Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty

2021 ◽  
Author(s):  
Per Hedén ◽  
Sebastian Fischer
Keyword(s):  
Online Survey ◽  
Study Groups ◽  
Fat Grafting ◽  
Fat Graft ◽  
The Novel ◽  
Level Of Evidence ◽  
Lower Blepharoplasty ◽  
Novel Technique ◽  
Tear Trough ◽  
Tear Trough Deformity

Abstract Background Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. Objectives The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. Methods A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. Results There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. Conclusions The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. Level of Evidence: 4

Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

2021 ◽  
pp. 229255032110499
Author(s):  
Rebecca Miller ◽  
Sheina Macadam ◽  
Daniel Demsey
Keyword(s):  
Breast Reconstruction ◽  
Citation Analysis ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Number Of Patients ◽  
Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

The Effect of Minocycline on Fat Graft Survival and Apoptotic Pathway

2019 ◽  
Vol 35 (01) ◽  
pp. 096-102 ◽  
Author(s):  
Kırdar Güney ◽  
Bora Özel ◽  
Cemile Seymen ◽  
Çiğdem Elmas ◽  
Serhan Tuncer ◽  
...  
Keyword(s):  
Graft Survival ◽  
Study Groups ◽  
Fat Grafting ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Fat Graft ◽  
Albino Rats ◽  
Apoptotic Pathway ◽  
Fat Grafts ◽  
Dorsal Area ◽  
Wistar Albino Rats

AbstractVariable absorption rate is one of the biggest problems of fat grafting and one of the most important causes of fat graft volume loss is apoptosis. Minocycline is a tetracycline derivative and besides its antibacterial capacity, it has been widely using for anti-apoptotic effects. This study was designed to investigate the effect of minocycline on fat graft survival and adipocyte apoptosis. A total of two main and eight subgroups were designed and a total of 48 experimental animals, 6 in each group, were used. Fat grafts are obtained from Wistar albino rats and implanted to dorsal area of rats. Local and systemic minocycline was applied in the study groups. On the 9th day, apoptotic cells were detected by the terminal deoxynucleotidyl transferase dUTP nick end labeling method and on the 90th day morphologic characteristics and viability of adipocytes were evaluated using histologic and immunohistochemical methods and statistically compared. This study revealed that the fat grafts were bigger, and they kept their structures better and they were more vascular in the minocycline groups and apoptosis was significantly lower in the minocycline groups. The authors demonstrated that minocycline increases fat graft survival and statistical improvement in apoptosis inhibition via using minocycline therapy has been shown.

Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms

2020 ◽  
Vol 41 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Felipe Molina-Burbano ◽  
J Michael Smith ◽  
Michael J Ingargiola ◽  
Saba Motakef ◽  
Paymon Sanati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fat Grafting ◽  
Treatment Modalities ◽  
Fat Graft ◽  
Cochrane Library ◽  
Complication Rates ◽  
Volume Loss ◽  
Level Of Evidence ◽  
Superficial Musculoaponeurotic System ◽  
Age Related

Abstract Background Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers. Objectives The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. Methods A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: (“fat grafting” OR “lipotransfer” OR “lipofilling” OR “fat transfer”) AND (“facelift” OR “rhytidectomy” OR “SMASectomy” OR “facial rejuvenation”). Data on techniques, outcomes, complications, and patient satisfaction were collected. Results The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub–superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments. Conclusions Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities. Level of Evidence: 3

scholarly journals Internal Fixation Method Using EZ-Tcon for Transconjunctival Fat Repositioning: Clinical Outcomes and Efficacy

2020 ◽  
Vol 44 (5) ◽  
pp. 1-12
Author(s):  
Cheol Ho Chang ◽  
Juyoung Bae ◽  
Myung Kyu Cha ◽  
Sa Ik Bang ◽  
Kyeong-Tae Lee
Keyword(s):  
Internal Fixation ◽  
Fixation Method ◽  
Full Description ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
If Technique ◽  
Fat Repositioning

