Comparison of clinical efficacy between autologous fat injection and orbital septum fat reset for infraorbital margin depression in young people / 中华医学美学美容杂志

Objective:To compare the clinical efficacy of autologous fat injection and conjunctival pedicled orbital septal fat grafting for infraorbital margin depression in young people.Methods:Fourty young patients with lower eyelid pouch and infraorbital margin depression with age of 20 to 40 years and average age of 30.6 yaers in the First Affiliated Hospital of Nanchang University from September 2017 to September 2019 were enrolled. According to the surgical method, all patients were divided into 2 groups with 20 cases each. Group 1 underwent transconjunctival orbital septum fat reset. Group 2 underwent various autologous fat injection after proper amount of orbital septal fat being removed, including structural fat, fine-particle fat and nano-fat, performed in different parts and layers. The tear trough rating scale (TTRS) scores and patients＇ satisfaction at 1 year after operation between 2 groups were compared.Results:Compared with the preoperative TTRS scores, the differences in scores at 6 months and 1 year after surgery were statistically significant ( P<0.01). The scores between two groups were compared at 6 months and 1 year respectively after the operation, and the difference were both statistically significant ( P<0.01). 6 months after the operation, the TTRS scores including four items were carefully compared between the two groups. It showed that the reduction of tear groove depth ( P<0.05), pigmentation ( P<0.01) and wrinkle ( P<0.01) in group 2 were more obvious than those in group 1. The percentage of satisfaction in group 2 (95%) was higher than that in the group 1 (70%), and the difference was statistically significant ( P<0.01). Conclusions:For infraorbital margin depression of young people, after proper amount of orbital septal fat being removed, various free fats graft injection into different parts and layers could obtain better treatment results, reducing not only the depth of the tear groove, but also periorbital pigmentation and fine wrinkles.

Total cerebral infarction caused by autologous fat injection in the forehead: a case report / 中华整形外科杂志

Cerebral artery embolism is a rare but serious complication of facial plastic surgery. This paper reports a case of severe total cerebral arterial fat embolism caused by facial autologous fat injection. The patient past away after 40 hours of treatment. The cause of this total cerebral artery embolism patient was analyzed by tracing relevant medical history and cephalic CTA examination. By studying this case, we hope to reduce the occurrence of similar situations in the future.

Efficacy of autologous fat injection to treat patulous Eustachian tube / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the efficacy of autologous fat injection of eustachian tube pharyngeal orifice in the treatment of Patulous eustachian tube (PET). METHODS We selected 18 patients who had no obvious improvement after medical treatment of PET over 1 months. They were treated with autologous fat injections to narrow the pharyngeal ostium of the eustachian tube. The treatment results were documented, including the patient's supervisory feeling and visual analogue scale (VAS). RESULTS The total effective rate was 83.3％ after 12 months of follow-up (symptoms significantly reduced in 27.8％ of patients and partial improvement is 55.6％), 16.7％ the symptoms remain unchanged, no one worsened. No patients had any complications. CONCLUSION Autologous fat injection of the eustachian tube is a effective and safe treatment for PET with the percentage of significant or partial relief of 83.3％, It is easy to conduct in clinical practice which could potentially serve as an alternative treatment for PET.

Periorbital Lipogranuloma after Autologous Fat Injection for Facial Augmentation / 대한피부과학회지

No abstract available.

Research progress of Autologous Fat Grafting for Scar Treatment / 医学研究生学报

The scar tissue, resulting from aberrant process of wound healing , can bring about cosmetic deformeties and func-tional limitation, even the displacement of tissues and organs .The widely use of autologous fat graft in regenerative medicine offers a relatively new option for scar treatment .Lipofilling has improved symptoms and appearance of scars in several studies .The application , therapeutic effect and mechanism research of autologous fat graft for scar treatment are summarized in this paper .

Periorbital Lipogranuloma after Facial Autologous Fat Injection and Its Treatment Outcomes

PURPOSE: To investigate periorbital lipogranuloma cases that developed after autologous fat injection and to determine various treatment outcomes from these cases. METHODS: This retrospective study involved 27 patients who presented with periocular mass (final diagnosis of lipogranuloma) and had history of facial autologous fat injection. The collected data included information on patient sex, age, clinical presentation, number and site of fat injections, interval between injections, duration from injection to symptom onset, fat harvesting site, use of cryopreservation, and treatment outcome. RESULTS: The most common presenting symptom was palpable mass (92.6%), followed by blepharoptosis and eyelid edema. The mean time from injection to symptom onset was 13.6 +/- 29.2 months (range, 2 to 153 months). Patients were managed by intralesional triamcinolone injection (six patients) and surgical excision (three patients); 18 patients were followed without treatment. Among the six patients who underwent intralesional triamcinolone injection, five showed complete resolution, and one showed partial resolution. Among the 18 patients who were followed without management, three showed spontaneous resolution over a 5-month follow-up period. CONCLUSIONS: Lipogranuloma can develop in the eyelid after autologous fat injection into the face. Both surgical excision and intralesional triamcinolone injection yield relatively good outcomes. Simple observation can be a good option because spontaneous resolution can occur in a subset of patients.

