Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression

BACKGROUND Nasolabial fold(NLF)depression can affect the facial appearance of patients to some extent and increase their psychological burdens.In recent years,autologous fat grafting(AFG)combined with botulinum toxin A(BTX-A)injection(AFG+BTX-A injection)has been gradually applied in the treatment of patients with NLF depression.Although studies have been conducted on the efficacy and safety of AFG+BTX-A injection in treating NLF depression,the experimental design,observational indicators,and sample enrollment criteria vary remarkably,making it difficult to draw convincing and consistent conclusions.Thus,further relevant research is warranted.AIM To assess the esthetic improvement,efficacy,and safety of AFG+BTX-A injections in patients with NLF depression.METHODS This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021.These patients were categorized into control(n=30)and observation(n=30)groups.The observation group received AFG+BTX-A injection,whereas the control group underwent AFG only.All patients were evaluated using the wrinkle severity rating scale(WSRS)and global aesthetic improvement scale.The compactness of facial contours,skin evaluation indexes,adverse reactions,and satisfaction of the two groups were evaluated 3 months postoperatively.RESULTS The WSRS scores of the observation group at 1,3,and 6 months postoperatively were lower than those of the control group(P<0.05).Three months postoperatively,facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group(P<0.05).The compactness of facial contours was better in the observation group than in the control group(P<0.05).In addition,no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness,facial asymmetry,facial bruising,and facial concavity inequality(P>0.05).CONCLUSION AFG+BTX-A injection is a highly safe,cost-effective,effective,and long-lasting treatment for NLF depression with high esthetic value,which should be promoted in the future.

Negative pressure device-assisted autologous fat grafting: A case report

This report describes a novel technique for improving depressed scars using negative pressure suction-assisted autologous fat grafting.A 35-year-old woman presented with a 20-year history of bilateral central buttock con-cavities,causing aesthetic concerns.To maximize fat graft survival and enhance tissue volume,we implemented intermittent negative pressure suction on the recipient area for one month preoperatively.The patient expressed satisfaction with the cosmetic outcome,and a three-month follow-up confirmed a significantly improved fat graft survival rate.This minimally invasive,cost-effective,and easily reproducible technique offers a promising clinical strategy for treating depressed scars.

Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary insertion of the implant after preceding dermis fat graft

AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.

Effects of radiation and chemotherapy on adipose stem cells: Implications for use in fat grafting in cancer patients

Autologous fat transplantation is a versatile tool in reconstructive surgery.Adipose-derived stem cells(ASCs)increase survival of fat grafts and thus are increasingly used for breast reconstruction in breast cancer patients.However,radiation and/or chemotherapy have been proposed to inhibit soft tissue regeneration in wound healing thus suggesting alteration in stem cell pathways.Therefore,elucidating effects of radiation and chemotherapy on ASCs is critical if one desires to enhance the survival of fat grafts in patients.This review outlines our work evaluating the function and recoverability of ASCs from radiation or chemotherapy patients,focusing specifically on their availability as a source of autologous stem cells for fat grafting and breast reconstruction in cancer patients.Even though evidence suggests radiation and chemotherapy negatively influence ASCs at the cellular level,the efficiency of the isolation and differentiation capacity did not appear influenced in patients after receiving chemotherapy treatment,although fat from radiated patients exhibited significantly altered ASC differentiation into endothelial-like cells.Further,the in vitro growth rates of patient’s ASCs do not differ significantly before or after treatment.Taken together,these studies suggest ASCs as an important new tool for grafting and reconstruction even when radiation and chemotherapy treatment are involved.

Augmentation mammoplasty with autologous fat grafting

Considering the issues that can accompany prosthetic breast implants,augmentation mammoplasty(AM)with autologous fat grafting(AFG)has attracted growing interest globally,especially in the last two decades,as breast implant-associated anaplastic large cell lymphoma has been increasing in incidence over time.Here,we review the detailed processes of AFG to the breast and the pertinent complications associated with this procedure.This study aims to elucidate the critical points and technique improvements in AM with AFG in recent years,as well as discuss how to decrease complications related to this procedure.Attention was focused on the specific AFG steps,clinical outcomes,and complications to highlight the advantages and disadvantages of the available protocols.

Current state and exploration of fat grafting

Fat grafting has become one of the most frequently used techniques in plastic and reconstructive surgery.Many studies have focused on optimizing procedures,such as donor site selection,harvesting,processing,and grafting.Representative basic techniques include Coleman’s and“3L3M”techniques.A new technique called compartment-based targeted fat grafting(CTFG)has gradually been established based on anatomical findings of the facial and hand compartments.CTFG achieved precise restoration of the fat volume in the anatomical state.Cell-based fat grafting has introduced new fields involving tissue repair and regeneration,including facial rejuvenation and scar improvement,among others.In this review,we summarize the timeline for the development of fat grafting.

