Management of Severe Dysphonia and Dysphagia Following Lateral Skull Base Surgery.

OBJECTIVES: Lateral skull base surgeries pose a risk of injuring the lower cranial nerves, leading to potential postoperative complications such as dysphonia and dysphagia. Conservative treatments have shown limited efficacy in addressing these resultant voice and swallowing dysfunctions, significantly impacting patient quality of life. This study aims to evaluate the safety and effectiveness of a combined surgical approach involving autologous fat injection laryngoplasty (AFIL) and transcervical cricopharyngeal myotomy (TCPM) in patients suffering from severe dysphonia and dysphagia following lateral skull base surgery. METHODS: A retrospective analysis was conducted on 16 patients who underwent concurrent AFIL and TCPM to improve severe dysphonia and dysphagia following lateral skull base surgery. Preoperative and postoperative assessments of voice and swallowing functions were performed using the Voice Handicap Index-10 (VHI-10), GRBAS scale, maximum phonation time (MPT), the Chinese version of Swallow Quality-of-Life Questionnaire (CSWAL-QOL), and videofluoroscopic swallowing studies (VFSS). RESULTS: The results demonstrated notable improvements in voice quality and swallowing function. The VHI-10 score improved significantly from a preoperative mean of 32.06 ± 4.92 to a postoperative 9.06 ± 5.24. The results of the perceptual parameters of the GRBAS scale also improved significantly. The MPT increased from a preoperative average of 3.91 ± 1.00 seconds to 9.14 ± 2.44 seconds postoperatively. The CSWAL-QOL scores significantly improved from a preoperative score of 92.44 ± 17.75 to 130.19 ± 26.07 postoperatively. The VFSS-SWAL scores decreased from 6.63 ± 1.36 before surgery to 3.56 ± 1.58 after surgery. Similarly, the Penetration Aspiration Scale (PAS) scores significantly dropped from 6.38 ± 1.05 preoperatively to 2.93 ± 1.48 postoperatively. Nine out of 11 patients were able to have their gastric tubes successfully removed after surgery. There were no significant postoperative complications. CONCLUSION: Concurrent AFIL and TCPM present a promising reconstructive method for patients experiencing severe dysphonia and dysphagia following lateral skull base surgery, highlighting its value in the postoperative management of complex lower cranial nerve injuries.

A case report of Parry-Romberg syndrome.

Key Clinical Message: Parry-Romberg syndrome is characterized by progressive dystrophy in one half of the face, which usually begins in childhood. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance. Abstract: Parry-Romberg syndrome is characterized by progressive dystrophy or loss of subcutaneous tissue in one half of the face, which usually begins in childhood and continues with skin changes, and can also be associated with linear scleroderma. Although this disease has been known for more than 150 years, its exact cause and pathogenesis are not well understood. The clinical feature of Parry-Romberg syndrome that makes it possible to diagnose is unilateral idiopathic facial atrophy. The reported case is a 14-year-old boy who suffered from hemifacial atrophy of the frontal area since he was 7 years old was referred to a plastic and cosmetic surgery specialist and underwent surgery without systemic symptoms and in the inactive phase of the disease. Correct and timely diagnosis of this disease, as well as a multidisciplinary approach and timely and appropriate surgical treatment to minimize the psychological effects and improve the patient's appearance are of particular importance.

Comparison the Effect of Conventional and Nanofat Injection Methods on Nasolabial Fold Lipofilling: A Case- Control Study.

Background: Nasolabial folds are a common sign of aging, accompanied by various manifestations such as skin and tissue loosening, wrinkles, lip corner drooping, mandibular angle loss, platysmal bands, and skin pigmentation changes. Limited research has explored Nanofat injection methods. this study was done with the aim of comparing the effect of fat injection by two methods, conventional and Nanofat, in nasolabial folds. Method: The study conducted in 2020-2021 at the skin clinic in Ilam, western Iran was a case-control study. Participants were divided into two groups, and lipofilling procedures were performed using conventional and nanofat methods with autologous fat. Data collection utilized a researcher-made questionnaire and radiographic results. Follow-up visits occurred on the 30th, 90th, and 180th days to assess complications and recovery rates. After 6 months, participant's photographs were taken and compared with pre-intervention photographs using the GIAS criteria. Data analysis was conducted using SPSS22 version software. Results: The average age of the participants was 37.80±8.30 yr. The treatment response in the conventional fat injection group was significantly better than the nanofat group (P<0.05). Both groups were satisfied with the treatment methods, but high satisfaction was reported in the conventional group, but there was no statistically significant difference between the groups. Conclusion: Both methods of improving wrinkles were effective, but the improvement and response to treatment in the conventional method was better than the Nanofat method, and its effect was felt by the participants for an average period of 3 months.