Abstract Background Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a devised needle (EZ-Tcon) and to compare its outcomes with those of the conventional EPS technique. Methods Patients with primary tear trough deformity who underwent transconjunctival fat repositioning were reviewed and categorized into two cohorts according to the fixation technique: cohort 1 consisted of patients treated using the conventional EPS technique and cohort 2 consisted of those in whom the new IF technique using EZ-Tcon was adopted. Post-operative complications and aesthetic outcomes were assessed using a four-scale grading system. Results A total of 545 patients, 211 from cohort 1 and 344 from cohort 2 were evaluated with a median follow-up of 70 days. Compared to cohort 1, cohort 2 showed significantly lower rates of long-standing conspicuous scars on lower eyelid, re-operation and overall complications. In the analysis of aesthetic outcomes, 88.9 percent of cohort 2 showed grade 0 (no deformity) or I (mild deformity) post-operatively. The rate of excellent outcomes (improvements of ≥ two grades) was significantly higher in cohort 2 than in cohort 1 (p-value < 0.001). Conclusion Our technique using EZ-Tcon could possess advantages of the conventional IF and EPS techniques, showing lower complication rates and aesthetically satisfactory outcomes, and could be a safe and reliable method of transconjunctival fat repositioning. Level of Evidence IV 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.

scholarly journals Autologous cartilage and fibrin sealant may be superior to conventional fat grafting in preventing physeal bone bridge formation – a pilot study in porcines

2020 ◽  
Vol 14 (5) ◽  
pp. 459-465
Author(s):  
Ahmed A. Abood ◽  
Bjarne Møller-Madsen ◽  
Juan Manuel Shiguetomi-Medina ◽  
Hans Stødkilde-Jørgensen ◽  
Casper Foldager ◽  
...  
Keyword(s):  
Articular Surface ◽  
Donor Site ◽  
Current Treatment ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
Bone Bridge ◽  
Magnetic Resonance Imaging Mri ◽  
Paired Design ◽  
Made In

Purpose The article compares physeal recovery after insertion of autologous cartilage and a conventional fat graft in a standardized porcine physeal gap model. Presence of a bone bridge was the primary outcome. Methods Ten porcines in two groups of five were included in a paired design. A standardized physeal gap in the distal femur was made in all animals. One group (n = 5) was randomized for deposition of autologous cartilage and a Tisseel® or Tisseel® alone. The autologous cartilage was harvested from the femoral articular surface. The other group was randomized for fat grafting or no grafts at all. All animals were housed for 14 weeks. Magnetic resonance imaging (MRI) was performed at 14 weeks prior to euthanasia. The physis was harvested for histology. Results MRI – Three bone bridges were seen in the fat grafted gaps. All empty gaps formed a bone bridge. No gaps filled with autologous cartilage and Tisseel® resulted in bone bridges. One gap filled with Tisseel® only caused a bone bridge. Histology – The cartilage grafted gaps recovered with physeal-like cartilaginous tissue in histological analysis. Conclusions Fat grafts seems ineffective in preventing bone bridges. The use of autologous cartilage may be superior to the current treatment. However, donor site complications were not investigated. The study serves as a proof of concept study and requires further investigation. Level of evidence III

Observations on the Tear Trough

2019 ◽  
Vol 40 (9) ◽  
pp. 938-947 ◽  
Author(s):  
Sathyadeepak Ramesh ◽  
Robert Alan Goldberg ◽  
Allan Edward Wulc ◽  
Alan Bart Brackup
Keyword(s):  
Lower Eyelid ◽  
Surgical Patients ◽  
Level Of Evidence ◽  
Erbium Laser ◽  
Laser Resurfacing ◽  
Men And Women ◽  
Lower Blepharoplasty ◽  
Tear Trough ◽  
Midface Lift ◽  
Topographic Structure

Abstract Background The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. Objectives The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. Methods We undertook a retrospective review of “ideal” subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients. Results The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P &lt; 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P &lt; 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P &lt; 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P &lt; 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P &lt; 0.01) than after all other procedures. Conclusions A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways. Level of Evidence: 4

Hybrid Breast Augmentation: A Reliable Formula for Preoperative Assessment of Fat Graft Volume Based on Implant Volume and Projection

