Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities
Abstract
:Materials and Methods
Surgical Procedure
- Under general anesthesia, patients were prepared with all aseptic precautions. For infiltration of donor site (medial aspect of thigh), we prepare a mixture of 500 mL of Ringer’s lactate and 0.5 mL of 1:1000 adrenaline. This solution was infiltrated as required.
- After a waiting period of a minimum 20 min, fat harvesting was done by manual aspiration using Sydney Coleman aspiration system which consists of a 3-mm bore cannula attached to a 10-mL Luer lock syringe (Figure 1).
- Same 10-mL syringe is used for its placement in manual centrifuge apparatus (Figure 2). Speed of manual centrifuge, as measured by digital tachometer, does not exceed 500 RPM (revolutions per minute). Centrifugation was thus performed at 500 RPM for 2 min.
- The aspirate after centrifuge form three layers (Figure 3):
- The upper oily layer of fatty acids.
- The intermediate layer consists of adipocytes cell mass.
- The lower one is the dark red mass of packed red blood cells.
- Placement of the fat: A 3- or 2-mL Luer lock syringe with blunt tipped cannula of 3-mm bore attached to its nozzle is used. Through small stab incision, the cannula is used to create subcutaneous tunnels in a fan-shaped manner into which the fat cells are deposited as the cannula is withdrawn. In cases of fat grafting in scarred tissue, subcision was done using 16-gauge needle. Over correction of ~25% was done considering postoperative resorption.
- Postoperative care:
- Broad-spectrum antibiotic and anti-inflammatory drugs for 1 week.
- The patient should be in semi sitting position to decrease the amount of edema.
- Routine cold fermentation was advised to enhance resolution of ecchymosis and postoperative edema.
- Application of antibiotic cream over the incision site twice daily.
- Patient was asked to avoid pressure or massage over grafted site.
- Follow-up: Every case was subjected to postoperative photography biweekly for 3 months and subsequently at 6th month, 1 year, and 2 years postoperatively. Postoperative MRI was taken at 1st and 12th months.
- The presence of notable asymmetries in terms of volume of the treated areas (Yes/No)
- The presence of nodules, infection, thickened areas, ecchymosis, or pain on either side or any other postoperative complications (Yes/No)
- Their level of satisfaction scoring from 0 (very bad) to 10 (very good)
Results
Clinical Evaluation
Radiographic Evaluation
Discussion
Sr. No. | Questions | Options | Answers | Remarks | |
---|---|---|---|---|---|
I. Subjective Evaluation | 1 | The presence of notable asymmetries in terms of volume of the treated areas after 1st surgery | Yes | 4/25 | 16% |
No | 21/25 | 84% | |||
2 | Postoperative complications | Yes | 1/25 | 4% | |
No | 24/25 | 96% | |||
3 | Level of satisfaction | 0 (very bad) to 10 (very good) | Mean score | Very good | |
9.1 | |||||
II. | Objective assessment | 0 (very bad) to 10 (very good) | Mean score | Good | |
8.8 |
Sr. No. | Measurement in Preoperative Scan (mm) (A) | Measurement in 1 mo Postoperative Scan (mm) (B) | Measurement in 1 y Postoperative Scan (mm) (C) | Difference Between B and C (Expressed in %) |
---|---|---|---|---|
1 | 0.5 | 6.7 | 5.2 | 22.39 |
2 | 3.4 | 10.0 | 7.8 | 22 |
3 | 1.8 | 4.5 | 2.8 | 37.77 |
4 | 2.9 | 6.3 | 3.9 | 38.09 |
5 | 6.3 | 12.2 | 10.1 | 17.21 |
6 | 2.4 | 6.0 | 3.9 | 35 |
7 | 1.3 | 7.4 | 5.8 | 21.62 |
8 | 2.5 | 7.5 | 4.8 | 36 |
9 | 3.9 | 8.0 | 6.8 | 15 |
10 | 6.1 | 13.0 | 11.2 | 13.84 |
11 | 7.2 | 13.1 | 10.6 | 19.08 |
12 | 2.4 | 7.2 | 6.0 | 16.67 |
13 | 3.1 | 7.0 | 6.7 | 18.57 |
14 | 6.0 | 12.0 | 10.3 | 14.16 |
15 | 1.3 | 8.3 | 6.3 | 24.09 |
16 | 2.0 | 5.1 | 5.0 | 1.96 |
17 | 3.0 | 7.1 | 6.0 | 15.49 |
18 | 2.2 | 8.1 | 5.9 | 27.16 |
19 | 5.2 | 12.2 | 10.1 | 17.21 |
20 | 1.8 | 11.2 | 9.0 | 19.64 |
21 | 5.0 | 12.0 | 9.3 | 22.50 |
22 | 4.7 | 9.4 | 7.3 | 22.34 |
23 | 3.9 | 6.8 | 4.9 | 27.94 |
24 | 7.1 | 12.6 | 11.1 | 11.90 |
25 | 4.2 | 11.2 | 8.0 | 28.57 |
Mean | 21.85 |
Conclusions
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© 2015 by the author. The Author(s) 2015.
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Agrawal, K.S.; Bachhav, M.; Naik, C.S.; Tanwar, H.; Sankhe, S.S. Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities. Craniomaxillofac. Trauma Reconstr. 2016, 9, 113-120. https://doi.org/10.1055/s-0035-1566163
Agrawal KS, Bachhav M, Naik CS, Tanwar H, Sankhe SS. Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities. Craniomaxillofacial Trauma & Reconstruction. 2016; 9(2):113-120. https://doi.org/10.1055/s-0035-1566163
Chicago/Turabian StyleAgrawal, Kapil S., Manoj Bachhav, Charudatta S. Naik, Harshwardhan Tanwar, and Shilpa S. Sankhe. 2016. "Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities" Craniomaxillofacial Trauma & Reconstruction 9, no. 2: 113-120. https://doi.org/10.1055/s-0035-1566163
APA StyleAgrawal, K. S., Bachhav, M., Naik, C. S., Tanwar, H., & Sankhe, S. S. (2016). Autologous Fat Transfer for Esthetic Contouring of Face in Posttraumatic Nonfunctional Maxillofacial Deformities. Craniomaxillofacial Trauma & Reconstruction, 9(2), 113-120. https://doi.org/10.1055/s-0035-1566163