Volumetric lipoinjection of the fronto-orbital and temporal complex with adipose stem cells for the aesthetic restoration of sequelae of craniosynostosis

Abstract

BackgroundNon-syndromic craniosynostosis causes craniofacial asymmetry and may persist after cranioplasty. These postoperative asymmetries are primarily depressions. In some cases, patients may be subjected to pranks and harassment by their peers, affecting their psychosocial development. We propose lipoinjection enriched with adipose stem cells (ASCs) to treat the sequelae of craniosynostosis in the fronto-orbital and temporal complex in cranioplasty patients, with the goal of improving the appearance of the upper third of the face.MethodsTwelve children (four boys and eight girls) between 4 and 8 years of age (mean age, 6 years) in the postoperative period after treatment for plagiocephaly, brachycephaly, and trigonocephaly were included, with a follow-up period of 1 to 18 months. Fat tissue was obtained from the lower abdomen, and ASCs were isolated using the Yoshimura technique. Lipoinjection was performed using several mini-approaches to ensure adequate distribution.ResultsTwo different scales were used to evaluate the aesthetic outcomes. At 6 months, three plastic surgeons independent of the study classified the results using a Likert scale. The patients’ parents categorized the results using a visual analog scale at 6, 9, and 18 months. R esults were favorable on both scales, as the patients’ facial appearance improved and they reported increased happiness and self-esteem due to their remodeled facial appearance.ConclusionsWe suggest that lipoinjection enriched with ASCs is a good alternative for correcting asymmetry of the fronto-orbital and temporal contour in patients with sequelae of craniosynostosis. This treatment will help boost patients’ self-esteem starting at an early age.

Recent advances in trigonocephaly

“…These irregularities can vary in extent but are invariably palpable and often visible [42]. Because facial asymmetry causes psychological issues which may affect academic performance and the development of the child's personality, lipoinjection has been proposed to further refine the results obtained after the primary procedure [42,43]. This technique is a low-risk, minimally invasive, J o u r n a l P r e -p r o o f reproducible and inexpensive procedure.…”

“…This technique is a low-risk, minimally invasive, J o u r n a l P r e -p r o o f reproducible and inexpensive procedure. To improve the volumetric results of lipoinjection, some authors propose adipose stem cells to enrich autologous fat grafts for mild to moderate depressions [43].…”

Applications of Fat Grafting in Pediatric Patients

“…resulting in significant distortion of the cranium and craniofacial asymmetry. [9][10][11] Cranial vault remodeling is the standard treatment option for patients with craniosynostosis. 11 Despite adequate surgical correction of involved cranial sutures, small postoperative contour deformities can sometimes persist or recur.…”

“…11 Despite adequate surgical correction of involved cranial sutures, small postoperative contour deformities can sometimes persist or recur. 10 Previous reports have described autologous fat grafting as a method to correct these contour deformities following craniosynostosis repair. 10,12,13 In 2018, a case series analyzing post-craniosynostosis repair asymmetry in patients with a mean age of 6 years was published by Castro-Govea et al The authors used autologous fat grafts (mean volume ¼ 19 mL) enriched with adipose-derived stem cells (ADSCs) to correct asymmetry and improve facial appearance with high levels of reported patient and family satisfaction.…”

“…10 Previous reports have described autologous fat grafting as a method to correct these contour deformities following craniosynostosis repair. 10,12,13 In 2018, a case series analyzing post-craniosynostosis repair asymmetry in patients with a mean age of 6 years was published by Castro-Govea et al The authors used autologous fat grafts (mean volume ¼ 19 mL) enriched with adipose-derived stem cells (ADSCs) to correct asymmetry and improve facial appearance with high levels of reported patient and family satisfaction. 10 A 2006 study also reported positive outcomes in nine patients with a mean age of 16 years who underwent autologous fat augmentation for the correction of cranioplasty-related contour deficits.…”