FACIAL FAT GRAFTING- OUR EXPERIENCE AT A TERTIARY CARE CENTRE IN INDIAN SCENARIO

INTRODUCTION: Facial scars cause aesthetic impairment and functional limitation for the patient. Till date there is no gold standard treatment for facial scar tissue. Autologous fat grafting has shown promising results for depressed scar tissue and soft tissue volume deciency seen in certain congenital syndromes. METHODS AND MATERIAL: 14 patients (11 female and 3 male) with depressed scars and syndromic facial volume deciencies were treated with autologous fat grafting. A visual 4-grade scale was used for the evaluation of the results. RESULTS: All patients showed improvement. 12 patients required single operation whereas 2 patients required another operation. The patients were followed up till 18 months. CONCLUSION : Autologous fat grafting is a great method to address the problems of volume deciency and depressed scars on the face. Its use as a natural soft tissue ller are long lasting.

Newer Insights Into Fetal Growth and Body Composition

Based on epidemiological and experimental evidence, the origins of childhood obesity and early onset metabolic syndrome can be extended back to developmental processes during intrauterine life. It is necessary to actively investigate antecedent conditions that affect fetal growth by developing reliable measures to identify variations in fetal fat deposition and body composition. Recently, the resolution of ultrasonography has remarkably improved, which enables better tissue characterization and quantification of fetal fat accumulation. In addition, fetal fractional limb volume has been introduced as a novel measure to quantify fetal soft tissue volume, including fat mass and lean mass. Detecting extreme variations in fetal fat deposition may provide further insights into the origins of altered fetal body composition in pathophysiological conditions (i.e., fetal growth restriction or fetal macrosomia), which are predisposed to the metabolic syndrome in later life. Further studies are warranted to determine the maternal or placental factors that affect fetal fat deposition and body composition. Elucidating these factors may help develop clinical interventions for altered fetal growth and body composition, which could potentially lead to primary prevention of the future risk of metabolic dysfunction.

Teprotumumab for the treatment of chronic thyroid eye disease

Background Teprotumumab, a novel IGF-1R antibody was recently shown to significantly reduce the signs of active Thyroid eye disease (TED). The current study reviews its efficacy in chronic TED. Methods In this retrospective review, consecutive patients with chronic stable TED (>2 years), who had received ≥3 infusions of teprotumumab were included. All patients had measurements of proptosis, and calculation of the CAS and diplopia scores before and after therapy. Five-point strabismus scores were also calculated. Patients who had imaging within 4 months prior to therapy and 6 weeks post therapy underwent orbital 3D volumetric analysis. Results Thirty-one patients met the inclusion criteria. The mean (SD) duration of TED was 81 months (56) and the mean (SD) number of infusions received by each patient was 7 (2). Mean (SD) reduction in proptosis for each study orbit was 3.5 mm (0.4) and 3 mm (0.3) for the fellow orbit. The CAS response was 90% for the study orbit and 87% for the fellow orbit. Of the 15 patients who had diplopia at baseline, 67% had a clinically significant response, while 47% had complete resolution following treatment. Following teprotumumab, mean (SD) reduction of muscle tissue was 2011 mm3 (1847) in the study orbit and 1620 mm3 (1759) in the fellow orbit. The mean (SD) reduction of fat volume was 2101 mm3 (1681) in the study orbit and 1370 mm3 (1181) in the fellow orbit. Conclusion Teprotumumab significantly reduces proptosis, inflammation, diplopia, strabismus and orbital soft tissue volume in patients with chronic TED.

Differences in Temporal Volume between Males and Females and the Influence of Age and BMI: A Cross-Sectional CT-Imaging Study

