Retroauricular approach provides good exposure of the temporomandibular joint and satisfactory protection from nerve injuries and vascular lesions, allowing an adequate osteosynthesis. The scar is hidden behind the ear, and the morbidity is low in terms of auditory stenosis, aesthetic deformity, and salivary fistulas.

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Although we cannot draw statistically significant conclusions, we think that further randomized clinical trials should be necessary to analyze this method; we believe that there is not an ideal approach for a fracture, but each patient needs to be fully evaluated carefully preoperatively, and the more convenient approach needs to be selected for each case.

The first autologous adipose tissue grafting was performed in 1893 with an open approach by a German surgeon named Neuber, 1 who successfully managed an orbitopalpebral scar secondary to tubercular osteomyelitis with fat harvested from the arm.In early 1980s Illouz introduced liposuction performed by a syringe and Fournier introduced liposuction performed by a suction pump. 2-5 They described a closed technique of unpurified fat injection that was called "lipofilling." The inconsistent results of their work characterized by a complete or almost complete absorption of the injected materials did not attract the attention of the scientific literature.In the 1990s Coleman published a new method of fat transplantation by pioneering the concept of structural fat grafting. 6,7 He codified atraumatic surgical steps of harvesting and centrifugation and transfer, stating that the fat must not be compressed, filtered, washed, or manipulated with vacuum or high pressure. Originally developed for reconstructive purposes, this technique has spread to various areas of plastic and aesthetic surgery. Results Nineteen patients were surgically treated with fat transplantation for facial asymmetry due to a pathological postoperative healing of the soft tissue. Clinical examination and software analysis showed adequate postoperative facial balance without major complications. Conclusion Fat grafting is a very powerful tool to correct posttraumatic maxillofacial deformities and to ensure a long-term follow-up. Although we have achieved excellent clinical results in our reconstructive clinical cases, we are convinced that more complex prospective studies, enriched by long-term radiological controls, are needed to fully understand the biological behavior of the transplanted fat in the posttraumatic face.