHOD A single-institution, prospective cohort study involving 18 applications of AFT for volume augmentation in the periocular and orbital area. All patients had sequential 3D VECTRA photographs following a validated standardized protocol. Patient demographics, including gender, age, ethnicity, underlying diagnosis, and volume of fat injected, were also collected. RESULTS In total 13 patients were enrolled, 9 female (69.2%) and 4 male (31.0%). Mean age at the time of surgery was 47.8 years. Patients had volume deficiency secondary to a variety of causes; the most common cause was postenucleation socket syndrome following trauma in 6 patients (46.2%). The mean fat survival volume at the 1-month postoperative point was 70% and 55% by 6 months. AFT conducted with a multiport cannula for fat harvesting use had an initial higher rate of fat reabsorption with ANOVA p = 0.002, however, this was not observed at the later follow-up periods. There was no statistically significant difference in fat survival between abdominal or thigh donor fat sites. There was no statistically significant difference in residual injected volume at the early follow-up period between patients who had prior radiotherapy and those who did not p = 0.8496. CONCLUSION AFT is an effective treatment for periorbital volume compromise with an acceptable survival rate in all categories of patients. Complex etiologies such as radiotherapy-related orbital and midface dysgenesis should not be a contraindication for AFT, with no difference in outcomes.
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Affiliation(s)
- Fabiola Murta
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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4
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Ma X, Huang J, Long X, Wang X. Quantifying outcomes of autologous fat transplantation in different facial deformities: A systemic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 87:117-130. [PMID: 37837945 DOI: 10.1016/j.bjps.2023.09.007] [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] [Received: 06/07/2023] [Revised: 08/10/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Autologous fat transplantation has become a common treatment for facial deformities. However, facial deformities are the result of complex diseases with different causes, and there has been no review on the effectiveness of autologous fat transplantation for facial deformities of different aetiologies. METHODS A systematic literature search of the Web of Science, Embase, and Medline Ovid databases was performed up to December 2022. Two investigators independently performed screening and data extraction according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by a meta-analysis using random-effects model for surgeon and patient satisfaction, facial symmetry, and complication rates. Twelve-month postoperative fat graft retention was estimated by meta-regression. RESULTS Thirty-one studies met the criteria, including 13 case series studies, 14 cohort studies, and four randomized clinical trials, with a total of 1572 patients. Follow-up visits within 6-12 months were performed in most of the studies. The results of the meta-analysis showed high overall surgeon satisfaction of 97% (95% CI: 92%-100%) and patient satisfaction of 95% (95% CI: 89%-99%), with a low complication rate of 3.4% (95% CI: 1.9%-5.9%). At 12 months postoperatively, a lower retention rate of 43% (95% CI: 28%-58%) was estimated in cases of acquired atrophic deformities compared with 64% (95% CI: 57%-71%) in cases of mixed deformities. Overall, autologous fat transplantation improved facial symmetry by 13% (95% CI: 8.4%-18%). CONCLUSION Autologous fat transplantation is generally a safe and effective procedure that can compensate for facial volume deficits and improve facial symmetry but may be less effective in cases of acquired atrophic facial deformities.
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Affiliation(s)
- Xuda Ma
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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5
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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6
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Louis F, Sowa Y, Irie S, Higuchi Y, Kitano S, Mazda O, Matsusaki M. Injectable Prevascularized Mature Adipose Tissues (iPAT) to Achieve Long-Term Survival in Soft Tissue Regeneration. Adv Healthc Mater 2022; 11:e2201440. [PMID: 36103662 DOI: 10.1002/adhm.202201440] [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: 10/04/2021] [Revised: 09/01/2022] [Indexed: 01/28/2023]
Abstract
Soft tissue regeneration remains a challenge in reconstructive surgery. So far, both autologous fat implantations and artificial implants methods used in clinical applications lead to various disadvantages and limited lifespan. To overcome these limitations and improve the graft volume maintenance, reproducing a mature adipose tissue already including vasculature structure before implantation can be the solution. Therefore, injectable prevascularized adipose tissues (iPAT) are made from physiological collagen microfibers mixed with human mature adipocytes, adipose-derived stem cells, and human umbilical vein endothelial cells, embedded in fibrin gel. Following murine subcutaneous implantation, the iPAT show a higher cell survival (84% ± 6% viability) and volume maintenance after 3 months (up to twice heavier) when compared to non-prevascularized balls and liposuctioned fat implanted controls. This higher survival can be explained by the greater amount of blood vessels found (up to 1.6-fold increase), with balanced host anastomosis (51% ± 1% of human/mouse lumens), also involving infiltration by the lymphatic and neural vasculature networks. Furthermore, with the cryopreservation possibility enabling their later reinjection, the iPAT technology has the merit to allow noninvasive soft tissue regeneration for long-term outcomes.