2020 ◽  
Vol 40 (8) ◽  
pp. NP438-NP452 ◽  
Author(s):  
João Maximiliano ◽  
Alexandre Mendonça Munhoz ◽  
Mirian Pedron ◽  
Antonio Carlos Pinto de Oliveira ◽  
Daniele Walter Duarte ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Low Cost ◽  
Preoperative Assessment ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Clinical Series ◽  
Fat Removal

Abstract Background Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. Objectives This aim of this study was to develop a method based on a mathematical formula, which utilizes implant volume and projection to predict AFG volume. Methods Thirty patients (60 breasts) underwent primary hybrid BA. A software package (SketchUp) was used to simulate 3-dimensional AFG and implant volumes, which in turn were used to develop an equation for estimating AFG volume according to 3 different implant projections. The results for each group were compared, via Pearson’s correlation coefficient, with the results of the clinical series. Results All patients received Motiva Ergonomix SmoothSilk/SilkSurface implants, ranging in volume from 175 to 355 cc (mean, 265 cc), as well as an average AFG volume of 79.2 cc/breast (range, 50-110 cc). Twenty-nine patients (96.6%) were either very satisfied or satisfied during a mean follow-up of 18 months (range, 6-28 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (r = 0.938, P &lt; 0.001). Conclusions The AFG volume in hybrid BA procedures can be estimated utilizing measurements based on implant volume/projection. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for BA. Level of Evidence: 4

scholarly journals Tear trough – Anatomy and treatment by autologous fat grafting

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Chang Yung Chia
Keyword(s):  
Subcutaneous Fat ◽  
Anatomical Study ◽  
Personal Characteristic ◽  
Fat Grafting ◽  
Fat Graft ◽  
Autologous Fat Grafting ◽  
Autologous Fat ◽  
Tear Trough ◽  
Grafting Technique ◽  
Thin Skin

<p>Tear trough is the main irregularity at midface, of which treatment is difficult. There is no agreement in literature about its anatomy and best treatment. The author presented an anatomical study and personal autologous fat grafting technique for tear trough treatment. Anatomical dissections were done on two fresh cadavers to examine the skin, subcutaneous, muscle and bone layers, spaces, and attachments. Safety and efficacy were evaluated via retrospective analysis of the last 200 consecutive procedures performed by the author. Tear trough is caused by the abrupt transition of the palpebral orbicular oculi muscle (OOM) (<em>i.e.</em>, thin skin without subcutaneous fat compartment) to the orbital OOM (<em>i.e.</em>, thicker skin with malar fat compartment). The tear trough region is located at the OOM bony origin at the medial canthus where no specific ligament was found. The grafted fat volume stabilized at two or three months after the procedure, instead of six months as stated in literature, with excellent results and no severe complications. Tear trough is a personal characteristic, a natural anatomical depression caused by subcutaneous irregularity and can worsen with age. The lack of volume is not effectively corrected by surgeries and thus it must be filled. Fat grafting has several advantages over alloplastic fillers, although it may be more difficult. Fat graft is autologous and abundant, and tissue transplantation could enhance skin quality. Fat grafting is a simple, safe, and effective solution for adding extra volume to correct the deflation phenomenon of the midface aging process. There is no specific anatomical plane for volume injection; the fat graft must be evenly distributed in the deep and superficial plane for uniformity.</p>

scholarly journals Free adipose tissue (FAT) graft pooling for severe dead space management

2020 ◽  
Vol 14 (3) ◽  
pp. 293-296
Author(s):  
Gustavo Souza ◽  
Robinson Pires ◽  
Egídio Santana Junior ◽  
Lydia Ferreira ◽  
Richard Yoon ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Fat Grafting ◽  
Fat Graft ◽  
Soft Tissue Reconstruction ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Space Management ◽  
Extremity Trauma ◽  
Tissue Reconstruction

Complex lower extremity trauma with large soft tissue defects requires early wound coverage to reduce the risk of complications. In particular circumstances, however, local or free flaps may be contraindicated due to local or systemic issues. This study presents a helpful and effective salvage procedure for soft tissue reconstruction that uses autologous fat grafting combined with negative pressure wound therapy. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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