Long-term Outcome of Autologous Lipoinjection Medialization Laryngoplasty versus Type I Thyroplasty.

Glottic insufficiency is incomplete or soft closure of the true vocal folds during phonation and is a common cause of dysphonia. Treatment includes voice therapy, type I thyroplasty, vocal fold injection augmentation (with materials such as autologous fat), arytenoid cartilage repositioning, or a combination of treatment modalities. The present study aimed to compare long-term outcomes of lipoinjection medialization with type I thyroplasty for patients with glottic insufficiency. METHODS: Adult voice center patients who had undergone surgical vocal fold medialization with autologous lipoinjection or with type I thyroplasty for glottic insufficiency were included in this retrospective study. The primary outcome measures were the need for further medialization surgery and improvement in the glottic gap. RESULTS: There were 172 subjects included in this study: 100 subjects underwent type I thyroplasty and 72 subjects underwent autologous lipoinjection medialization. Neither age nor gender differed significantly between thyroplasty and lipoinjection groups. The rate of further medialization surgery did not differ significantly between thyroplasty and lipoinjection groups, but further medialization surgery was performed longer after the initial operation in the thyroplasty group Baseline glottic gap did not differ significantly between thyroplasty and lipoinjection groups. When improvement from baseline was compared between thyroplasty and lipoinjection subjects, the improvement from baseline was similar for both groups at 6 months and at 12 months. Voice handicap index scores improved significantly after thyroplasty or after lipoinjection, and the improvement from baseline was similar in both cohorts. CONCLUSION: Both autologous lipoinjection medialization and type I thyroplasty provide effective medialization for patients with glottic insufficiency. Both techniques yield similar reoperation rates, and the benefit of surgery appears to last for at least 1 year for most patients.

Lipoinjection with Adipose Stem Cells for Nasal Modeling: Rhino Cell, a Highly Versatile Alternative.

It is undeniable that a significant number of patients who want to improve their facial appearance is increasingly interested in nonsurgical procedures. Without a doubt, the use of autologous fat could not be left out as a magnificent alternative for nasal modeling simply because of four influential factors: ease of collection, compatibility, the temporality of the results, and safety. This work describes an innovative alternative technique for nasal modeling using micrografts enriched with adipose-derived mesenchymal stem cells (ASCs). With this technique, fat was collected and divided into two samples, nanofat and microfat. Nanofat was used to isolate the ASCs; microfat was enriched with ASCs and used for nasal modeling. Lipoinjection was performed in a supraperiosteal plane on the nasal dorsum. Through a retrolabial access, the nasal tip and base of the columella were lipoinjected. We consider that nonsurgical nasal modeling using micrografts enriched with ASCs can be an attractive and innovative alternative. This technique will never be a substitute for surgical rhinoplasty. It can be performed in a minor procedure area with rapid recovery and return to the patient's daily activities the next day. If necessary, the procedure can be repeated.

Total breast reconstruction with a fat-augmented latissimus dorsi flap: A comparative study between muscle and myocutaneous flaps.

The fat-augmented latissimus dorsi myocutaneous flap can overcome the volume insufficiency of latissimus dorsi flaps by immediate fat grafting into the flap. When breast skin supplementation is unnecessary, latissimus dorsi flaps can be harvested as a muscle flap to avoid an additional back incision. Here, we compared the efficacy of fat-augmented latissimus dorsi myocutaneous and muscle flaps in total breast reconstruction. We retrospectively reviewed 94 cases of unilateral total breast reconstruction using fat-augmented latissimus dorsi flaps (muscle: 40, myocutaneous: 54) at our hospital from September 2017 to March 2022. The muscle flap group had a significantly shorter operative time than the myocutaneous flap group (p < 0.0001). Mastectomy specimen weight did not differ between the 2 groups, but total flap weight in the muscle flap group was significantly lower (p < 0.0001). Conversely, total fat graft volume, fat graft volume to the latissimus dorsi flap, and fat graft volume to the pectoralis major muscle were significantly greater in the muscle flap group (p < 0.0001, p < 0.0001, and p = 0.02, respectively). The percentage of cases requiring additional fat grafting was significantly higher in the muscle flap group, but postoperative esthetic evaluation did not significantly differ between the 2 groups. Both groups scored high on each BREAST-Q item, but the muscle flap group scored significantly higher for "Satisfaction with Back." Although the frequency of additional fat grafting was higher than with fat-augmented latissimus dorsi myocutaneous flaps, total breast reconstruction with fat-augmented latissimus dorsi muscle flaps is a viable technique with a short operative time and high patient satisfaction.

