Autologous Fat Grafting in the Treatment of Facial Scleroderma

Abstract

Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations of systemic sclerosis are extremely disabling and treatment options are limited. In this study, we aimed to assess the safety and efficacy of autologous fat grafting in the face of patients with systemic sclerosis. We enrolled 16 SSc patients suffering from facial sclerosis and limited mouth opening capacity. Autologous fat injection ranging from 15 to 40 ml was administered per patient, based on their face morphology. The patients were evaluated at baseline and 3 months after fat injection. Evaluations included mouth opening capacity, mouth handicap in systemic sclerosis (MHISS), Rodnan skin sclerosis score, skin biophysical properties using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT), volumizing and aesthetic effects based on pre- and posttreatment photographs, possible side effects, and global patient satisfaction. Clinical assessment showed autologous fat transfer significantly improved mouth opening capacity and the MHISS and Rodnan score of patients with facial scleroderma (p value <.001). The aesthetic and/or functional results of fat injection were satisfying to about 80% of the patients. The changes in CRRT values were not significant. Our findings support the possible therapeutic role of autologous fat grafting in improving facial scleroderma both in aesthetic and in functional aspects. This trial is registered with IRCT20180209038677N1.

Validity and reliability of the Mouth Handicap of Systemic Sclerosis questionnaire in a UK population

“…However, concerns have been expressed regarding the suitability of OHIP‐14 as an OHRQoL measure in certain patient cohorts 25 . Therefore, using specific disease HRQoL measures could offer more accurate and reliable results in both clinical and research settings as seen in recent reports 26,27 …”

“…MHISS was developed as a disease‐specific tool to specifically evaluate the “Mouth Handicap” in patients with SSc, and this may be a viable alternative to OHIP‐14 in this patient population. The oral health‐related quality of life has been assessed by MHISS scale in many studies 27,28 . MHISS has been reported with acceptable validity and reliability in different languages over different countries 11‐13 .…”

Effectiveness of autologous lipoinjection into the hand to improve function in patients with scleroderma: pilot study

“…Its use can revert fibrosis in different pathological conditions, among them scleroderma. 10 Regarding its safety, it does not immune response, and it is not carcinogenic, teratogenic or infectious. It is easily accessible in areas such as the abdomen or gluteus and being a self-transplant tissue, is not necessary to purchase synthetic materials.…”

Oro-facial fibrosis in systemic sclerosis: a reconstructive journey

“…This is reflected in the literature where treatment of oro-facial fibrosis secondary to SSc with AFG significantly improved mouth opening with corresponding decrease in the Mouth Handicap in Systemic Sclerosis Scale (MHISS), a validated scale assessing mouth disability including mouth opening, dental issues, mouth dryness and aesthetic components. [3,[21][22][23]] Del Papa et al [18] did not find a significant change in mouth opening from baseline at 1-month assessment, but a statistically significant increase was observed at 3-months post-procedure, and this correlated to a significant decrease in skin hardness, assessed using a durometer, and increase in labial microvasculature, as observed using videocapillaroscopy. Our group reviewed a cohort of 62 SSc patients treated with peri-oral AFG performed by the senior author, and found a significant improvement in mouth function that was maintained 100% at 6 months, 94% at 7 to 12 months and 66% at 1 year follow-up.…”