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Affiliation(s)
- Fiona Louis
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan
| | - Shinji Irie
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,TOPPAN INC, Taito, Tokyo, 110-0016, Japan
| | - Yuriko Higuchi
- Department of Drug Delivery Research, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, 606-8501, Japan
| | - Shiro Kitano
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,TOPPAN INC, Taito, Tokyo, 110-0016, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Michiya Matsusaki
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan
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7
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Stem Cell Banking of Adipose Tissue. CURRENT STEM CELL REPORTS 2022. [DOI: 10.1007/s40778-022-00222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Fat Grafting: Basic Science, Techniques, and Patient Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3987. [PMID: 35317456 PMCID: PMC8932485 DOI: 10.1097/gox.0000000000003987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.
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9
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Chauvel-Picard J, Allavena J, Beuriat PA, Di Rocco F, Gleizal A, Paulus C. Lipofilling of the lower eyelids: A craniofacial tool to postpone the facial advancement in craniofacial syndromes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:448-451. [PMID: 34649014 DOI: 10.1016/j.jormas.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Many genetic diseases are responsible for a defect in the growth of the maxilla. Craniofacial syndromes such as Crouzon syndrome or Apert syndrome are typically associated with a major hypoplasia in the midface responsible for exophthalmos, leading to palpebral malocclusion and frequent corneal complications. Several treatments have been used to manage ocular protection in craniofacial syndromes such as tarsorrhaphy, a fronto-orbital advancement and/or a Lefort III osteotomy with or without distraction. We describe a new approach as a waiting solution to relieve exophthalmos: the autologous fat grafting of the lower eyelids. MATERIAL AND METHODS Children operated from lipofilling of the lower eyelids at the Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital in Lyon, were included. All the patients suffered from midface hypoplasia and exophthalmos with insufficient eyelid closure responsible of multiples episodes of keratitis and corneal ulcerations. RESULTS Four children were included: three suffered from Crouzon Syndrome and one suffered from Apert Syndrome. The fat was reinjected at the level of the infraorbital rim, the nasolabial fold or the palpebrojugal fold, in the different planes, according to the patients' needs. Six months after surgery, a second surgery was performed for the patients whose lagophtalmos persisted. Six months after the second procedure, the results are satisfactory with a good eyelid closure. CONCLUSION The lipofilling, well used in pediatric surgery to restore facial symmetry, can also be used, as a waiting solution or complement to treat complicated exophtalmos with visual prognosis involved in congenital craniofacial syndromes.
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Affiliation(s)
- Julie Chauvel-Picard
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France.
| | - Julie Allavena
- Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Arnaud Gleizal
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Christian Paulus
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
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10
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Changing the Paradigm of Craniofacial Reconstruction: A Prospective Clinical Trial of Autologous Fat Transfer for Craniofacial Deformities. Ann Surg 2021; 273:1004-1011. [PMID: 30985369 DOI: 10.1097/sla.0000000000003318] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to prospectively assess outcomes for surgical autologous fat transfer (AFT) applied for traumatic and postsurgical craniofacial deformities. The minimally invasive nature of AFT has potential for reduced risk and superior outcomes compared with current reconstructive options. BACKGROUND Craniofacial deformities have functional and psychosocial sequelae and can profoundly affect quality of life. Traditional reconstructive options are invasive, invasive, complex, and often lack precision in outcomes. Although AFT is safe, effective, and minimally invasive, only anecdotal evidence exists for reconstruction of craniofacial deformities. METHODS In this Institutional Review Board-approved prospective cohort study, 20 subjects underwent AFT (average volume: 23.9 ± 13.2 mL). Volume retention over time was determined using high-resolution computed tomography. Flow cytometry was used to assess cellular subpopulations and viability in the stromal vascular fraction. Quality of life assessments were performed. After the completion of 9-month follow-up, 5 subjects were enrolled for a second treatment. RESULTS No serious adverse events occurred. Volume retention averaged 63 ± 17% at 9 months. Three-month retention strongly predicted 9-month retention (r=0.996, P < 0.0001). There was no correlation between the total volume injected and retention. Patients undergoing a second procedure had similar volume retention as the first (P = 0.05). Age, sex, body mass index, and stromal vascular fraction cellular composition did not impact retention. Surprisingly, former smokers had greater volume retention at 9 months compared with nonsmokers (74.4% vs 56.2%, P = 0.009). Satisfaction with physical appearance (P = 0.002), social relationships (P = 0.02), and social functioning quality of life (P = 0.05) improved from baseline to 9 months. CONCLUSIONS For craniofacial defects, AFT is less invasive and safer than traditional reconstructive options. It is effective, predictable, and reaches volume stability at 3 months. Patient-reported outcomes demonstrate a positive life-changing impact.
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11
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the types of tumescence available for liposuction. 2. Explain the various modalities available for liposuction. 3. Describe the patient selection, staging, and complications associated with debulking liposuction. 4. Describe ways to optimize outpatient liposuction. SUMMARY Liposuction is one of the most common procedures performed by board-certified plastic surgeons and is likely greatly underestimated, given underreporting of office procedures and the number of non-plastic surgeons performing these operations. With the ever-increasing popularity of liposuction, various methodologies and technology have been designed to make this task simpler and faster for the surgeon and hasten the recovery for the patient. In the past 10 years, over 50 devices or techniques have been released to assist, refine, or altogether replace liposuction. With the advent of these newer tools, a thorough Continuing Medical Education study was performed to review the available literature.