Global Analyses and Latest Research Hot Spots of Adipose-Derived Stem Cells in Fat Grafting: A Bibliometric and Visualized Review.

BACKGROUND: Fat grafting is one of the most effective treatments for soft tissue restoration and augmentation. Adipose-derived stem cells (ASCs) supplementation is one of the foremost concerns to improve its efficiency. There have been several studies aiming at adipose-derived mesenchymal stem cells in fat grafting, but no relevant bibliometric research has conducted. METHODS: Articles about fat grafting and ASCs were retrieved in Web of Science Core Collection (WoSCC). Using VOSviewer 1.6.10.0 (Leiden University, the Netherlands) and CiteSpace 6.1.R2 (Drexel University, USA), the information of national distribution, institutions, journals, authors and keywords were evaluated and calculated. RESULTS: A total of 1166 papers in the field of ASCs in fat grafting were retrieved from 2002 to 2021. The USA produced the most articles, and the top 2 productive institutions were all from the USA. Researchers and institutions conducting ASCs in fat grafting research have shown a widespread and close connection. Plastic and Reconstructive Surgery published the most article on ASCs in fat grafting, and professor Rubin Peter is the most productive author. The top 10 references with the highest LCS mainly focused on applying ASCs to assist fat transplantation in plastic surgery. The most cited keywords formed 4 clusters, and "mesenchymal stem," "mesenchymal stromal cell," "stromal vascular fraction" and "long term" were the most recently trending keywords. CONCLUSIONS: This article provides a summary of the current research status focusing on fat grafting and ASCs. More efforts will be made to promote the application of ASCs in fat grafting. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Embolismo graso fulminante por lipoinyección glútea. Reporte de un caso con enfoque Médico Legal / Fulminant fat embolism due to gluteal lipoinjection. Report of a case with a Medical Legal approach

Resumen La liposucción es uno de los procedimientos estéticos que se realizan con mayor frecuencia a nivel mundial, con una baja incidencia de complicaciones y una mortalidad de 20 por cada 100 000 procedimientos y cuando se realiza en conjunto con una lipoinyección glútea la principal causa de muerte el embolismo graso. Se presenta el caso de una femenina de 32 años, sin patologías crónicas conocidas, la cual se asistió a un centro médico para que le realizaran una liposucción con lipoinyección glútea y falleció casi al finalizar la cirugía; en la autopsia Médico Legal se observó la presencia de material de aspecto adiposo en el tronco principal de la arteria pulmonar y en sus ramificaciones, en las cuales se obstruía por completo el lumen, mediante un estudio histopatológico se confirmó el diagnostico de embolismo graso, el cual se estableció como causa de muerte. Se realizó una revisión de la literatura sobre embolismo graso asociado a liposucción con lipoinyección glútea.

Abstract Liposuction is one of the most frequently performed cosmetic procedures worldwide, with a low incidence of complications and a mortality of 20 per 100 000 procedures, and when it is performed in conjunction with gluteal lipoinjection, the main cause of death is fat embolism. This article presents a case of a 32-year-old female, with no known chronic pathologies, who was attended at a medical center to undergo liposuction with gluteal lipoinjection and died almost at the end of the surgery; In the Medico-Legal autopsy, the presence of adipose-like material was observed in the main trunk of the pulmonary artery and in its ramifications, in which the lumen was completely obstructed, a histopathological study confirmed the diagnosis of fat embolism, which was established as the cause of death. A review of the literature about fat embolism associated with liposuction with gluteal lipoinjection was made.

Fat-augmented latissimus dorsi myocutaneous flap for total breast reconstruction: A report of 54 consecutive Asian cases.

