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Long-term fate of transplanted autologous fat in the face
Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, e68ee69
CORRESPONDENCE AND COMMUNICATION
Long-term fate of transplanted autologous fat in the face
Dear Sir, Restoration of depleted facial volume is becoming increasingly recognised by plastic surgeons as a necessary component of facial rejuvenation. Although there is an increased trend in replacement of facial soft-tissue volume with autologous fat transfer, the literature fails to provide definitive evidence of long-term fat survival1 A 58-year-old woman requested facial rejuvenation in March 2007. She had undergone facial autologous fat transplantation 18 years earlier for facial contouring by the senior author. According to her medical file, in one intervention, the total volume of fat injected in her face was 36 ml. The amount of fat injected in each of the malar area, buccal area and nasolabial fold was 5, 11 and 2 ml, respectively. Our technique and considerations for harvesting, refinement and injection of fat in the face and neck areas have been previously published.2 Rhytidoplasty for her facial flaccidity was planned. Intra-operatively, when performing undermining of the facial flap, a ‘lipomalike’ tissue in the supra-muscular level of the superficial musculoaponeurotic system (SMAS) was noticed (Figures 1 and 2) Histological evaluation of the harvested specimen demonstrated viable fat tissue. The mechanism of facial-fat graft survival is not clear. The autologous fat transplantation results, like those of any procedure, are technique dependent.3 An important consideration for harvesting and refinement in preparation for grafting is to respect and maintain the tissue architecture of living fat. Any mechanical or chemical insult that damages the fragile tissue architecture of fat will result in eventual necrosis of the injected fat. In an experimental study performed in face of rabbits, morphometric as well as histopathological analyses revealed a statistically significant increase of fat-graft survival in the supramuscular layer when compared to subcutaneous and submuscular layer.4 This is in accordance with the senior authors’ practice of injecting facial-fat graft in a supramuscular plane for the last 20 years.
A recent study in rabbits has reported that the facial transplanted fat remains viable at 1 year, with good overall survivability and minimal fibrosis in rabbit model.5 Although the published experimental animal studies have proved the survival of autologous fat transplantation in the face, the macroscopic observation and the histological examination in this particular case, confirms for the first time in clinical practice the long-term fate of transplanted fat in the face. Although in this specific case, only one session of autologous fat transplantation was performed, a small percentage of patients may need to undergo more than one session of facial fat augmentation in order to achieve the desired result.
Figure 1 Intra-operative view of ‘lipoma-like’ tissue in malar and buccal areas.
1748-6815/$ - see front matter ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.040
Correspondence and communication
e69
Conflict of interest/funding None.
References 1. Kaufman MR, Miller TA, Huang C, et al. Autologous fat transfer for facial recontouring: is there science behind the art? Plast Reconstr Surg 2007 Jun;119:2287e96. 2. Sterodimas A, Huanquipaco JC, de Souza Filho S, et al. Autologous fat transplantation for the treatment of ParryRomberg syndrome. J Plast Reconstr Aesthet Surg; 2008 Aug 15. 3. Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006 Sep;118(3 Suppl):108Se20S. 4. Karacaoglu E, Kizilkaya E, Cermik H, et al. The role of recipient sites in fat-graft survival: experimental study. Ann Plast Surg 2005 Jul;55:63e8 [discussion 68]. 5. Brucker M, Sati S, Spangenberger A, et al. Long-term fate of transplanted autologous fat in a novel rabbit facial model. Plast Reconstr Surg 2008 Sep;122:749e54.
Luiz Haroldo Pereira Department of Plastic Surgery, Luiz Haroldo Clinic, Rua Xavier da Silveira 45/206, 22061-010 Rio de Janeiro, Brazil
Figure 2 Macroscopic proof of facial-fat graft tissue at the supramuscular level of the superficial musculo-aponeurotic system (SMAS).
