The Role of Fat Grafting in the Treatment of Posttraumatic Maxillofacial Deformities

Abstract

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.

The Versatility of Autologous Fat Transplantation in Correction of Facial Deformities: A Single-Center Experience

“…Although multiple procedures are usually required, the procedures are minimally invasive and hospitalization is short. We also found that sedation and local anesthesia can be sufficient when transplanting fat into the head and neck area, as has been described in prior studies [ 6 , 25 , 26 ].…”

“…A study by Arcuri et al investigated 19 patients who underwent posttraumatic reconstruction of maxillofacial deformities with fat transplantation. They achieved excellent results with adequate facial balance after clinical and software analysis [ 6 ]. We treated a 44-year-old patient, who had suffered a gunshot wound to the face two decades ago, resulting in enucleation of the right eye and the need for reconstruction of the right lower eyelid with a paramedian forehead flap.…”

Psychodynamic Features Associated With Orthognathic Surgery: A Comparison Between Conventional Orthognathic Treatment and “Surgery-First” Approach

“…[3][4][5][6][7][8][9][10][11][12][13][14] Currently, little and contradictory information is available regarding the impact of the surgery-first approach and traditional approach on patients' psychological status and quality-of-life outcomes. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Therefore, the aims of this study were to assess the personality traits of orthognathic patients and to investigate and compare the changes related to psychosocial well-being, self-esteem, anxiety, and quality of life between presurgical and postsurgical phases in patients undergoing traditional and surgery-first orthognathic treatments.…”

Autologous Fat Grafting in Facial Volumetric Restoration

“…2 , 9 – 11 The design of a new small blunt cannula, the fat centrifugation, has become the Coleman technique, an elective therapy of many craniofacial deformities. 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 – 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.…”

“… 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 – 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.…”