A Case of Autologous Microfat Grafting in Lip Reconstruction of a Whistle Deformity Following Cancer Treatment

Abstract

A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient's whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy – both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site.

Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

“…Major complications, including blindness or impending necrosis, have been reported following the injection of both HA and autologous fat, but the absence of an antidote as hyaluronidase makes vascular complications more "thoughtful" for lipofilling than HA injection. In reconstructive surgery, it was demonstrated that fat transplantation is a viable option for correcting a post-oncological surgery deformity, even if surgery potentially reduces graft viability secondary to decreased vascularity of the recipient site [79].…”

“…Schweiger et al [108] reported the use of HA fillers for lip asymmetry correction in cleft lip surgery sequelae. Belyea et al [79] described the use of HA filler combined with autologous microfat for the management of lip whistle deformity secondary to surgical wedge resections and postoperative radiotherapy in squamous cell carcinoma treatment. Stolic et al [109] restored with HA injections a lip notch defect after cleft surgery.…”

Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients.

“…18 For mild deformities dermal fillers or autologous microfat grafting may be an option. 19 More serious deformities need musculo-cutaneous flaps for repair.…”

Autologous dermis-fat grafts in head and neck patients: Indications and evaluation in reconstructive surgery

“…However, several sessions are necessary due to the expected resorption (Belyea et al, 2010). In some cases, therefore, a dermis-fat graft can be considered as a differential therapy.…”