Autologous Free Fat Grafting for Management of the Facial Contour Asymmetry (original) (raw)
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Morphea is a rare sclerotic autoimmune disorder primary affecting the skin and subcutaneous tissues. The linear head variants involve the facial area, with asymmetries and deformities. Eighteen patients with hemifacial deformity (age range 14–75 years) were assessed before surgery (T0), and after one (T1, 18 patients) or two (T2, six patients) surgical treatments of facial autologous fat grafting. A stereophotogrammetric reconstruction of the facial surface was obtained for each patient and a group of control subjects, and facial symmetry was quantified according to the root mean square distance between homologous areas of trigeminal innervation. Values obtained from the control subjects were used to calculate z-scores for patients. At T0, all facial thirds of the patients resulted significantly more asymmetrical than those of the control subjects (Mann–Whitney test, p < 0.05), while at T1, the symmetry of the middle facial third did not differ from that of control subjects (p = ...
2018
Facial rejuvenation surgery has evolved from simple excision and tightening to soft tissue repositioning and augmentation. It is important to keep in mind that the face per se is composed of both soft tissues and bony skeleton. Nonetheless, there has been a paucity of approaches that simultaneously address the bony or hard tissue aspects in addition to the soft tissues. A “pan-facial” approach to facial surgery encompassing both the bony and soft tissue components will therefore yield the most favourable outcomes.
Craniomaxillofacial Trauma & Reconstruction, 2020
Study Design: This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting. Objectives: The aim of the present article is to highlight how fat grafting helps to improve aesthetic and functional outcome in facial scars and contour deformities. It also highlights the factors that need to be considered while planning autologous fat grafting to get better aesthetic results. Methods: This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity. The study was conducted from May 2014 to April 2019 in a tertiary care hospital. All the patients were followed up for a minimum period of 1 year from the date of surgery. Assessment of post-operative aesthetic outcome, in terms of satisfaction, was done using the Visual Analogue Scale (VAS), which ranges from 1 to 10 by the patient and operative surgeon. Results: The mean age was 30.8 9.8 years. Out of 60 patients, 20 pa...
Autologous Fat Grafting in Facial Volumetric Restoration
Journal of Craniofacial Surgery, 2015
The authors reported their surgical experience about structural fat grafting in the management of facial volumetric deficit. The purpose of this study was to assess the real indications, cosmetic results, complications, and global patient satisfaction of the Coleman technique in redefining facial contours in congenital and postoperative deformities. A retrospective analysis of 32 patients grafted according to Coleman's technique was performed, and the long-term outcomes and patient satisfaction were evaluated. The mean postoperative clinical follow-up was 14 months. The morphological changes were analyzed by comparing the photographic presurgical facial contour and the postoperative correction of soft tissue defects. All consecutive cases reported showed a progressive fat resorption for 3 months after surgery and its stable integration only after this period. Best results were performed in the treatment of genetically determined syndromes, such as the Franceschetti and Romberg syndromes. The authors suggest this surgical technique also for the treatment of unaesthetic cutaneous abscess cavity after incision and drainage. Unsatisfactory outcomes were obtained in the treatment of the posttraumatic facial scar, which needed more surgical procedures.
Annals of Plastic Surgery, 2019
Background: Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. However, most surgical techniques are difficult to reproduce, and none follow anatomical principles. Objectives: The aim of this study was to assess the clinical outcomes of upper lip contour asymmetry and lip cant correction by anatomical upper lip fat grafting using the subunit and fat compartment principles. Methods: A prospective analysis was conducted of 113 consecutive patients who underwent anatomical upper lip fat grafting using the subunit and fat compartment principles for the management of lip cant and/or upper lip contour (volumetric) asymmetry. Quantitative photogrammetric upper lip symmetry and lip cant measurements were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment (by 8 blinded external plastic surgeons and 8 laypersons) was obtained to grade the qualitative upper lip symmetry. Bivariate and multivariate analyses were performed to identify independent variables associated with the 12-month postoperative lip cant change. Results: There was significant (all P < 0.05) postoperative quantitative and qualitative upper lip symmetry and lip cant enhancement (preoperative < postoperative) after a single upper lip fat grafting procedure, and the outcomes were maintained (all P > 0.05) from 3 to 12 months postoperatively. Parry-Romberg syndrome was negatively associated (P < 0.05) with the 12-month postoperative lip cant change. Conclusions: Anatomical upper lip fat grafting, using the subunit and fat compartment principles, improves lip cant and symmetry in patients with unilateral upper lip asymmetries.