Fat Grafting for Rejuvenation and Regeneration with Stromal Vascular Fraction Gel

Lipotransfer has become a powerful regenerative tool,largely because of its cellular components,the stromal vascular fraction(SVF).However,the clinical separation of cells with collagenase is strictly legislated.In 2017,Yao et al.postulated a novel fat-derived product mechanically concentrating SVF cells and an extracellular matrix(ECM)and named it stromal vascular fraction gel(SVF-gel).This review discussed the protocol of SVF-gel and its component as well as its inner structure.The histologic examination and the retention rate after the transplantation of SVF-gel were also rendered.Moreover,we summed up the rejuvenating and regenerative use of SVF-gel and introduced its possible mechanism.

Current Status of ADSCs-Enriched Fat Grafts in Plastic Surgery

Autologous fat grafting is an increasingly popular technique in plastic surgery for volume augmentation and rejuvenation.However,the unpredictability of long-term volume retention limits its clinical application.Various animal studies have documented the positive effects of adipose tissue-derived stem cells(ADSCs)on the acceleration of lipofilling.However,the results have been inconsistent,and there is an insufficient number of high-quality clinical studies to formulate evidence-based recommendations for ADSC-enriched fat grafts.Moreover,related technical standards,such as the final count of harvested ADSCs and the enrichment ratio,have not yet been established.This systematic review included all clinical trials on ADSC-enriched fat grafts in plastic surgery from PubMed in the past 10 years,as well as all registered clinical trials on ClinicalTrials.Gov.To examine the current landscape of ADSCs harvest,we summarize the current applications of ADSCs in the field of plastic surgery and discuss the current barriers to universal clinical use.

Treatment of Temporomandibular Joint (TMJ) Reankylosis with Preservation of the TMJ Prosthesis and Use of Fat Graft: A Case Report and Review of the Literature

We report on a case of TMJ reankylosis (heterotopic bone) following total TMJ alloplastic reconstruction in a 40-year-old Black male. The heterotopic bone was excised following removal of the fossa component. The fossa component was re-inserted, and the periarticular tissue was grafted with fat procured from the abdomen. Patient was placed on an aggressive physiotherapy programme which was monitored for a period of 6 months. He returned for review one year later with a mouth opening of 27 mm. We present also a short review of the literature on heterotopic bone formation. This case is of particular interest in that despite the heterotopic bone around it;the prosthesis was preserved after the bone was removed.

Initial Experience of Face Augmentation Using Fat Graft-Platlet Rich Plasma Mix

Plastic surgeons accustomed to use autologous fat grafs for augmentation of soft tissues in the last two decades. The main drawback of fat grafting is unpredictable graft resorption. Several studies have searched for new ways of increasing the viability of the transplanted tissue to overcome this disadvantage. The most recent and promising approach is to mix the fat graft with Platelet-Rich Plasma (PRP) before transplantation. The purpose of this article is to present the initial experience using the autologous fat injection with platlet rich plasma as a method for fascial augmentation.

Treatment of Steroid Induced Lipoatrophy with Structural Fat Grafting

Background: Systemic corticosteroid injections are used to treat a variety of medical conditions. Inaccurate placement of intramuscular injections of corticosteroid can result in local lipoatrophy, and a resultant cosmetic deformity. Objective: Describe the condition, and a simple, reproducible method of correcting the volume deficiency and skin changes associated with steroid induced lipoatrophy Methods: A retrospective chart review was undertaken of all patients treated by the author for steroid induced lipoatrophy between June of 2005 and March of 2011. Results: Structural fat grafting was used to treat 11 patients with steroid induced lipoatrophy during this time period. 10 patients were female and one was male. 9 of the patients had atrophy of the buttock or hip, and 2 had atrophy of the upper extremity. All patients had satisfactory correction of their deformities, and only one of the patients required a second grafting session to achieve an adequate volume for complete correction. Conclusions: Structural fat grafting can eliminate the volume deficiency and skin changes associated with steroid induced lipoatrophy. It is a straightforward, well tolerated method for correcting a problem which can be quite cosmetically deforming.

Dermis-fat graft for contracted socket reconstruction in an indigenous black population, Southwestern Nigeria

The purpose of this case series is to report the indications for dermis-fat grafting and the outcome of treatment in orbital soft tissue contraction among patients in a tertiary center. It is a retrospective, consecutive, interventional case series where all patients with orbital soft tissue contraction who had dermis-fat grafting were studied. All nine patients in our series underwent secondary dermis-fat grafting for orbital soft tissue reconstruction. The major cause for contracted socket was surgical eye removal following trauma. Eight of nine patients had no orbital implants inserted at the time of primary eye removal and eight patients have had failed orbital reconstructive procedures. Satisfactory cosmetic results were reported in all patients post-operatively. Dermis-fat grafting for contracted socket reconstruction was found to give satisfactory cosmetic results in our studied population.