Background The temple has been identified as one of the most compelling facial regions in which to seek aesthetic improvement—both locally and in the entire face—when injecting soft tissue fillers. Objective The objective of this study is to identify influences of age, gender, and body mass index (BMI) on temporal parameters to better understand clinical observations and to identify optimal treatment strategies for treating temporal hollowing. Methods The sample consisted of 28 male and 30 female individuals with a median age of 53 (34) years and a median BMI of 27.00 (6.94) kg/m2. The surface area of temporal skin, the surface area of temporal bones, and the temporal soft tissue volume were measured utilizing postprocessed computed tomography (CT) images via the Hausdorff minimal distance algorithm. Differences between the investigated participants related to age, BMI, and gender were calculated. Results Median skin surface area was greater in males compared with females 5,100.5 (708) mm2 versus 4,208.5 (893) mm2 (p < 0.001) as was the median bone surface area 5,329 (690) mm2 versus 4,477 (888) mm2 (p < 0.001). Males had on average 11.04 mL greater temporal soft tissue volume compared with age and BMI-matched females with p < 0.001. Comparing the volume between premenopausal versus postmenopausal females, the median temporal soft tissue volume was 46.63 mL (11.94) versus 40.32 mL (5.69) (p = 0.014). Conclusion The results of this cross-sectional CT imaging study confirmed previous clinical and anatomical observations and added numerical evidence to those observations for a better clinical integration of the data.

The influence of soft-tissue volume grafting on the maintenance of peri-implant tissue health and stability

Background To investigate the influence of soft-tissue volume grafting employing autogenous connective tissue graft (CTG) simultaneous to implant placement on peri-implant tissue health and stability. Material and methods This cross-sectional observational study enrolled 19 patients (n = 29 implants) having dental implants placed with simultaneous soft-tissue volume grafting using CTG (test), and 36 selected controls (n = 55 implants) matched for age and years in function, who underwent conventional implant therapy (i.e., without soft-tissue volume grafting). Clinical outcomes (i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mucosal recession (MR)) and frequency of peri-implant diseases were evaluated in both groups after a mean follow-up period of 6.15 ± 4.63 years. Results Significant differences between test and control groups at the patient level were noted for median BOP (0.0 vs. 25.0%; p = 0.023) and PD scores (2.33 vs. 2.83 mm; p = 0.001), respectively. The prevalence of peri-implant mucositis and peri-implantitis amounted to 42.1% and 5.3% in the test and to 52.8% and 13.9% in the control group, respectively. Conclusion Simultaneous soft-tissue grafting using CTG had a beneficial effect on the maintenance of peri-implant health.

Use of a volumetric-stable collagen matrix to correct soft tissue volume

Aim. To study keratinized gingiva using a volume-stable collagen matrix in the first 6 months after soft tissue augmentation.Materials and methods. The clinical study included 59 patients (27 men and 32 women, aged 27 to 50). The surgical protocol includes the following steps: supracrestal incision with a full-thickness flap elevation. Setting the stable collagen matrix (Fibro-Gide®, Geistlich Pharma, Wolhusen, Switzerland). The flap was closed with 5-0 non-absorbable nylon continuous sutures.Results. The average operation time was 75.1 ± 13.2 minutes. The width of the keratinized gingiva before the operation was 0.7 ± 0.32 mm and after 180 days its dimensions were 9.3 ± 3.1 mm.Conclusions. The results of this study showed that 3D collagen matrix is an effective agent for soft tissue augmentation in the implant area.

Buccal Fat Pad Sculpting for Lower Facial Contouring With 3-Dimensional Volume Assessment

Buccal fat pad sculpting and removal (BFPS) can create narrowing of the lower 1/3rd of the face by selective removal and reduction of soft tissue volume. Three-dimensional (3D) imaging allows for quantitative and objective assessment of volume changes over traditional 2-dimensional photographs that has not been previously studied in BFPS. A prospective study was designed in consecutive subjects undergoing BFPS from April 2018 through March 2020. Only those patients that underwent solely BFPS were included. VectraXT 3D imaging and software was used to compare preoperative and postoperative volume changes. Fifteen patients were enrolled in the study with 2 males and 13 females. The mean length of follow up was 7.7 months (range: 1-21 months). All patients were found to have volume reduction in the area evaluated. The mean volume reduction of the selected mid-lower face in the frontal view was 7.2 mL on the left side and 7.5 mL on the right side. There was no statistical difference between the volume change when the 2 sides were compared (P= 0.82). This study demonstrate the use of 3D photography to objectively and quantitatively assess volume change following BFPS and that the volume removed is significant enough to demonstrate favorable results using 3D imaging. Buccal fat pad sculpting is a safe and reliable option for creating a narrowed lower one-third of the face. This is accomplished by selective fat removal and cautery induced reduction of the lower one-third of the face soft tissue volume. VectraXT 3D imaging and analysis is a powerful tool to objectively and quantitatively assess volume changes in BFPS.