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12
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Efficacy of Autologous Fat Grafting in Restoring Facial Symmetry in Linear Morphea-Associated Lesions. Symmetry (Basel) 2020. [DOI: 10.3390/sym12122098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Morphea is a rare sclerotic autoimmune disorder primary affecting the skin and subcutaneous tissues. The linear head variants involve the facial area, with asymmetries and deformities. Eighteen patients with hemifacial deformity (age range 14–75 years) were assessed before surgery (T0), and after one (T1, 18 patients) or two (T2, six patients) surgical treatments of facial autologous fat grafting. A stereophotogrammetric reconstruction of the facial surface was obtained for each patient and a group of control subjects, and facial symmetry was quantified according to the root mean square distance between homologous areas of trigeminal innervation. Values obtained from the control subjects were used to calculate z-scores for patients. At T0, all facial thirds of the patients resulted significantly more asymmetrical than those of the control subjects (Mann–Whitney test, p < 0.05), while at T1, the symmetry of the middle facial third did not differ from that of control subjects (p = 0.263). At T2, the upper and the lower facial thirds also did not differ from the control values (p > 0.05). The faster result obtained in the facial middle third was in accord with clinical findings. In conclusion, autologous fat grafting significantly improved facial asymmetry after one (middle facial third) or two (lower and upper thirds) treatments; the outcomes were efficaciously quantified by stereophotogrammetry.
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13
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Isolated Fat Grafting for Reconstruction of Lower Face Volumetric Asymmetry in Skeletally Immature Patients: A Clinical Outcome Study. Ann Plast Surg 2020; 83:529-537. [PMID: 31232814 DOI: 10.1097/sap.0000000000001934] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to assess the objective and subjective outcomes of lower face volumetric (contour) asymmetry correction with isolated fat grafting in skeletally immature patients. METHODS A prospective analysis was conducted of skeletally immature patients (n = 73) with craniofacial microsomia and Parry-Romberg syndrome who underwent isolated fat grafting (with no previous or concomitant bone surgery) using anatomical surgical principles (facial subunits and fat compartments) for the reconstruction of lower face volumetric asymmetry. Objective ultrasound and photogrammetric lower face symmetry analyses were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment of blinded surgical professionals and laypersons was also obtained to grade the subjective lower face symmetry. RESULTS There were significant (all P < 0.05) postoperative objective and subjective lower face symmetry enhancements (preoperative < postoperative) after isolated fat grafting, with no differences (all P > 0.05) between 3 versus 12 months' postoperative comparisons. CONCLUSIONS Growing patients with unilateral lower face volumetric asymmetries presented with improvement of objective and subjective symmetry after a single isolated fat grafting procedure.
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14
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Ziade G, Karam D. Emulsified fat and nanofat for the treatment of dark circles. Dermatol Ther 2020; 33:e14100. [DOI: 10.1111/dth.14100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Georges Ziade
- Faculty of Medicine American College of Surgeons, Lebanese University Beirut Lebanon
| | - Desiree Karam
- Faculty of Medicine Holy Spirit University of Kaslik Mount Lebanon Lebanon
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15
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The Current Status of the Autologous Fat Grafting for Pediatric Craniofacial Patients. Ann Plast Surg 2020; 85:568-573. [DOI: 10.1097/sap.0000000000002286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
Craniofacial deformities represent a great challenge for the patient and the plastic surgeon. Fat grafting has allowed a shift in paradigm for craniofacial reconstruction by providing a less invasive and safer alternative than traditional reconstructive options. Increasing evidence supports its use with optimal results. This article examines the evidence and practical aspects involved in the decision making and technique of fat grafting to treat secondary craniofacial deformities.
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Affiliation(s)
- Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA
| | - Sydney R Coleman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA.
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17
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Shih L, Abu-Ghname A, Davis MJ, Xue AS, Dempsey RF, Buchanan EP. Applications of Fat Grafting in Pediatric Patients. Semin Plast Surg 2020; 34:53-58. [PMID: 32071580 DOI: 10.1055/s-0039-3402517] [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: 12/12/2022]
Abstract
Autologous fat grafting has become a widely utilized technique for a variety of cosmetic and reconstructive procedures. Its potential for volume restoration and tissue regeneration has made it a popular method for treating soft tissue defects in both adult and pediatric populations. While autologous fat grafting in the pediatric setting is not as well characterized as it is in the adult setting, various reports have demonstrated the safety and utility of its applications in nonadult patient populations. In this article, we present the first comprehensive review of the current applications of autologous fat grafting in pediatric patients. Specific challenges to fat grafting in the pediatric setting and future applications will also be discussed.