Magnetic Resonance Findings in Two Episodes of Repeated Cerebral Fat Embolisms in a Patient with Autologous Fat Injection into the Face

We report magnetic resonance image (MRI) and magnetic resonance spectroscopy (MRS) findings in a patient of cerebral fat embolism (CFE) occurred in a 26-year-old woman after an autologous fat injection into the face. After initial neurologic symptom onset, MRI and MRS data were obtained two times to investigate repeated CFE. We obtained the MRS data in the two different time intervals and two different echo times to compare the lesions with normal brain parenchyma. The results of MRS data showed that a decrease in N-acetyl-aspartate, an increase in lactate and a very high early peak of free lipids between 0.9 and 1.4 ppm were obtained at the acute infarcted lesion as compared with normal brain parenchyma. In addition, these findings were more clearly detected on short echo time spectrum rather than long spectrum. A close relationship between the clinical manifestations and MRI and MRS findings of the brain can helpful to distinguish CFE with other conditions and to evaluate the cause materials of infarctions rather than conventional MRI or diffusion-weighted imaging.

Segurança oncológica no uso de células tronco de origem adiposa e lipofilling na reconstrução mamária após câncer / Oncological safety in the use of stem cells from adipose origin and lipofilling in breast reconstruction after cancer

Lipofilling ou enxerto de gordura é uma técnica muito utilizada para corrigir defeitos em qualquer região do corpo humano. O objetivo deste estudo foi analisar a segurança desta técnica para corrigir defeitos de reconstruções mamárias após câncer de mama. Foram analisados 158 pacientes que receberam 194 procedimentos de enxerto de gordura, segundo a técnica de Coleman e realizados por um único cirurgião (MR). 98% das pacientes desta série tinham cirurgia oncológica mamária precedente: conservadora ou mastectomia com reconstrução. A única complicação pós-operatória encontrada nesta série foi a liponecrose associada à mastite em sete casos (3.6%), todos tratados com terapia antibiótica e curativos diários. Nos pacientes com precedente de cirurgia conservadora e tratados com enxerto de gordura, somente quatro (5.9%) apresentaram pequenas alterações na mamografia, simulando alterações benignas. Conclusão: O enxerto gorduroso pode ser uma boa solução para reparar defeitos após reconstrução em pacientes tratados de câncer de mama e pode reduzir indicações de cirurgias maiores, como reconstruções com retalhos miocutâneos. A incidência de complicações pósoperatórias é muito baixa e não ocorrem alterações significativas nas mamografias de seguimento oncológico...

Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast cancer reconstruction. A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer treated with conservative surgery or mastectomy followed by breast reconstruction. In all cases, fat grafting was performed according to the Coleman’s technique by a single surgeon. Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5,9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in the follow-up mammograms...

Nasolacrimal Duct Obstruction Following Midfacial Autologous Fat Injection / 대한이비인후과학회지

Epiphora is usually caused by nasolacrimal duct obstruction. The nasolacrimal duct obstruction is related with facial trauma, other nasal or paranasal sinus diseases, or recurrent dacryocystitis. We describe a case of iatrogenic nasolacrimal duct obstruction that occurred secondary to midfacial autologous fat injection. In our case, mal positioned fat tissue was detected on the dacryocystogram to be present in the lacrimal sac and the nasolacrimal duct. They were safely removed during dacryocystorhinostomy.

Augmentation Rhinoplasty with Dermofat Graft & Fat Injection

PURPOSE: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. METHODS: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. RESULTS: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. CONCLUSION: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

Contouring of Forehead and Temple Area with Auto-Fat Injection

PURPOSE: Facial contouring surgery for improving congenital, acquired deformity and senile change were attempt in past. Recently contouring surgery became more interested subject for improving the flat forehead and temple area. Many synthetic materials were used such as Collagen, silicon, polyacrylamide gel as liquid form and Gore-tex, silicon implant, endotine as solid form. But, these synthetic implants associate complications as foreign body reaction, infection, displacement, granuloma formation and absorption. Auto-fat injection are used for disfigurement of many part of body. We did auto-fat injection for facial contouring of forehead and temple region. Auto-fat injection is suitable without foreign body reaction, displacement, and toxic reaction. Also auto-fat is relatively simple to obtain from patient and less expensive and able to repeat surgeries. METHODS: From 2006 to 2009, 150 patients were treated with Auto-fat injection for facial contouring. For follow up, we sent questionnaire to all patients but 110 patients returned answer sheets. The patients consisted of 20 male patients and 90 female patients with an age ranged from 26 to 60, and the mean 43. Fat tissue were injected 6-8cc in forehead, 7-12cc in temple area and fat were harvested from thigh and abdomen. RESULTS: In follow up, all patients, showed absorption of injected fat varied degree and except two patients all patients underwent secondary fat injection. Complications were minimal and neuropraxia of facial nerve were recovered. Most of the patients were satisfied with result of procedure, and answered that they recommend same procedure to their friends and will do surgery again. CONCLUSION: Auto-fat injections were implemented for facial contouring in 150 patients and obtained satisfactory result. Auto-fat injection is relatively easy procedure and applicable widely. Even though, by passing time, some of the injected fats are absorbed, auto-fat injection could be choice of treatment for contouring forehead and temple. With accumulations of cases and development of surgical technique, better result could be expected.

