"No-Touch" Technique for Lip Enhancement.

BACKGROUND: The purpose of this study was to examine the anatomical principles of lip structure as they relate to individualized lip enhancement procedures and to describe a technique that does not violate lip mucosa during injection. METHODS: A retrospective analysis of patients undergoing lip enhancement procedures between 2001 and 2014 was performed. Preprocedural and postprocedural photographs were analyzed for lip subunit changes. A stepwise treatment algorithm targeting specific anatomical subunits of lip is described. RESULTS: Four hundred ten patients were treated with a "no-touch" technique for lip enhancement. Lip profile is determined by the position of the white roll. The white roll is accessed by a 30-gauge needle at a point 5 mm lateral to the oral commissure and at the base of the philtral columns. Lip projection is established by vermilion formation contributing to the arc of the Cupid's bow. To improve projection, the labial commissure is entered with a 25-gauge cannula and tunneled into the submucosal space between the white and red rolls. Lip augmentation is a direct reflection of the prominence of the red line and can be approached in a perpendicular fashion with a needle or cannula descending to the level of the wet-dry junction. CONCLUSIONS: Accurate assessment of the white and red rolls, arc of Cupid's bow, philtrum, and gingival show can guide the injector on the proper enhancement that individual patients require. The no-touch technique minimizes mucosal trauma. Tailoring treatment toward lip profile, projection, and/or augmentation can yield predictable and reproducible outcomes in this commonly performed cosmetic procedure.

Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: no effect of PDGF.

BACKGROUND: This work evaluates the effect of adding platelet-derived growth factor to autologous adipose tissue grafts in the treatment of human immunodeficiency virus facial lipoatrophy by means of objective measurements. METHODS: This is a randomized clinical trial conducted at the Hospital Clinic of Barcelona. Patients with facial human immunodeficiency virus atrophy were randomized into two groups, one treated with autologous fat injection (group A), and another treated with autologous fat injection with plasma rich in growth factors (group B). Before the treatment, structural changes were identified in facial soft tissue by means of computed tomography, and clinical changes were also assessed by means of photographic records. Posttreatment assessments were repeated after 2 and 12 months to compare the results. Posttreatment complications were recorded. RESULTS: Forty-nine patients (33 men and 16 women), with a mean age of 46 years, participated in the study. In both groups, there was a statistically significant average increase of volume in the facial area measured by computed tomography between the baseline and the 2- and 12-month posttreatment assessments. All cases showed an improvement of the clinical facial atrophy grade after treatment, which was statistically significant. This improvement was related to a statistically significant fat volume increase measured by means of computed tomography. There was no difference in the volume gain between both groups. No major complications were observed. CONCLUSIONS: Fat grafting is a safe, effective, and durable treatment for human immunodeficiency virus facial atrophy. The results of this study show that it is not necessary to add plasma rich in growth factors to the adipose tissue graft to get a better result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Autologous fat grafting for correction of unaesthetic scars.

BACKGROUND: Autologous fat grafting has many clinical applications, and its use in Plastic Surgery is increasing. Currently, autologous fat grafts are used in breast surgery, facial rejuvenation, and facial lipoatrophy secondary to antiretroviral therapy and as a treatment for liposuction sequelae, buttock augmentation, and congenital facial hemiatrophy. Their use is expanding rapidly, and their applications in other fields are an ever growing interest within the Plastic Surgery community. OBJECTIVE: To introduce a new application of lipoinjection for the correction of unaesthetic, retracted, or sunken scars. METHODOLOGY: The study consisted of a total of 8 patients (6 women and 2 men), with a mean age of 47 years old, all of whom presented retractile and dystrophic scars in the abdomen (n = 3), arm (n = 1), male breast (n = 1), and face (n = 3). They all received treatment with a fat injection using Coleman technique. General anesthesia was used in 3 patients; deep intravenous sedation plus local anesthesia was used in the remaining 5 patients. A COL-ASP15 cannula was used to harvest the fat and a blunt-tipped COL-19 cannula (Byron Medical) to release the fibrosis and retraction, and for the fat grafting injection. A 4-grade visual scale was use to evaluate the results. RESULTS: An improvement in the scar was achieved in all patients. One operation was required in 5 cases, and 2 operations in 3 cases. There were no complications in any patient and the results were lasting in all cases (the mean follow-up period was of 18 months). CONCLUSIONS: Autologous fat grafting is a good method for correction of retracted or sunken scars instead of the traditional scar surgical excision.

Assessing the long-term viability of facial fat grafts: an objective measure using computed tomography.

BACKGROUND: Autologous fat transplantation for soft tissue augmentation is a commonly used technique without a universally accepted approach. The literature includes a variety of reports describing varying degrees of success or failure. OBJECTIVE: To evaluate the behavior of facial fat grafts in humans with the use of an objective measuring tool. METHODS: A prospective randomized study, comparing patients pre- and postoperatively, was designed to evaluate the long-term viability of fat grafting. Participants were 18 men and 8 women between 34 and 59 years of age (mean, 45.07 yrs; standard deviation, 6.54 yrs). A total of 52 hemifaces in 26 patients diagnosed with HIV and demonstrating facial lipoatrophy were treated with fat transplantation using Coleman's technique. HIV-positive patients were chosen as study participants because their nearly total lack of subcutaneous fat diminishes the bias in the evaluation of fat volume. Fat graft viability was evaluated by measuring the volume of adipose tissue evolution via computed tomography scan before fat grafting, at the second month after fat grafting, and 1 year after fat grafting. Descriptive statistical analysis was performed. RESULTS: The mean volume on the right and left cheeks before fat grafting was 1.57 cc. The mean volume 2 months after the procedure was 2.93 cc with a statistically significant mean increase of 1.36 cc (P < .001) between baseline and the second month after the procedure. The mean volume after 12 months was 3.29 cc (P < .001), with a mean increase compared with the baseline of 1.72 cc, and of 0.36 cc between months 2 and 12. The statistically significant posttreatment improvement (P < .001) was maintained until month 12 of the follow-up period. CONCLUSIONS: Using objective measurement, this study demonstrates that with one fat grafting procedure a durable result can be achieved, persisting for a minimum of 12 months without any trend towards reabsorption.

Endoscopic breast reconstruction with intraoperative complete tissue expansion and partial detachment of the pectoralis muscle.

We present the surgical technique for mammary reconstruction using tissue expander with endoscopic approach, associated to partial detachment of the pectoralis muscle at the fourth rib and complete or nearly complete intraoperative expansion. Tissue expansion for breast reconstruction is a well-honored technique that provides satisfying esthetic outcomes, with minimal morbidity for the patient. Nevertheless, this technique has some potential problems: (1) wound dehiscence with extrusion of the expander; (2) the patient discomfort during the expansion process (weekly visits for the refill of the expander); (3) the poor definition of the lower pole of the breast and cranial migration of the expander with excessive roundness of the upper pole. By using intraoperative tissue expansion, these drawbacks can be avoided. We report herein our experience with this technique in 53 consecutive patients (56 breasts) undergoing a secondary breast reconstruction since December 2001.