Aris Sterodimas Department of Plastic Surgery, Ivo Pitanguy Institute, Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute, Rua Dona Mariana 65, 22280-020 Rio de Janeiro, Brazil E-mail address: [email protected]
CORRESPONDENCE AND COMMUNICATION
Long-term fate of transplanted autologous fat in the face
Dear Sir, Restoration of depleted facial volume is becoming increasingly recognised by plastic surgeons as a necessary component of facial rejuvenation. Although there is an increased trend in replacement of facial soft-tissue volume with autologous fat transfer, the literature fails to provide definitive evidence of long-term fat survival1 A 58-year-old woman requested facial rejuvenation in March 2007. She had undergone facial autologous fat transplantation 18 years earlier for facial contouring by the senior author. According to her medical file, in one intervention, the total volume of fat injected in her face was 36 ml. The amount of fat injected in each of the malar area, buccal area and nasolabial fold was 5, 11 and 2 ml, respectively. Our technique and considerations for harvesting, refinement and injection of fat in the face and neck areas have been previously published.2 Rhytidoplasty for her facial flaccidity was planned. Intra-operatively, when performing undermining of the facial flap, a ‘lipomalike’ tissue in the supra-muscular level of the superficial musculoaponeurotic system (SMAS) was noticed (Figures 1 and 2) Histological evaluation of the harvested specimen demonstrated viable fat tissue. The mechanism of facial-fat graft survival is not clear. The autologous fat transplantation results, like those of any procedure, are technique dependent.3 An important consideration for harvesting and refinement in preparation for grafting is to respect and maintain the tissue architecture of living fat. Any mechanical or chemical insult that damages the fragile tissue architecture of fat will result in eventual necrosis of the injected fat. In an experimental study performed in face of rabbits, morphometric as well as histopathological analyses revealed a statistically significant increase of fat-graft survival in the supramuscular layer when compared to subcutaneous and submuscular layer.4 This is in accordance with the senior authors’ practice of injecting facial-fat graft in a supramuscular plane for the last 20 years.
A recent study in rabbits has reported that the facial transplanted fat remains viable at 1 year, with good overall survivability and minimal fibrosis in rabbit model.5 Although the published experimental animal studies have proved the survival of autologous fat transplantation in the face, the macroscopic observation and the histological examination in this particular case, confirms for the first time in clinical practice the long-term fate of transplanted fat in the face. Although in this specific case, only one session of autologous fat transplantation was performed, a small percentage of patients may need to undergo more than one session of facial fat augmentation in order to achieve the desired result.
Figure 1 Intra-operative view of ‘lipoma-like’ tissue in malar and buccal areas.
1748-6815/$ - see front matter ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.040
Correspondence and communication
e69
Conflict of interest/funding None.
References 1. Kaufman MR, Miller TA, Huang C, et al. Autologous fat transfer for facial recontouring: is there science behind the art? Plast Reconstr Surg 2007 Jun;119:2287e96. 2. Sterodimas A, Huanquipaco JC, de Souza Filho S, et al. Autologous fat transplantation for the treatment of ParryRomberg syndrome. J Plast Reconstr Aesthet Surg; 2008 Aug 15. 3. Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006 Sep;118(3 Suppl):108Se20S. 4. Karacaoglu E, Kizilkaya E, Cermik H, et al. The role of recipient sites in fat-graft survival: experimental study. Ann Plast Surg 2005 Jul;55:63e8 [discussion 68]. 5. Brucker M, Sati S, Spangenberger A, et al. Long-term fate of transplanted autologous fat in a novel rabbit facial model. Plast Reconstr Surg 2008 Sep;122:749e54.
Luiz Haroldo Pereira Department of Plastic Surgery, Luiz Haroldo Clinic, Rua Xavier da Silveira 45/206, 22061-010 Rio de Janeiro, Brazil
Figure 2 Macroscopic proof of facial-fat graft tissue at the supramuscular level of the superficial musculo-aponeurotic system (SMAS).
Aris Sterodimas Department of Plastic Surgery, Ivo Pitanguy Institute, Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute, Rua Dona Mariana 65, 22280-020 Rio de Janeiro, Brazil E-mail address: [email protected]