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Affiliation(s)
- Linden Shih
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amy S Xue
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F Dempsey
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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18
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The Influence of Negative Pressure and of the Harvesting Site on the Characteristics of Human Adipose Tissue-Derived Stromal Cells from Lipoaspirates. Stem Cells Int 2020; 2020:1016231. [PMID: 32104182 PMCID: PMC7035580 DOI: 10.1155/2020/1016231] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/13/2020] [Indexed: 01/18/2023] Open
Abstract
Background Adipose tissue-derived stromal cells (ADSCs) have great potential for cell-based therapies, including tissue engineering. However, various factors can influence the characteristics of isolated ADSCs. Methods We studied the influence of the harvesting site, i.e., inner thigh (n = 3), outer thigh (n = 3), outer thigh (n = 3), outer thigh ( Results We revealed higher initial cell yields from the outer thigh region than from the abdomen region. Negative pressure did not influence the cell yields from the outer thigh region, whereas the yields from the abdomen region were higher under high negative pressure than under low negative pressure. In the subsequent passage, in general, no significant relationship was identified between the different negative pressure and ADSC characteristics. No significant difference was observed in the characteristics of thigh ADSCs and abdomen ADSCs. Only on day 1, the diameter was significantly bigger in outer thigh ADSCs than in abdomen ADSCs. Moreover, we noted a tendency of thigh ADSCs (i.e., inner thigh+outer thigh) to reach a higher cell number on day 7. Discussion. The harvesting site and negative pressure can potentially influence initial cell yields from lipoaspirates. However, for subsequent in vitro culturing and for use in tissue engineering, it seems that the harvesting site and the level of negative pressure do not have a crucial or limiting effect on basic ADSC characteristics.in vitro culturing and for use in tissue engineering, it seems that the harvesting site and the level of negative pressure do not have a crucial or limiting effect on basic ADSC characteristics.
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Role of Autologous Fat Injection in Neglected Patients With Anterior Plagiocephaly. J Craniofac Surg 2019; 30:e637-e639. [DOI: 10.1097/scs.0000000000005662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rajan S, Ajayakumar K, Sasidharanpillai S, George B. Autologous Fat Graft for Soft Tissue Camouflage in Craniofacial Microsomia. J Cutan Aesthet Surg 2019; 12:223-226. [PMID: 32001966 PMCID: PMC6967170 DOI: 10.4103/jcas.jcas_99_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In India, a large majority of patients with craniofacial microsomia are unable to undergo complex reconstructions owing to unaffordability, lack of access to good craniofacial centers, or reluctance of parents to accept the surgical risk. There is also considerable social stigma attached to the resultant facial scars of surgery, especially in a girl child. Hence, we have explored autologous fat graft transfer as a "stand-alone" reconstructive option for soft tissue camouflage and aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky-Kaban Grades I and II. MATERIALS AND METHODS Twelve patients who were seeking aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky-Kaban Grades I and II, and who had adequate fat in the preferred donor sites of lower abdomen and antero-medial thighs, were selected. Patients with Grade III deformity, facial palsy, and previous skeletal surgeries were excluded. Autologous fat harvesting was done with the standardized Coleman's technique and injected after decantation. Volumetric augmentation was assessed by clinical comparison with normal side for facial symmetry, skin pinch thickness at four reference points, and by two-dimensional analysis of pre- and postoperative standardized photographs at periodic intervals. RESULTS AND ANALYSIS Eleven of our patients were female and one was a male (N = 12). In each session, 20-40mL (mean 28.75 ± standard deviation [SD] 5.69) fat was aspirated and 12-35mL (mean 23.67 ± SD 6.07) fat was injected. The average operating time was 35min (mean 32.91 ± SD 4.05). Majority of our patients needed three sessions (mean 2.8 ± SD 1.03) of serial fat injections to achieve bilateral facial symmetry. Increase in skin pinch thickness was 6.4167 ± 1.31 mm. The mean patient satisfaction score was 8.83 ± SD .717. CONCLUSION Based on our results, we conclude that autologous fat transfer, when used for soft tissue camouflage, is a versatile, easy, effective, and inexpensive method for obtaining consistent long-term aesthetic goals in mild to moderate cases of craniofacial microsomia.