The Combined Effect of Autologous Fat Injection and Liposculpture for Gluteal Reshaping in Koreans

PURPOSE: Together with the breast, buttocks are an important element of attractive body contour. To make a beautiful buttocks, improvement of body contour around the buttock as well as buttock augmentation and lifting is also important. The authors investigated characteristic features of buttocks in Koreans and report about the results of liposculpture and autologous fat injection for improving buttock's contour. METHODS: We performed a retrospective study of 21 patients who would like to gluteal reshaping. We checked about buttock's ptosis, projection, depression, gluteal retraction and excessive fat accumulation around buttocks. Depending on it, we performed liposculpture and autologous fat injection. Under general anesthesia, we harvested fat from excessive fat accumulation areas around buttocks, and injected into buttocks medio-superiorly. Postoperatively, pillows were positioned on the bed not to press the buttocks which were injected with the fat. RESULTS: Based on the shape of buttocks, A-shape is seen in 4 cases(19%), V-shape 3 cases(14%), square-shape 9 cases(43%), round-shape 5 cases(24%). Based on the Gonzalez's ptosis grading method, 1 degree ptosis is 1 case(4%), 2 degree ptosis is 6 cases(29%), 3 degree ptosis is 8 cases(38%), 4 degree ptosis is 6 cases(29%). There were no complications such as infection, hematoma, pain, dysparethesia. The subjective assessment of surgical results by patients was excellent. CONCLUSION: To make a beautiful buttock, improvement of body contour around the buttock as well as buttock augmentation and lifting is also important. Liposculpture and autologous fat grafting are very safe, useful and easy methods for improving buttock's contour.

Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

PURPOSE: To report an unusual case of anterior ischemic optic neuropathy and choroidal ischemia after injection of autologous fat into the periorbital region due to embolism of the short posterior ciliary artery without involving the retinal artery. CASE SUMMARY: A 39-year-old female presented with sudden blurred vision, diplopia and ptosis of her left eye immediately after receiving an autologous fat injection into the periorbital area. The first ophthalmologic examination revealed that the patient s left eye had decreased visual acuity, relative afferent pupillary defect, exotropia, and hypertropia. Fundus examination of the left eye showed disc edema. Fluorescein angiography showed multiple choroidal vascular filling defects at the early phase and wedge-shaped or geographic fluorescein staining at the superior, inferior, and temporal peripheral areas at late phase. Humphrey visual field test results disclosed an inferior visual field defect. On the follow-up visit after oral steroid therapy (prednisolone 30 mg) for 7 days, diplopia disappeared and visual acuity recovered to 1.0. The inferior visual field defect and relative afferent pupillary defect were still present.

Sonographic assessment for breast augmentation by repeated injection of low volume of autologous fat / 中华医学美学美容杂志

Objective To assess the absorbance rate of the fat after the operation of breast augmentation of the repeated injection of low volume, using ultrasonic imaging method. Methods Thirty three patients were injected with low volume of autologous fat (50-60 ml per time) to bilateral breasts for 1-5 times and breast sonographic examination was performed to evaluate the grafted fat tissues. The thickness of the retromammary fat layer before and after each injection was measured to calculate the absorbance index. Results The 264 points of breast were measured in this study. The fat was distributed in the retro-mammary fat layers at 224 points of the breast and in the pectoralis major muscle layer at 32 points of the breast, and the others distributed in the mammary gland layer.The average thickness of the retromammary fat layer increased gradually from 0.2 cm before the first operation to 1. 0 cm after the fifth operation. The average absorbance index one month after each operation was 34 %-66 %. Conclusion The present study demonstrates that breast augmentation by repeated autologous fat graft with low volume injection at each time is applicable and satisfactory and that breast ultrasound is an accurate and simple method to e-valuate the absorbance index.

