Search Results (5)

Background: Incomplete eyelid closure and lagophthalmos due to facial nerve palsy are significant functional and aesthetic concerns often requiring surgical correction. The aim of this systematic review is to quantitatively assess the efficacy, safety, and patient satisfaction associated with gold or platinum weight implantation, autologous fat grafting (lipofilling), and müllerectomy. Methods: A systematic review was performed following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to March 2025. Studies included clinical data on surgical correction for incomplete eyelid closure in facial palsy, reporting functional, anatomical, and satisfaction outcomes. Quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-six studies including a total of 1205 patients were included. Gold/platinum weight implantation achieved complete or near-complete eyelid closure in 83–92% of cases, with a reduction in lagophthalmos to <1 mm. Complication rates ranged from 5–15% (mainly extrusion/migration), and patient satisfaction averaged 7.9/10. Lipofilling showed persistent benefit in 77% of cases, with 9–20% requiring repeat procedures and 10–12% experiencing minor complications. Müllerectomy yielded symptomatic improvement or resolution in 92% of cases, with a mean lagophthalmos reduction of 1.18 mm. Conclusions: Gold or platinum weight implantation provides the most reliable improvement for severe upper eyelid dysfunction in facial palsy. Lipofilling is a viable autologous alternative, while müllerectomy is effective in selected cases. Further prospective comparative trials are needed to refine surgical selection and optimize outcomes. Full article

Heat preconditioning has been shown to promote nutritive perfusion and tissue survival in autologous fat grafting as well as in flap and breast surgery. However, its impact on the vascularization properties of nanofat has not been investigated so far. Therefore, we exposed nanofat from donor mice to a temperature of 43 °C for 1 h and assessed the effects of this heat stress on cell viability and the expression of heat shock proteins (HSPs) and angiogenesis-related factors. Moreover, dermal substitutes seeded with heat-preconditioned and non-preconditioned control nanofat were implanted into dorsal skinfold chambers of recipient mice to study their vascularization and tissue integration in vivo by means of repeated intravital fluorescence microscopy, histology and immunohistochemistry. Heat preconditioning upregulated the expression of HSPs in nanofat without affecting cell viability. Moreover, it resulted in the downregulation of many pro-angiogenic factors and the increased expression of anti-angiogenic factors, indicating a shift towards an anti-angiogenic phenotype. Accordingly, implanted dermal substitutes seeded with heat-preconditioned nanofat exhibited a reduced vascularization and were not better integrated into the host tissue when compared to controls. These findings indicate that heat preconditioning cannot be recommended for enhancing the vascularization capacity of nanofat. Full article

Background/Objectives: Combining autologous fat grafting with implant placement is meant to improve the quality of implant-based breast reconstruction. The present study explores the concept of multi-stage composite breast reconstruction with repeated sessions of autologous fat grafting to increase mastectomy flap thickness and provide better pre-pectoral implant coverage. Methods: Twenty-five consecutive patients underwent bilateral multi-stage composite expander-to-implant breast reconstruction and reverse expansion from August 2020 to April 2024. Subcutaneous thickness of the mastectomy flap was evaluated in predefined regions of interests of the breast on standardized MR images at two timepoints (before the first fat grafting session, with the tissue expander fully inflated, and 3 months after implant placement). Furthermore, the incidence of complications requiring surgery and implant-related complications were evaluated. All values are expressed as mean ± standard deviation, accepting statistical significance for a p-value < 0.05. Results: Patients underwent an average of 2.5 ± 0.6 fat grafting sessions, with a fat injection volume of 170 ± 60 mL per breast per session. The mean duration of the reconstructive process from mastectomy to final implant placement was 12 ± 5 months and the mean follow-up was 17 ± 8 months. The overall thickness of both breasts amounted to 190% of baseline thickness and was significantly higher in the upper breast quadrants than in the lower quadrants (p < 0.05). Tissue thickness increase correlated well with the number of fat grafting sessions and was independent of the patient’s weight gain. Complications requiring surgery occurred in eight breasts during the reconstruction, with iatrogenic expander puncture being the most frequent (three cases, 6%). During follow-up, only one implant-related complication was observed (one case of bilateral rippling, 4%). No breast animation or symptomatic capsular contracture were observed. Conclusions: Multi-stage pre-pectoral composite expander-to-implant breast reconstruction using autologous fat grafting is an effective concept for breast reconstruction. Despite the need for multiple surgeries, the significant increase in subcutaneous tissue thickness, resulting in better soft tissue coverage, compensates for the longer reconstructive process. Full article

Background: Autologous fat grafting, enriched with platelet-rich plasma (PRP), has been established as an effective and affordable treatment for various types of wound healing. However, its efficacy in managing wounds with tendon exposure has not been thoroughly investigated. Methods: We report the case of a 40-year-old male who sustained a severe friction burn on his hand and forearm from a car accident, resulting in significant tissue loss and exposed extensor tendons. Results: Traditional wound treatment strategies were not implemented due to specific patient circumstances. After initial surgical management failed to prevent necrosis and maintain coverage of the exposed tendons, the patient underwent a novel treatment involving autologous fat grafting combined with PRP and growth factors. The procedure was repeated twice within a month to promote granular tissue formation over that area and facilitate subsequent coverage with an epidermoreticular graft. By day 21 post-initial graft, the exposed tendons were 98% covered with granular tissue. Complete wound coverage was achieved by day 60, and by day 130 the patient had regained 90% functionality of the affected limbs. Conclusions: This case illustrates the potential of autologous fat grafting combined with PRP and growth factors as a viable, flap-free alternative for covering tendon exposures. This approach not only enhances wound healing but also supports functional recovery, underscoring the need for further research into its broader applicative potentials. Full article

Systemic sclerosis (SSc) or scleroderma, is a rare, systemic autoimmune connective tissue disease that can cause fibrosis of cutaneous tissue and visceral organs. Facial involvement can have a deleterious effect on patients’ function, cosmetic appearance and quality of life. This study describes our experience and results with total facial autologous fat grafting for treating scleroderma. It includes 14 women and 3 men with SSc, at an average age of 51.3 years who underwent 32 autologous fat grafting surgeries between 2017–2022. The surgical technique is further described and demographic and surgical data, including preoperative and postoperative measurements were analyzed. Patients who had multiple surgeries ultimately received grafts with twice the volume of fat than in the first procedure. The oral opening increased an average of 33%. All patients reported improvement in quality of life and were very satisfied with the aesthetic outcomes. The use of autologous fat grafting to treat SSc patients successfully increased oral openings and improved facial manifestations. The procedure is reproducible, safe and leads to improvement in facial manifestations and patients’ quality of life. It can be repeated over time to preserve or enhance the results. Full article