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Affiliation(s)
- Sheeja Rajan
- Associate Professor, Department of Plastic and Reconstructive Surgery, Government Medical College, Kozhikode, Kerala, India
| | - K Ajayakumar
- Professor, Department of Plastic and Reconstructive Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sarita Sasidharanpillai
- Associate Professor, Department of Dermatology and Venerology, Government Medical College, Kozhikode, Kerala, India
| | - Biju George
- Associate Professor, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
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Krastev TK, Beugels J, Hommes J, Piatkowski A, Mathijssen I, van der Hulst R. Efficacy and Safety of Autologous Fat Transfer in Facial Reconstructive Surgery: A Systematic Review and Meta-analysis. JAMA FACIAL PLAST SU 2019; 20:351-360. [PMID: 29596574 DOI: 10.1001/jamafacial.2018.0102] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The use of autologous fat transfer (AFT) or lipofilling for correcting contour deformities is seen as one of the major breakthroughs in reconstructive plastic surgery. Its applications in facial reconstructive surgery have been of particular interest owing to the prospect of achieving autologous reconstruction by a minimally invasive approach. However, its unpredictability and variable degree of resorption have limited its utility and much skepticism still exists regarding its efficacy. Furthermore, more than 2 decades of clinical research have produced a highly fragmented body of evidence that has not been able to provide definite answers. Objective To investigate the safety and efficacy of AFT in facial reconstruction through a systematic review and meta-analysis. Data Sources A literature search was performed in PubMed, Embase, and the Cochrane Library from inception to October 11, 2017. Study Selection All published studies investigating the efficacy and safety of AFT in facial reconstructive surgery. Data Extraction and Synthesis Two independent reviewers performed data extraction systematically, adhering to the PRISMA guidelines. Summary measures were pooled in a random-effects model meta-analysis. Main Outcomes and Measures The patient and surgeon satisfaction, graft survival, number of AFT sessions, and the incidence of AFT-related complications were the main outcomes of interest in this meta-analysis. Results This systematic review resulted in the inclusion 52 relevant studies consisting of 1568 unique patients. These included 4 randomized clinical trials, 11 cohort studies, and 37 case series. The overall follow-up averaged 1.3 years after AFT. Meta-analysis revealed a very high overall patient satisfaction rate of 91.1% (95% CI, 85.1%-94.8%) and overall surgeon satisfaction rate of 88.6% (95% CI, 83.4%-92.4%). The number of AFT sessions required to achieve the desired result was 1.5 (95% CI, 1.3-1.7) and 50% to 60% of the injected volume was retained at 1 year. Only 4.8% (95% CI, 3.3%-6.9%) of procedures resulted in clinical complications. Conclusions and Relevance To our knowledge, this study provides the first overview of the current knowledge about AFT in facial reconstructive surgery. Our results confirm that AFT is an effective technique for treating soft-tissue deformities in the head and neck, with low rate of minor complications. Level of Evidence NA.
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Affiliation(s)
- Todor K Krastev
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Jip Beugels
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Juliette Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Irene Mathijssen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rene van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Cabrejo R, Sawh-Martinez R, Steinbacher DM. Effect of Fat Grafting on Postoperative Edema After Orthognathic Surgery. J Craniofac Surg 2019; 30:698-702. [DOI: 10.1097/scs.0000000000005287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Paranasal Fat Grafting Improves the Nasal Symmetry in Patients With Parry-Romberg Syndrome. J Craniofac Surg 2019; 30:958-960. [PMID: 30839470 DOI: 10.1097/scs.0000000000005424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gornitsky J, Viezel-Mathieu A, Alnaif N, Azzi AJ, Gilardino MS. A systematic review of the effectiveness and complications of fat grafting in the facial region. JPRAS Open 2019; 19:87-97. [PMID: 32158860 PMCID: PMC7061561 DOI: 10.1016/j.jpra.2018.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/15/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the safety and efficacy of fat grafting to the facial region for the reconstruction and aesthetic enhancement of facial contour. METHODS A systematic literature review of the National Library of Medicine (PubMed), MEDLINE and Cochrane databases was performed. Studies involving the outcomes of autologous fat grafting to correct or enhance contour defects of the face were included. Extracted data included patient demographics, harvest and injection sites, graft harvesting and injection technique, mean injected volume, retained volume percentage and complications. RESULTS Forty-three articles met the inclusion criteria, resulting in 4577 patients with various facial contour defects treated with autologous fat grafting. Injection sites were categorized by anatomic facial regions as upper (32.5%), middle (53%) and lower face (14.5%). The mean volume of injected fat was 16.9 ml. The mean weighted volume retention of non-enriched grafts was 41.63% at the time of follow up (mean 13.9 months). A total of 104 (2.27%) complications were reported including asymmetry (74), skin irregularities (14), prolonged edema (4), graft hypertrophy (4), fat necrosis (3), infection (2), erythema (1), telangiectasia (1), and activation of acne (1). CONCLUSION The present study represents the first systematic review of fat grafting in the facial region, a widely-performed procedure within plastic surgery practice. Importantly, it presents pooled important data such as retained grafting volume and complication rates in this anatomical region, providing clinicians with more accurate information with which to guide their decision-making and patient education.