Fat grafting in autologous breast reconstruction:applications,outcomes,safety,and complications

Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability;it can be used independently to replace more invasive flap procedures or implants,or as an adjunct for smaller volume supplementation.The breadth of applications in the breast necessitates diversity in technique and approach,and while there is no universally agreed-upon protocol,basic principles have guided the evolution of some commonly adopted tenets.Broadly,fat grafting outcomes are highly favorable but dependent on patient and procedure factors,requiring learned patient selection and expertise in recipient site assessment.Common complications from fat grafting,such as fat necrosis and the development of nodules,are particularly troublesome for post-oncologic patients,requiring considerable pre-surgical consultation for patient education and managing expectations.In addition to volume and contour augmentation,fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or postmastectomy pain syndrome,improved skin quality and reduced fibrosis following radiation,and possible anti-tumorigenic effects.New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma.Preclinically,research towards safe and effective regenerative medicine approaches is actively underway,with the ultimate goal of achieving predictable and increased graft retention,reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.

Treatment of recurrent carpal tunnel syndrome with fat grafting as an adjunct

Aim:The purpose of this study is to compare the surgical outcomes of treating recurrent carpal tunnel with recurrent carpal tunnel release only compared to recurrent carpal tunnel release with fat grafting as an adjunct.Methods:Retrospective case-control study was performed of the recurrent carpal tunnels treated,excluding explicit nerve injury such as transections,neuromas in continuity,etc.Patients with recurrent carpal tunnel received re-release of carpal tunnel only or fat grafting as an adjunct.The outcomes of both groups were compared utilizing chi-square analysis.Results:A total number of 81 patients were found to meet the inclusion criteria.Of the recurrences,a total of 16 patients did not receive fat grafting and 65 did.The rate of improvement in symptoms for performing a carpal tunnel release was only 50.0%and for performing carpal tunnel release with fat grafting was 92%,with P-value<0.00.Conclusion:Adipose-derived stem cells as an adjunct to carpal tunnel release increased the rate of improvement in symptoms of carpal tunnel compression after recurrence compared to carpal tunnel release alone.Further studies need to be performed to confirm the validity of these findings.

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

Objective：Clinical application ofautologous fat grafting （AFG） is quickly expanding.Despite the widely acceptance,long-term survival rate （SR） of AFG remains a question not yet solved.Meanwhile,although rare,severe complications related to AFG including vision loss,stroke even death could be seen in the literature.Data Sources：A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.Articles were screened using predetermined inclusion and exclusion criteria.Study Selection：Data collected included patient characteristics,surgical technique,donor site,recipient site,graft amount,and quantified measurement methods.Patient cohorts were pooled,and SR was calculated.All the severe complications were also summarized according to the different clinical characteristics.Results：Of 550 articles,16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods.Totally,596 patients were included.SR varied from 34％ to 82％ in breast and 30-83％ in the facial area.Nude mice were applied to investigate human fat grafting SR （38.3-52.5％ after 15 weeks）.Rabbits were commonly used to study animal AFG SR （14.00-14.56％ after 1-year）.Totally,21 severe complications were reported,including death （2）,stroke （10）,vision loss （11,8 of which accompanied with stroke）,sepsis （3）,multiple abscess （1） and giant fat necrotic cyst （2）.Ten of these complications happened within 10 years.Conclusions：There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite.Body mass index change between pre-and postoperation may be the bias factor in evaluating fat SR.Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

Comparison of adipose particle size on autologous fat graft retention in a rodent model