Microsurgical Correction of Facial Asymmetry in 60 Consecutive Cases
Plastic & Reconstructive Surgery, 1996
Facial asymmetry in hemifacial microsomia presents reconstructive problems of bone and soft tissue. In most cases, this is managed by skeletal reconstruction followed by microvascular free tissue transfer for patients requiring soft tissue augmentation. We present here our experience using customized parascapular free flaps with extensions of dorsal thoracic fascia, which yields esthetically satisfying results. KEY WORDS: parascapular mlcrovascular flap; parascapular fasciocutaneous; hemifaclal mlcrosomla Hemifacial microsomia presents reconstructive problems for both bone and soft tissue. It is best managed with a team approach using the expertise of craniofacial surgeons, microsurgeons, orthodontists, and psychologists. Extensive craniofacial surgery may be required to build a functional skeletal scaffold on which soft tissue can be molded. More recently, bone expansion of the deficient mandible and possibly the maxilla and midface may precede free tissue transfer to yield an esthetic symmetrical face. The timing of bony reconstruction, microsurgical free tissue transfer, ear reconstruction, and other techniques is still evolving. This paper will present our approach in the microsurgical correction of facial asymmetry involved with hemifacial microsomia using modifications of the parascapular microvascular flap with variable extensions of fat and surrounding fascia. Bone can also be incorporated for reconstruction of the mandibular ramus and condyle. Other fasciocutaneous donor sites such as the superficial inferior epigastric flap may be used. This donor site has a less conspicuous scar and should be considered when the tissue requirements are fairly uniform. However, the ability to correct subtle associated deformities about the upper lip, nose, eyelids, ear, and chin is maximized in using the parascapular flap with variable fascial extensions. This technique has evolved over time within the craniofacial program at New York University Medical Center and now provides us with results, which, we believe, are functionally and estheticaUy satisfying. We have come to rely on the parascapular fasciocutaneous flap with large fascial extensions because it is reliable and less bulky than muscle flaps, and it yields predictable long-term results without accompanying muscle atrophy. 1 It can be customized to provide varied tissue depth. Separated areas of relative tissue deficiency with interposed, more symmetrical regions can be recon
Plastic surgery international, 2015
Deformities in the craniofacial region are of great social and functional importance. Several surgical techniques have been used to treat such pathologies often with high morbidity and lacking the ability to address smaller contour defects. The minimally invasive technique of fat transplantation has evolved rapidly within the last few decades. The objective of this paper is to present the versatility and applicability of fat transplantation in a wide range of contour deformities in the craniofacial region. We share our experiences in treating 13 patients with autoimmune disorders, congenital malformations, and acquired defects. Future perspectives of fat transplantation in the field of craniofacial reconstruction are discussed.
Zonal Analysis of Facial Asymmetry and Its Clinical Significance in Facial Plastic Surgery
JAMA Facial Plastic Surgery, 2013
To describe common patterns of facial asymmetry and to augment the facial analysis paradigm for improved preoperative counseling and surgical planning. Methods: We conducted a frontal photographic analysis of 50 patients who were seeking various types of facial cosmetic surgical procedures. The horizontal zonal thirds of the face were analyzed, and the bilateral data points were compared in regard to brow height, width of midface at maximum distance, malar eminence height, nasal alar height, and mandible width measured from the oral commissure to the gonial angle. Results: Forty-five patients demonstrated measurable asymmetry of the midface. The malar eminence was found to be more superiorly positioned and defined on the narrower side of the face in all cases. In contrast, the con-tralateral wider side of the face appeared flatter, with a more hypoplastic, inferiorly positioned malar eminence. Also, the wider side of the face more often demonstrated a wider mandibular dimension and a superiorly displaced ala. The upper third of the face, in regard to brow height, was the most variable and showed little correlation to the lower two-thirds of the face. Conclusion: This facial analysis exercise can assist the surgeon in (1) preoperative counseling, (2) managing expectations, (3) choosing appropriate-sized implants for improved symmetry, and (4) offering a more detailed assessment during the counseling of patients before facelift surgery.
Implementing Fat Grafting in the Management of Complex Facial Reconstructive Patients
2013
Exhibiting many of the qualities of the ideal filler, fat grafting has been embraced among the most popular procedures in facial aesthetic surgery. This work emphasizes the implementation of fat grafting in the management of difficult facial reconstructive cases. Coleman’s principles for structural fat grafting were used to replenish volume in different aesthetic units of the face in 27 patients with age ranging from sixteen till twenty eight years presenting with facial soft tissue deficiencies and/or skeletal deficiencies. Three patients had only soft tissue deficiencies and they all belonged to the hemifacial atrophy category and were operated upon, with fat grafting only, after they have been in their stable phase of the disease for at least one year. The remaining 24 patients had both skeletal and soft tissue deficiencies. They included 7 repaired cleft lip and palate patients, 5 patients with hemifacial microsomia, 4 orthognathic and jaw deformity cases, 3 patients with Treach...