Immediate fat grafting to the latissimus dorsi myocutaneous (LD) flaps is a breakthrough that addresses the issue of insufficient volume of LD. However, the use of this procedure in Asian patients has not yet been reported. Retrospective chart reviews were conducted on 54 Japanese cases of total breast reconstruction using fat-augmented LD flaps at our hospital from September 2017 to June 2019. There were 24 immediate reconstruction cases, 18 immediate two-stage reconstruction cases, nine delayed reconstruction cases, and three delayed two-stage reconstruction cases. Median age was 46 years (range, 29-69 years), and median body mass index was 21.5 (17-33.8). Median mastectomy specimen and flap weight was 225 g (123-993) and 225 g (130-796), respectively. The median volume of fat graft was 114 ml (46-305) for the LD flap and 58 ml (15-200) for the pectoralis major muscle. Of the 53 completed reconstruction cases, 38 (71.7%) achieved sufficient volume with the initial operation and six (11.3%) required additional fat grafting. The proportion of cases in the immediate reconstruction group, which achieved sufficient volume in the initial operation was significantly higher than those of the other three reconstruction groups (p = 0.007). Total breast reconstruction with fat-augmented LD flaps is a viable procedure for thin patients who have insufficient abdominal tissue, for those who wish to avoid abdominal scars, and for those in whom abdominal flaps have already been used. The procedure allows for large volume transplantation even with small skin paddles, which allows for smaller skin paddles to be designed without the need for extensive subcutaneous dissection.

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells.

BACKGROUND: Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS: To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS: Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS: The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with lupus erythematosus.

The cutaneous manifestations of lupus, especially chronic cutaneous lupus erythematosus, are a source of significant morbidity and can negatively impact patient quality of life. While the active inflammatory component of the disease may be adequately treated, patients are frequently left with residual skin damage and disfiguring aesthetic deficits. Dermatologists lack guidelines regarding the use and safety of various reconstructive and cosmetic interventions in this patient population. Laser treatments are largely avoided in the lupus population because of the possible photodamaging effects of ultraviolet and visible light. Similarly, given the autoimmune nature of this disease, some physicians avoid injectable treatment and grafts because of the concern for disease reactivation via antigenic stimulation. In the second article in this continuing medical education series we compile available data on this topic with the goal of providing evidence-based guidance on the cosmetic treatment of patients with lupus erythematosus with a focus on chronic cutaneous lupus erythematosus.

Lipoinyección labial con grasa autóloga con fines estéticos / Autologous fat lipoinjection for aesthetic purposes

Introducción. La Lipoinyección de grasa autóloga con fines estéticos es una de las técnicas más jóvenes que permiten resolver problemas relacionados con valores concernientes a las elecciones personales que apuntan hacia la belleza, es un procedimiento quirúrgico sencillo y con resultados rápidos. Es una alternativa segura, real, sencilla y accesible que abarata costos, sobre todo con el uso de equipos y tecnología. Objetivos. Caracterizar los resultados estéticos de la Lipoinyección Labial con Grasa Autóloga en pacientes que asistieron a la consulta externa de Cirugía Plástica del Hospital Universitario "General Calixto García". Material y Método. Se realizó un estudio prospectivo, descriptivo, de corte transversal, en el período comprendido entre octubre de 2018 a septiembre del 2019. Se seleccionaron aquellos que cumplieron los criterios de inclusión y aceptaran a participar en el estudio voluntariamente. La muestra quedó constituida por 23 pacientes. La información obtenida se procesó mediante bases de datos confeccionadas en Excel, lo que permitió la realización de la estadística descriptiva simple para las variables individuales como media, desviación estándar y razón. La disposición a colaborar en el estudio se recogió en el modelo de Consentimiento Informado elaborado para esta investigación. Resultados. Predominio del sexo femenino en el 60.87 % de los operados. El grupo de edad entre 51 a 61 años fue el de mayor número de pacientes. Las complicaciones inmediatas más frecuentes en los labios fueron: la inflamación y los hematomas; las tardías fueron nodulaciones y endurecimiento. El 82.60 % de los pacientes se mostró satisfecho con los resultados. Conclusiones. La Lipoinyección labial con Grasa Autóloga se caracterizó por ser un método capaz de satisfacer el resultado estético. Las variables edad y sexo evidencian que las mujeres se realizaron más Cirugía Estética Labial que los hombres. Las variables clínicas labios finos y volumen evidencian que el aumento de la edad es una condición importante que se asocia a la demanda de esta técnica quirúrgica y que el ser hombre o mujer no establece una diferencia para la solitud de este tipo de técnica quirúrgica. Se presentaron complicaciones inmediatas y tardías. Los niveles de satisfacción expresados por los pacientes fueron altos.