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Affiliation(s)
- Jordan Gornitsky
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic & Reconstructive Surgery, McGill University Health Center, Montreal Children's Hospital, 1001 Decarie Boulevard, B05.3310, Montreal, Quebec H4A 3J1, Canada
| | - Nayif Alnaif
- Division of Plastic & Reconstructive Surgery, McGill University Health Center, Montreal Children's Hospital, 1001 Decarie Boulevard, B05.3310, Montreal, Quebec H4A 3J1, Canada
| | - Alain Joe Azzi
- Division of Plastic & Reconstructive Surgery, McGill University Health Center, Montreal Children's Hospital, 1001 Decarie Boulevard, B05.3310, Montreal, Quebec H4A 3J1, Canada
| | - Mirko S. Gilardino
- Division of Plastic & Reconstructive Surgery, McGill University Health Center, Montreal Children's Hospital, 1001 Decarie Boulevard, B05.3310, Montreal, Quebec H4A 3J1, Canada
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Facial Contour Symmetry Outcomes after Site-Specific Facial Fat Compartment Augmentation with Fat Grafting in Facial Deformities. Plast Reconstr Surg 2019; 143:544-556. [PMID: 30688900 DOI: 10.1097/prs.0000000000005220] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fontes T, Brandão I, Negrão R, Martins MJ, Monteiro R. Autologous fat grafting: Harvesting techniques. Ann Med Surg (Lond) 2018; 36:212-218. [PMID: 30505441 PMCID: PMC6251330 DOI: 10.1016/j.amsu.2018.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Autologous fat grafting is widely used for soft-tissue augmentation and replacement in reconstructive and aesthetic surgery providing a biocompatible, natural and inexpensive method. Multiple approaches have been developed in the past years, varying in the location of adipose tissue donor-sites, use of wetting solutions, harvesting, processing and placing techniques. Despite many advances in this subject, the lack of standardization in the protocols and the unpredictability of the resorption of the grafted tissue pose a significant limitation for graft retention and subsequent filling. In this review, we discuss several approaches and methods described over the last years concerning the harvesting of autologous fat grafts. We focus on contents such as the best donor-site, differences between existing harvesting techniques (namely tissue resection, hand aspiration or liposuction techniques), recommended harvesting cannula diameters, pressure application and volume of wetting solution injected prior aspiration. Results and comparisons between methods tend to vary according to the outcome measured, thus posing a limitation to pinpoint the most efficient methods to apply in fat grafting. Additionally, the lack of a standard assay to determine viability or volume augmentation of fat grafting remains another limitation to obtain universally accepted grafting procedures and protocols. Distinct harvesting procedures associate with different outcomes of fat graft take. Flank, abdomen, thigh and knee are the more consistently used donor-sites for fat. Higher vacuum pressures in liposuction are more traumatic for the tissue. The tumescent technique is a safer procedure with improved aesthetic results. Comparing harvesting techniques is a big challenge given the multiple variables.
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Affiliation(s)
- Tomás Fontes
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Inês Brandão
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
| | - Rita Negrão
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
| | - Maria João Martins
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
| | - Rosário Monteiro
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal.,Unidade de Saúde Familiar Pedras Rubras, Agrupamento de Centros de Saúde Maia-Valongo, Maia, Portugal
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Abstract
BACKGROUND The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial soft-tissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting. METHODS A retrospective analysis of consecutive patients (n = 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. RESULTS There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement, with a mean fat graft procedures per patient of 1.6 ± 0.7, ranging of 1 to 3. CONCLUSION A significant improvement of facial contour symmetry was obtained in a subset of patients using fat grafting according to the SOBRAPAR Hospital algorithm.
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Deferoxamine Preconditioning of Irradiated Tissue Improves Perfusion and Fat Graft Retention. Plast Reconstr Surg 2018; 141:655-665. [PMID: 29135894 DOI: 10.1097/prs.0000000000004167] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Radiation therapy is a mainstay in the treatment of many malignancies, but collateral damage to surrounding tissue, with resultant hypovascularity, fibrosis, and atrophy, can be difficult to reconstruct. Fat grafting has been shown to improve the quality of irradiated skin, but volume retention of the graft is significantly decreased. Deferoxamine is a U.S. Food and Drug Administration-approved iron-chelating medication for acute iron intoxication and chronic iron overload that has also been shown to increase angiogenesis. The present study evaluates the effects of deferoxamine treatment on irradiated skin and subsequent fat graft volume retention. METHODS Mice underwent irradiation to the scalp followed by treatment with deferoxamine or saline and perfusion and were analyzed using laser Doppler analysis. Human fat grafts were then placed beneath the scalp and retention was also followed up to 8 weeks radiographically. Finally, histologic evaluation of overlying skin was performed to evaluate the effects of deferoxamine preconditioning. RESULTS Treatment with deferoxamine resulted in significantly increased perfusion, as demonstrated by laser Doppler analysis and CD31 immunofluorescent staining (p < 0.05). Increased dermal thickness and collagen content secondary to irradiation, however, were not affected by deferoxamine (p > 0.05). Importantly, fat graft volume retention was significantly increased when the irradiated recipient site was preconditioned with deferoxamine (p < 0.05). CONCLUSIONS The authors' results demonstrated increased perfusion with deferoxamine treatment, which was also associated with improved fat graft volume retention. Preconditioning with deferoxamine may thus enhance fat graft outcomes for soft-tissue reconstruction following radiation therapy.
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Guo Y, Lopez J, Yang R, Macmillan A, Dorafshar AH. The Use of Virtual Surgical Planning in Total Facial Skeletal Reconstruction of Treacher Collins Syndrome: A Case Report. Craniomaxillofac Trauma Reconstr 2017; 11:230-237. [PMID: 30087754 DOI: 10.1055/s-0037-1604424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
Abstract
Facial skeletal reconstruction of patients with severe Treacher Collins syndrome (TCS) requires correction of both midface and mandibular deficiencies. Implementing virtual surgical planning can provide an accurate three-dimensional analysis of craniofacial abnormalities, creating calvarial donors that match the anatomy of the desired malar augmentation and facilitating bimaxillary movements, positioning, and fixation in orthognathic surgery. We present a case of an 18-year-old patient with TCS, who underwent staged zygomaticomaxillary reconstruction and double-jaw osteotomy with sliding genioplasty, using computer-assisted surgical planning. Following these operations, the patient achieved not only improved facial harmony but also class I occlusion.