Aim:Unpredictable retention outcomes remain a significant issue in autologous fat grafting procedures.Liposuction cannula variation leads to variability in fat particle size.Recent data suggest that the size of fat particles is closely related to graft healing outcomes;however,this remains a point of contention due to potential confounding variables such as tissue trauma with harvest.The aim of this study was to compare autologous fat grafting outcomes with variable fat particle sizes in an animal model which isolated fat particle size as the primary experimental variable.The overall goal of this work was to determine if reducing fat particle size is an effective method for enhancing graft retention in autologous fat grafting.Methods:The range of fat particle diameter harvested by four common liposuction cannulas was quantified to define relevant small and large particle target diameters.To determine if particle size impacted nutrient and oxygen permeability,small and large particles were incubated in vitro in a spinner flask with an abundance of culture media and vascular endothelial growth factor secretion was measured with enzyme-linked immunosorbent assay.Finally,small and large fat grafts were prepared from subcutaneous mouse fat pads and grafted in syngeneic Balb/CJ mice.Weight and volume retention were evaluated at 1,4,8,and 12 weeks.Histological analysis with Masson's trichrome and perilipin immunofluorescent staining was performed.Real-time quantitative polymerase chain reaction was performed foradipogenic,inflammatory and apoptotic genes.Results:The range of fat particle diameters harvested with four commonly used cannulas was 2-7 mm.In vitro studies showed that 5-7-mm particles had significantly increased VEGF secretion normalized to weight,indicating increased tissue hypoxia in these particles compared to 2-4-mm particles.Surprisingly,in vivo comparison in two unique studies showed 2-4-mm and 5-7-mm fat particles had comparable graft retention(P=0.5329).Masson's trichrome staining revealed increased extracellular matrix and fibrosis in the 5-7-mm particle group(P=0.0115).Adipocyte survival with perilipin demonstrated comparable viability.Gene expression showed large particles experienced increased inflammation and apoptosis at one week after grafting,but overall there were no significant differences between groups.Conclusion:The ideal fat particle size should be large enough to contain adequate mesenchyme while not so thick as to preclude imbibition.This study suggests that,despite changes in hypoxia and VEGF levels,differing fat particles(2-4-mm and 5-7-mm)can achieve similar graft retention.

A promising tool for surgical lipotransfer: a constant pressure and quantity injection device in facial fat grafting

Background: The purpose of this study was to preliminarily assess a constant pressure and quantity fat granule injection device for minimal invasive properties in clinic.Methods: A retrospective controlled study was carried out, from October 2013 to January 2015, on 76 female healthy patients aged between 26 and 53 years at the General Hospital of Lanzhou Military Command, China. To achieve small volume, high thrust, and precision requirements of facial fat grafting, an integrated handheld controller and motor design was adopted, reducing the volume and weight of the fat transplantation injection device. The 76 patients underwent 90 procedures each side of the face;each patient was treated with the aforementioned device on the face's left side, while a conventional hand-push injection device was used on the right side as control. The outcome was assessed on pre- and postoperative images, with 6-24 months follow-up.Results: The current device consistently allowed deposition of fat threads at about 55 μL/cm after cannula withdrawal;the volume of fat injected could be precisely adjusted to 0.04 mL/s. This device had the advantages of small-volume injection and convenient operation. The patients exhibited a good, stable shape and a smooth contour line in both sides. The long term satisfaction was higher for the left side than for the right one. Nodules and unevenness occurred only on the right side. Ecchymosis occurred significantly less frequent on the left side than the right one. Intraoperative pain was significantly lower for the left side than the right one.Conclusions: This device offered superior control compared with the conventional one and constitutes a promising tool for surgeons practicing lipotransfer.

A Novel Composite Skin Graft Technique with Fat Derivatives

Skin grafting,although a relatively classic and well-known technique,still has multiple disadvantages such as secondary contracture of the skin graft,sunken depression,poor elasticity,and color mismatch.Adding adipose tissues significantly improved the graft appearance compared to traditional skin grafting methods.Herein,we report two cases of modified skin graft procedures,both showing positive outcomes.In case 1,a mechanically processed fat-derived product was injected into the lower half of the skin graft area.In case 2,left upper eyelid blepharoplasty was performed,and the orbital fat strip was transferred and placed under the recipient area on the right side.Hair growth was observed only in case 1,whereas the extent of sunken depression was significantly reduced in both cases.Compared to traditional skin grafting methods,adding fat components to the skin graft recipient area improved the appearance and blood supply,together with enhancing the regenerative rate.

Fat Re-Grafting in Facial Asymmetry: A 2-Case Report

Fat redistribution through recycling of previously grafted fat hasn’t been reported. Two facial asymmetry patients are presented with history of fat grafting to the mandibular angle areas. Collected fat from these formerly fat grafted zones and swollen on subsequent extra body weight gain has been re-grafted in the temporal regions for contour enhancement and has retained volume as photographically documented up to 30 months.

颗粒脂肪联合纳米脂肪移植治疗重睑术后上睑凹陷的临床应用

目的:探讨颗粒脂肪联合纳米脂肪移植治疗重睑术后上睑凹陷的临床疗效。方法:选取2018年7月-2022年2月笔者科室应用颗粒脂肪联合纳米脂肪移植治疗重睑术后上睑凹陷的13例患者(20只眼)。抽取脂肪后,处理成颗粒脂肪和纳米脂肪。每只眼注射颗粒脂肪1.2~2.0 ml,纳米脂肪0.2~0.8 ml。结果:随访6~12个月,17只眼疗效良好;2只眼矫正不足,3个月后再次移植颗粒脂肪和纳米脂肪;1只眼眼尾分叉,6个月后行切开重睑修复,再次治疗后疗效均较好。结论:颗粒脂肪联合纳米脂肪移植治疗重睑术后上睑凹陷疗效好、创伤小、恢复快。