Introduction. Autologous fat lipoinjection for aesthetic purposes is one of the youngest techniques that allow solving problems related to values concerning personal choices that point towards beauty, it is a simple surgical procedure with quick results. It is a safe, real, simple and accessible alternative that lowers costs, especially with the use of equipment and technology,Objectives. To characterize the aesthetic results of Lip Lipoinjectionwith Autologous Fat in patients who attended the Plastic Surgery outpatient clinic at the "General Calixto García" University Hospital. Material and Method. A prospective, descriptive, cross-sectional study was conducted in the period from October 2018 to September 2019. Those who met the inclusion criteria and voluntarily agreed to participate in the study were selected. The sample consisted of 23 patients. The information obtained was processed through databases prepared in Excel, which allowed the performance of simple descriptive statistics for individual variables such as mean, standard deviation and ratio. The willingness to collaborate in the study was included in the Informed Consent model prepared for this research. Results. female predominance in 60.87% of those operated on. The age group between 51 and 61 years was the one with the largest number of patients. The most frequent immediate complications on the lips were: inflammation and bruising; the later ones were nodulations and hardening. 82.60% of the patients were satisfied with the results.Conclusions. Lip Lipoinjection with Autologous Fat was characterized as a method capable of satisfying the aesthetic result. The age and sex variables show that women underwent more cosmetic lip surgery than men. The clinical variables thin lips and volume show that increasing age is ́t a condition that is associated with the demand for this technique and that the Being male or female does not make a difference to the solitude of this type of surgical technique. There were immediate and late complications. The satisfaction levels expressed by the patients were high.

The Safe Gluteoplasty: Anatomic Landmarks to Predict the Superior and Inferior Gluteal Veins.

Objective: The increase in demand for gluteal fat grafting seen in recent years in the United States has not been met with an equal gain in knowledge of the perils of this anatomic territory. The purpose of this study was to identify anatomic landmarks that can be readily used by surgeons to identify the takeoff of the superior and inferior gluteal veins. Method: Six fresh cadaveric gluteal specimens were dissected at the University of Louisville anatomy laboratory. A question mark incision was made for exposure, followed by identification of the sciatic nerve in the proximal thigh. This was traced retrograde to the sciatic forearm. The piriformis muscle was identified dividing the foreman into superior and inferior portions, which corresponded to the takeoff of the superior and inferior gluteal vessels, respectively. The distance of the gluteal vessels from the one-third point of a line from the mid-sacrum to the greater trochanter was measured. Result: Our cadaveric dissection series demonstrated that the superior and inferior gluteal veins were on average 3.28 cm (2-5.9 cm) and 1.25 cm (0-3.5 cm) away from the point one third the distance from the mid-sacral border to the greater trochanter. Conclusion: The mid-sacrum and the trochanter of the femur are the anatomic landmarks used to identify the large gluteal vein trunks. Understanding the location and trajectory of these deep gluteal structures with use of readily identifiable landmarks may assist surgeons in avoiding inadvertent injection of fat to these veins during fat grafting.

Voice Outcomes of Lipoinjection Versus Medialization Laryngoplasty for Nonparalytic Glottic Insufficiency.

OBJECTIVE: To compare voice outcomes of autogenous fat injection versus medialization laryngoplasty in patients with glottic insufficiency due to vocal fold paresis or atrophy. METHODS: A retrospective review was performed from 2009 to 2017 of all patients who underwent lipoinjection or medialization laryngoplasty (ML) for glottic insufficiency. Charts were reviewed for demographic information, preoperative diagnosis, surgical intervention, Voice Handicap Index-10 (VHI-10) and Glottal Function Index (GFI) scores, follow-up time (minimum 3 months), and concomitant voice therapy. RESULTS: Eighty-three patients were initially identified and limited to 28 based on the inclusion/exclusion criteria. Thirty-five procedures were performed with a total of 15 fat injections and 20 MLs. The mean age was 60.7 years in the lipoinjection group and 55.6 years in the ML group. There was no significant difference in pretreatment VHI-10 scores between the two groups. Using the lowest recorded voice scores during the follow-up period, both groups had a significant decrease (P < 0.05) compared to preoperative scores (VHI-10: fat decreased from 27.8 to 14.2, ML decreased from 30.5 to 9.1; GFI: fat decreased from 13.7 to 5.27, ML decreased from 13.6 to 4.6). When evaluating the entire follow-up period (median 19 months in fat group, 16.3 months in ML), only the ML group maintained a significant improvement in VHI-10 (median delta 14.5) and GFI (median delta 7) compared to preoperative scores. CONCLUSION: Although both autogenous fat injection and ML result in improved voice scores in the short term, the effect of fat injection appears to be limited, as evidenced by worsening VHI-10 and GFI scores over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1164-1168, 2019.

