Structural Fat Grafting in Complex Reconstructive Surgery

Abstract

The use of adipous tissue transfer for the correction of maxillo-facial defects was reported for the first time at the end of the 19 century and has been the subject of numerous studies. Grafted fat tissue has been used for years as an excellent filler during facial enhancement and recontouring. Several techniques have been proposed for harvesting and grafting the fat. However, due to the damage caused by excessive adipose tissue during these maneuvers, the results were not satisfying. The situation required a larger amount of fat to be harvested even for small corrections. In 1988, the American plastic surgeon Sydney R. Coleman personally developed a technique called Structural Fat Grafting (SFG), which allows the fat to be harvested and injected with minimal risk of necrosis and reabsorption.

Evidences of autologous fat grafting for the treatment of keloids and hypertrophic scars

“…[1][2][3][4][6][7][8][9][10][11][12][13][14][15][16] Nine of the 15 studies were classified as level IV (case series), two as level III (a retrospective cohort and a comparative clinical study), one as level II (prospective cohort study), and three were not classified (for dealing with animal studies or review articles). No level I studies were found, that is, those with the strongest evidence (controlled and randomized clinical trials).…”

Autologous Fat Grafting in Facial Volumetric Restoration

“…2,3,9 -12 Some authors 3,12 add that it is potentially permanent too, but others 21,22 claim results are inconsistent and uncertain. From Coleman's technique, different approaches for fat harvesting, processing, and injection were suggested for improving the cosmetic outcome and graft survival.…”

“…[17][18][19] For its volumetric qualities and regenerative capacity, fat harvesting was suggested in many facial asymmetries: after trauma, post-tumor resection, congenital complex, and hemifacial asymmetry (Franceschetti and Romberg syndromes). 4,[13][14][15][16][29][30][31][32][33][34] Our best results, following the traditional Coleman technique, were performed in the treatment of genetically determined syndromes, such as the Franceschetti and Romberg syndromes. Autologous fat transportation appears, particularly indicated in complex reconstructive surgery, as a powerful tool to improve facial aesthetics.…”

“…Many authors considered the Coleman technique an excellent surgical solution for facial reconstruction and re-contouring with natural and longlasting results. 4,20 The authors reported their experience in redefining facial contours in congenital and postoperative deformities with Coleman's technique.…”

“…12 In recent years, maxillofacial and craniofacial applications have been reported and described: localized tissue atrophy, tissue loss after trauma, post-tumor resection, congenital complex craniofacial deformities, burns, and hemifacial asymmetry (eg, Romberg syndrome, scleroderma). [12][13][14][15][16] Recent studies have shown that human adipose tissue represents a rich source of adipose stem cells, featuring secretion of angiogenic and anti-apoptotic factors in animals. 17,18 Some authors have reported the differentiation of adipose-derived cells into chondrocytes, myocytes, osteoblasts, and, most recently, neural progenitor cells.…”