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Affiliation(s)
- Yifan Guo
- Department of Plastic and Reconstructive Surgery, Brody School of Medicine at East Carolina University, Greenville, South Carolina
| | - Joseph Lopez
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
| | | | - Amir H Dorafshar
- Department of Plastic and Reconstructive Surgery, JHMI, Baltimore, Maryland
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Bilateral Malar Reconstruction Using Patient-Specific Polyether Ether Ketone Implants in Treacher–Collins Syndrome Patients With Absent Zygomas. J Craniofac Surg 2017; 28:515-517. [DOI: 10.1097/scs.0000000000003351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Varghese J, Griffin M, Mosahebi A, Butler P. Systematic review of patient factors affecting adipose stem cell viability and function: implications for regenerative therapy. Stem Cell Res Ther 2017; 8:45. [PMID: 28241882 PMCID: PMC5329955 DOI: 10.1186/s13287-017-0483-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The applications for fat grafting have increased recently, within both regenerative and reconstructive surgery. Although fat harvesting, processing and injection techniques have been extensively studied and standardised, this has not had a big impact on the variability of outcome following fat grafting. This suggests a possible larger role of patient characteristics on adipocyte and adipose-derived stem cell (ADSC) viability and function. This systematic review aims to collate current evidence on the effect of patient factors on adipocyte and ADSC behaviour. METHODS A systematic literature review was performed using MEDLINE, Cochrane Library and EMBASE. It includes outcomes observed in in vitro analyses, in vivo animal studies and clinical studies. Data from basic science work have been included in the discussion to enhance our understanding of the mechanism behind ADSC behaviour. RESULTS A total of 41 papers were included in this review. Accumulating evidence indicates decreased proliferation and differentiation potential of ADSCs with increasing age, body mass index, diabetes mellitus and exposure to radiotherapy and Tamoxifen, although this was not uniformly seen across all studies. Gender, donor site preference, HIV status and chemotherapy did not show a significant influence on fat retention. Circulating oestrogen levels have been shown to support both adipocyte function and graft viability. Evidence so far suggests no significant impact of total cholesterol, hypertension, renal disease, physical exercise and peripheral vascular disease on ADSC yield. CONCLUSIONS A more uniform comparison of all factors highlighted in this review, with the application of a combination of tests for each outcome measure, is essential to fully understand factors that affect adipocyte and ADSC viability, as well as functionality. As these patient factors interact, future studies looking at adipocyte viability need to take them into consideration for conclusions to be meaningful. This would provide crucial information for surgeons when deciding appropriate volumes of lipoaspirate to inject, improve patient selection, and counsel patient expectations with regards to outcomes and likelihood for repeat procedures. An improved understanding will also assist in identification of patient groups that would benefit from graft enrichment and cryopreservation techniques.
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Affiliation(s)
- Jajini Varghese
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK.
| | - Michelle Griffin
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK.,UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - Afshin Mosahebi
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK.,UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - Peter Butler
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK.,UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
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Isolated Autologous Free Fat Grafting for Management of Facial Contour Asymmetry in a Subset of Growing Patients With Craniofacial Microsomia. Ann Plast Surg 2016; 76:288-94. [PMID: 25954839 DOI: 10.1097/sap.0000000000000533] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To report autologous free fat grafting as an isolated procedure to manage facial contour asymmetry of a subset of growing patients with craniofacial microsomia (CFM). METHODS A retrospective analysis of CFM patients (n = 11) with low socioeconomic and intellectual status, poor oral hygiene, living far from our center, Pruzansky-Kaban I/II mandibles, without functional concerns, and with no craniofacial skeletal surgery who underwent isolated free fat grafting between 2012 and 2013 was conducted. Surgeon and parent/patient satisfaction were elicited. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. RESULTS All patients underwent isolated autologous free fat grafting to restore the facial contour symmetry. Surgeon and patient/parent were mostly satisfied. There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement. CONCLUSIONS A significant improvement of facial symmetry was obtained in this subset of growing CFM patients using only isolated free fat grafting.
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Early Fat Grafting for Augmentation of Orbitozygomatic Region in Treacher Collins Syndrome. J Craniofac Surg 2016; 26:1258-60. [PMID: 26080169 DOI: 10.1097/scs.0000000000001722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This report presents our preliminary experience with the effect of early fat grafting (FG) (at ≥ 6 months of age) in timely bone reconstruction of the orbitozygomatic area in patients with Treacher Collins syndrome. FG is performed 2 to 3 consecutive times after the age 6 months. Bone reconstruction is performed ≥ 6 months after the last FG session. This protocol was applied in 3 patients. There was no need for further reconstruction of the lower eyelids in 2 patients. Malar bone reconstructions, using calvarial bone grafts, were performed in all of the patients. Eighteen months after bone reconstruction, there was limited absorption of the bone grafts. Early FG of the orbitozygomatic area improves contour and tissue quality, restores volume, and can possibly minimize bone resorption following zygomatic bone framework reconstruction.
