Improvement of skin quality after fat grafting: clinical observation and an animal study.

BACKGROUND: Restoration of volume and contour defects is a challenge in plastic surgery. Autologous fat tissue transfer is gaining increasing popularity in this field. The aim of this study was to investigate the histologic modifications of the skin after fat tissue grafting on an animal model. METHODS: Thirty nude mice, divided into three groups, were used in the experiment. All 30 mice received human fat tissue on one side. On the opposite side, 10 mice received nothing (negative control group), 10 mice received cell proliferation medium, and the remaining 10 mice received only subcutaneous tunneling. Eight weeks later, biopsies of the skin and subcutaneous tissue were performed and specimens were analyzed by hematoxylin-phloxin-saffron staining. Dermis thickness was measured. To differentiate human from murine collagen fibers, human and murine collagen type I antibodies were used. The other types of collagen were investigated by immunohistochemistry (immunostaining) using collagen type III, V, and VI antibodies. RESULTS: Fat tissue was found in all animals. Macroscopically, fat tissue presented normal aspects, with abundant peripheral neovascularization. Histologic examination showed abundant extracellular matrix around the injected human fat tissue. This was attributable to increased type I collagen fibers of murine origin as a result of the murine fibroblast stimulation by the grafted human fat tissue. Dermal thickness after fat grafting was significantly greater. This was not attributable to inflammatory reactions, because no modification was detected in our control groups. CONCLUSIONS: This study shows that fat tissue grafting stimulates a neosynthesis of collagen fibers at the recipient site and makes the dermis thicker. However, the long-term effects remain undetermined and need further investigation.

Influence of the recipient site on the outcomes of fat grafting in facial reconstructive surgery.

BACKGROUND: The purpose of this study was to analyze the role of fat grafting for restoration of facial contour deformities (volumes) in traumatic and malformation cases. Outcomes were evaluated for each facial aesthetic subunit to demonstrate the role of the recipient site. An algorithm for the treatment of facial malformations and traumatic sequelae by subunits, in relation to the results obtained in this study, is proposed. METHODS: This retrospective study involved 100 patients treated by structural fat grafting of the facial region. Results were evaluated by a subjective self-evaluation survey (i.e., a questionnaire answered by patients) and an objective assessment by a five-member jury. Each subunit of the face was studied separately. Results were presented separately and compared. RESULTS: The average follow-up period was 23 months. The overall satisfaction rate of patients was 74 percent. The average score for subjective evaluation was 14.5 of 20. The objective score was 13.9 of 20. The results were significantly different depending on the aesthetic subunit of the face. The best results were achieved in the malar (89 percent good results) and lateral cheek areas (84 percent good results). The poorest results were registered for the lower and upper lip areas (34 percent and 31 percent good results, respectively). Minor complications were observed in 3 percent of the cases. CONCLUSIONS: Fat tissue grafting is a simple, efficient, and reproducible technique for restoration of facial volumes. In the absence of functional disorders, it is the authors' first choice in the decision-making process for the treatment of facial soft-tissue deficiencies.

Analysis of a series of autologous fat tissue transfer for lower limb atrophies.

Localized and circumferential atrophies of the lower extremities have been difficult to treat with few simple autologous solutions available. The aim of this study was to analyze the efficacy of fat grafting in lower limb atrophies. There were 20 patients (17 females and 3 males) at an average age of 33 years. Twelve patients had localized and 8 patients circumferential atrophies of various etiologies: traumatic (60%), congenital (25%), and iatrogenic (15%). The average number of fat injections was 1.1 per patient (range 1-2) for localized atrophies and 2.2 per patient (range 1-3) for circumferential atrophies. The average follow-up period was 2 years. The average volume injected at each stage was 79 mL for localized atrophies and 137 mL for circumferential atrophies. In the cases of circumferential atrophies, an average augmentation of 1.9 cm (range 1-6 cm) of the limb perimeter per injection was achieved. The overall satisfaction of the patients was high. Autologous fat grafting is a reliable technique for lower limb atrophies.

The superior pedicle mammaplasty for the treatment of pedunculous breast.

AIM OF THE STUDY: The superior pedicle mammaplasty is a technique frequently employed in the treatment of breast ptosis, associated or not with hypertrophy of the gland, followed by satisfactory results. This technique is normally not indicated in severe breast ptosis (pendulous breast) because of the excessive length of the pedicle supplying nipple-areola-complex (NAC), with the risk of ischemia. In these cases the standard technique is the free-nipple-graft mammaplasty. However, the deepen knowledge about vascular anatomy of the breast and the aptitude to perform superior pedicle mammaplasty, induced the authors to indicate this technique even in these cases improving the aesthetic and functional outcomes. MATERIAL AND METHODS: The authors present a series of 30 patient with pendulous breasts, with sternal notch-nipple distance equal or superior to 32 cm (45 cm maximum; mean value 35.1), treated with the superior pedicle mammaplasty with inverted "T" scar. The results confirm the reliability of superior pedicle for the nipple-areolar complex blood supply, associated with satisfactory aesthetic results due especially to the good breast projection. CONCLUSIONS: They conclude that superior pedicle technique mammaplasty, even if normally not indicated in these cases, is instead suitable for the treatment of pendulous breasts with great sternal notch-nipple distance, permitting to take advantages of this technique.