Arteriovenous Fistula on Forehead after Autologous Fat Injection: A Case Report

PURPOSE: Autologous fat injection is ideal for patients who wish to add contour, projection and gross volumization of the aging, atrophic face and is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction after facial fat injection. This paper explores a rare case of vessel related complication, an arteriovenous fistula that occurs after fat injection on forehead. METHODS: A 28-year-old female who showed a non- tender, soft 1.0x2.5cm sized mass on forehead for 3 weeks. A thrill could be detected on the tortuous dilatated vessel-like structure around the mass. She had a fat injection on forehead for soft tissue augmentation 3 months prior to developing the mass. 3-dimensional brain CT angiography showed arteriovenous fistula. RESULTS: The fistula is totally excised with ligation of feeding vessels. Pathology report showed an atypical vessel which had intimal thickening, myxoid degeneration and thrombus formation. There were no evidences of recurrence at least for 2 months of follow-up. CONCLUSION: An occurrence of arteriovenous fistula after autologous fat injection is very rare. After perforation of artery and vein by coincidence, blood extravasates with the formation of a hematoma capsule and a pseudocapsule around it. The hematoma capsule would expand and clot would reabsorb resulting in a cavity leading to fistula formation. Other vessel related complications like acute visual loss or cerebral infarction are very severe. Therefore, surgeons should be cautious during facial fat injection to avoid vessel injuries.

Correction of Sunken Eyelid with Unfavorable Fold Using Autologous Fat Injection

PURPOSE: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. METHODS: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. RESULTS: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33mL in right eyelid, 1.31mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. CONCLUSION: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

Adipose Stem Cell and Its Clinical Application

At the last decade of 20th century, the existence of Adipose- derived stem cells(ASCs) within fat tissue was discovered by a research team of Plastic Surgery in Pittsburgh University. With this historic event, the clinical application of adult stem cell became practical. Before the discovery of ASCs, many scientist have been working on bone marrow stem cells(BMSCs) with difficult problems of proliferating cells without compromising natural stemness in short period. The greatest advantage of ASCs over other types of adult stem cells is its large number when we harvest primarily. The number of stem cells within adipose tissue reaches more than hundreds of times compared with BMSCs contained in the same amount of bone marrow. The major role of 'regenerative medicine' in 21st century is based on cell therapy and ASC is going to take the core position. Clinical fat graft, as fat injection, have been performed for one-hundred years and the mechanism of fat graft survival is not clearly understood. With the accumulation of knowledges related with ASCs, it becomes obvious that ASCs have great implications on clinical fat injection and the role of stem cells on fat graft survival is now actively under investigation. Many clinicians have their own favored methods of increasing fat graft survival but many of them are not based on scientific evidences. In this paper, I'd like to emphasize several scientific facts and popular biases which many plastic surgeons believe them as scientific facts. Method of fat harvesting such as liposuction and surgical excision affects fat graft survival because of the predisposition of ASCs near vascular structure within fat tissue. Plastic surgeons believe fat graft donor site is important for graft survival but literature review shows no scientific evidences. Rather, fat graft survival is greatly different according to the recipient sites and it have been proven by many scientists. Detailed techniques of handling fat after harvesting, such as size of suction cannula, degree of negative pressure for liposuction, speed of centrifugation, washing as well as method of fat injection, may or may not influence the graft survival. We may greatly increase the fat graft survival by changing basic concepts of fat grafts as below; (1) cell-assisted lipotransfer, (2) grafting cultured preadipocytes, and (3) fat graft as fat cell suspension. It is important to know the characteristics of ASCs for successful clinical application. There are several unique features of ASCs as a kind of adult stem cells which I believe a common characteristic of mesenchymal stem cells(MSCs). Cellular plasticity is one of the most important feature of ASCs as in other adult stem cells and the cells also have a special function of immune modulation and immunosuppression. Strong angiogenic potential is another important nature of ASCs. In many reports, ASCs are known not only to be differentiated into osteoblast, chondrocytes, vascular endothelial cells, but also to be cardiomyocytes and neuronal cells. In conclusion, the new knowledge of ASCs is going to impact on the regenerative medicine. To take the advantage of this new type of cells and utilize the cells, we need to understand the function of ASCs and future possibilities of ASCs. We plastic surgeons continue to stimulate the our curiosity and creativity, as well as our clinical inspiration.

Visual Disturbance following Autologous Fat Injection into Periorbital Area

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

Cerebral and Ocular Fat Embolism after Autologous Fat Injection into the Face: Confirmed by Magnetic Resonance Spectroscopy

No abstract available.

A Case of Acute Stroke after Autologous Fat Injection

Autologous fat injection for soft tissue augmentation in the face has been claimed to be a safe procedure. However, there are several case reports where patients suffered from various neurologic deficits following fat injections. We report a patient who suffered from cerebral infarction after fat injections into the face. We assume that fragments of fat reach cerebral arteries by reversed flow through the branches of the carotid arteries caused by local increase in pressure in highly vascularized tissue.