Lipoinjection and Multiple Internal Cuts for Congenital Constriction Bands: A New Treatment Approach.

BACKGROUND: Traditional treatment for a congenital constriction band of the limb involves multiple Z-plasties and W-plasties. We propose an alternative surgical procedure for the treatment of congenital constriction bands that obviates the need for Z-plasties and eliminates the constriction band. METHODS: We present the case of a 36-year-old woman with a congenital constriction band of the leg. Using a minimally invasive approach, the skin segment that included the band was dissected from the deep tissues. Afterwards, multiple slices were performed on the internal surface of the fibrous ring. This and lipoinjection were used to reverse the depression that characterizes the "hourglass sign" and homogenize the skin surface. RESULTS: Results have remained stable in a follow-up period of 18 months. CONCLUSIONS: This surgical alternative can be considered as an option for the treatment of congenital constriction bands. It is a safe, reproducible procedure that does not cause additional scars and has good functional and aesthetic results. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dynamic definition mini-lipoabdominoplasty combining multilayer liposculpture, fat grafting, and muscular plication.

BACKGROUND: There is a select group of women for whom mini-abdominoplasty techniques combined with 3-dimensional liposculpture and fat grafting can effectively correct postpartum deformities. OBJECTIVE: The authors describe a multilayer and 360-degree approach, dynamic definition mini-abdominoplasty (DDM), to create athletic definition and contour and to restore a feminine appearance postpartum. METHODS: A total of 181 consecutive women ages 20 to 56 years underwent DDM between January 2005 and May 2012. Patients who were a minimum of 6 months postpartum and in good health, with a body mass index below 30, were considered for inclusion in the study. Fat grafting was performed in select cases in the buttocks, deltoids, and/or calves. A satisfaction index (SI) was estimated based on patient survey responses. RESULTS: An overall SI of 91.5% was achieved. No major complications were reported. Twenty-nine minor complications included postoperative anemia, seroma, and infection in the surgical wound. In most patients, the postpartum abdomen was restored to an aesthetic and even athletic appearance. Athletic definition to the rectus, arms, trunk, thighs, and buttocks was also achieved. No burns or flap necrosis were reported. CONCLUSIONS: Dynamic definition mini-abdominoplasty is safe and reproducible. It serves as a viable alternative to a full abdominoplasty in selected cases and for women who wish to restore an athletic and feminine appearance after childbirth. LEVEL OF EVIDENCE: 4.

Cell-assisted lipotransfer for the treatment of parry-romberg syndrome.

Progressive facial hemiatrophy, also known as Parry-Romberg syndrome, is a progressive and self-limited deformation of the subcutaneous tissue volume on one side of the face that creates craniofacial asymmetry. We present the case of a patient with a five-year history of progressive right facial hemiatrophy, who underwent facial volumetric restoration using cell-assisted lipotransfer (CAL), which consists of an autologous fat graft enriched with adipose-derived stem cells (ASCs) extracted from the same patient. ASCs have the capacity to differentiate into adipocytes. They also promote angiogenesis, release angiogenic growth factors, and some can survive as stem cells. The use of autologous fat as a filler in soft tissue atrophy has been satisfactory in patients with mild and moderate Parry-Romberg syndrome. Currently, CAL has showed promising results in the long term by decreasing the rate of fat reabsorption. The permanence and stability of the graft in all the injected areas has showed that autologous fat grafts enriched with stem cells could be a promising technique for the correction of defects caused by this syndrome.

Cell-Assisted Lipotransfer for the Treatment of Parry-Romberg Syndrome

Progressive facial hemiatrophy, also known as Parry-Romberg syndrome, is a progressive and self-limited deformation of the subcutaneous tissue volume on one side of the face that creates craniofacial asymmetry. We present the case of a patient with a five-year history of progressive right facial hemiatrophy, who underwent facial volumetric restoration using cell-assisted lipotransfer (CAL), which consists of an autologous fat graft enriched with adipose-derived stem cells (ASCs) extracted from the same patient. ASCs have the capacity to differentiate into adipocytes. They also promote angiogenesis, release angiogenic growth factors, and some can survive as stem cells. The use of autologous fat as a filler in soft tissue atrophy has been satisfactory in patients with mild and moderate Parry-Romberg syndrome. Currently, CAL has showed promising results in the long term by decreasing the rate of fat reabsorption. The permanence and stability of the graft in all the injected areas has showed that autologous fat grafts enriched with stem cells could be a promising technique for the correction of defects caused by this syndrome.