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The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques. Plast Reconstr Surg 2016; 136:897-912. [PMID: 26086386 DOI: 10.1097/prs.0000000000001590] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in and acceptance of autologous fat grafting for use in contour abnormalities, breast reconstruction, and cosmetic procedures have increased. However, there are many procedural variations that alter the effectiveness of the procedure and may account for the unpredictable resorption rates observed. METHODS The authors highlighted studies investigating the effects of harvesting procedures, processing techniques, and reinjection methods on the survival of fat grafts. This review focused on the impact different techniques have on outcomes observed in the following: in vitro analyses, in vivo animal experiments, and human studies. RESULTS This systemic review revealed the current state of the literature. There was no significant difference in the outcomes of grafted fat obtained from different donor sites, different donor-site preparations, harvest technique, fat harvesting cannula size, or centrifugation speed, when tumescent solution was used. Gauze rolling was found to enhance the volume of grafted fat, and no significant difference in retention was observed following centrifugation, filtration, or sedimentation in animal experiments. In contrast, clinical studies in patients found more favorable outcomes with fat processed by centrifugation compared with sedimentation. In addition, higher retention was observed with slower reinjection speed and when introduced into less mobile areas. CONCLUSIONS There has been a substantial increase in research interest to identify methodologies for optimizing fat graft survival. Despite some differences in harvest and implantation technique in the laboratory, these findings have not translated into a universal protocol for fat grafting. Therefore, additional human studies are necessary to aid in the development of a universal protocol for clinical practice.
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Orbital soft tissue surgery for patients with Treacher-Collins or Nager syndrome. A new surgical approach with early correction of soft tissue: prospective study. Br J Oral Maxillofac Surg 2015; 53:421-5. [DOI: 10.1016/j.bjoms.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 02/05/2015] [Indexed: 11/20/2022]
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The versatility of autologous fat transplantation in correction of facial deformities: a single-center experience. PLASTIC SURGERY INTERNATIONAL 2015; 2015:703535. [PMID: 25821598 PMCID: PMC4363609 DOI: 10.1155/2015/703535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 11/18/2022]
Abstract
Deformities in the craniofacial region are of great social and functional importance. Several surgical techniques have been used to treat such pathologies often with high morbidity and lacking the ability to address smaller contour defects. The minimally invasive technique of fat transplantation has evolved rapidly within the last few decades. The objective of this paper is to present the versatility and applicability of fat transplantation in a wide range of contour deformities in the craniofacial region. We share our experiences in treating 13 patients with autoimmune disorders, congenital malformations, and acquired defects. Future perspectives of fat transplantation in the field of craniofacial reconstruction are discussed.
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Bulgin D, Vrabic E, Hodzic E. Autologous bone-marrow-derived-mononuclear-cells-enriched fat transplantation in breast augmentation: evaluation of clinical outcomes and aesthetic results in a 30-year-old female. Case Rep Surg 2013; 2013:782069. [PMID: 24024064 PMCID: PMC3760121 DOI: 10.1155/2013/782069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/24/2013] [Indexed: 01/21/2023] Open
Abstract
Autologous fat transfer (lipofilling) is becoming an invaluable tool for breast augmentation as well as for breast reconstruction. Autologous lipofilling has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main limitation is unpredictable fat graft resorption, which ranges from 25% to 80%, probably as a result of ischaemia and lack of neoangiogenesis. To obviate these disadvantages, several studies have searched for new ways of increasing the viability of the transplanted fat tissue. One promising approach is to enrich the fat graft with autologous bone-marrow-derived mononuclear cells (BMMNCs) before transplantation. BMMNCs produce many angiogenic and antiapoptotic growth factors, and their secretion is significantly enhanced by hypoxia. All of these mechanisms of actions could be beneficial for the stimulation of angiogenesis in ischemic tissues by BMMNCs administration. In our aesthetic surgery practice, we use fat transplantation enriched with BMMNCs, which caused a significant improvement in survival of fat grafts, compared with that of traditional lipofilling. Our experience with freshly isolated autologous fat enriched with BMMNCs for breast augmentation procedures is presented. The concept of this surgical and tissue handling technique is based on ability of BMMNCs to stimulate blood vessel growth.
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Affiliation(s)
- Dmitry Bulgin
- Polyclinic “ME-DENT,” 18 Istarska, 52210 Rovinj, Croatia
| | - Erik Vrabic
- Polyclinic “ME-DENT,” 18 Istarska, 52210 Rovinj, Croatia
- Department of Plastic and Reconstructive Surgery, University Clinical Centre (UCC), 5 Ljubljanska, 2000 Maribor, Slovenia
| | - Enes Hodzic
- Polyclinic “ME-DENT,” 18 Istarska, 52210 Rovinj, Croatia
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Nikkhah D, Ponniah A, Ruff C, Dunaway D. A classification system to guide orbitozygomatic reconstruction in Treacher-Collins syndrome. J Plast Reconstr Aesthet Surg 2013; 66:1003-5. [DOI: 10.1016/j.bjps.2013.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/06/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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