New autologous fat implantation technique for face lifting: A pilot study.

BACKGROUND: Autologous fat injection techniques are specially performed to restore the lack of face volume. AIM: However, no reports have focused on the effect of sides of injection on the sagging appearance improvements and facial lifting. This study aimed to evaluate face lifting using the autologous fat injection in to sides of the face as a new technique. METHODS: Ten patients with aging face were involved in this study. The procedure was done in an anaerobic method. To improve the method, to make patients more satisfied and gain better cosmetic outcomes autologous fat was injected on the sides of the face. To give a lifting effect to the face, the fat was injected on the hairline in the temple area, next to the ear, the angel of the jaw and the angel of the mandible leaning behind the ear to cause face lift. The patients were appraised clinically and photographically. RESULTS: The results showed that this autologous fat injection technique has significant improvement in face lifting. CONCLUSION: This new fat injection technique in sides of the face can create superior results on face lifting without any adverse side effects.

A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of Grade 3 and 4 Knee Osteoarthritis: Development and Preliminary Validation of precisionKNEE.

Objective To identify key variables predictive of patient responses to microfragmented adipose tissue (MFAT) treatment in knee osteoarthritis (KOA) and evaluate its potential to delay or mitigate the need for total knee replacement (TKR). Methods We utilised a dataset comprising 329 patients treated with MFAT for KOA, incorporating variables such as gender, age, BMI, arthritic aetiology, radiological grade, and Oxford Knee Scores (OKS) pre- and post-treatment. We employed random forest regressors for model training and testing, with gender bias mitigation and outlier detection to enhance prediction accuracy. Model performance was assessed through root mean squared error (RMSE) and mean absolute error (MAE), with further validation in a TKR-suitable patient subset. Results The model achieved a test RMSE of 6.72 and an MAE of 5.38, reflecting moderate predictive accuracy across the patient cohort. Stratification by gender revealed no statistically significant differences between actual and predicted OKS improvements (p-values: males = 0.93, females = 0.92). For the subset of patients suitable for TKR, the model presented an increased RMSE of 9.77 and MAE of 7.81, indicating reduced accuracy in this group. The decision tree analysis identified pre-operative OKS, radiological grade, and gender as significant predictors of post-treatment outcomes, with pre-operative OKS being the most critical determinant. Patients with lower pre-operative OKS showed varying responses based on radiological severity and gender, suggesting a nuanced interaction between these factors in determining treatment efficacy. Conclusion This study highlights the potential of MFAT as a non-surgical alternative for KOA treatment, emphasising the importance of personalised patient assessments. While promising, the predictive model warrants further refinement and validation with a larger, more diverse dataset to improve its utility in clinical decision-making for KOA management.

The Clinical Efficacy of Fat Injection on the Repair of Hand Flexor Tendon: A Randomized Clinical Trial.

Background: In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury. Methods: In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging). Results: In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment. Conclusion: Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

Vocal Fold Fat injection for Glottic Insufficiency: Systematic Review.

Vocal fold fat injection is a technique for treating glottic insufficiency (GI) resulting from various conditions. The use of fat as a graft has several advantages over other grafts. Similar pliability, and vibratory characteristics as a normal vocal fold, not causing foreign body reactions, having the potential to contain stem cells, and often can be done in the office. Long-term results, however, are unpredictable. The objective of this study is to carry out a systematic review of published articles using the technique of fat injection in the vocal folds. STUDY DESIGN: Systematic review. REVIEW METHODS: A literature search was conducted utilizing the combination of the following keywords "vocal folds fat injection," "laryngoplasty," and "autologous fat injection vocal folds." The criteria inclusion of the study for the systematic review were based on PICOTS (population, intervention, comparison outcome, timing, and setting) and Preferred Reporting Items for Systematic Reviews and Meta-analyses statements. Outcomes reviewed included technique, study duration, perceptual and acoustic analysis, and quality of life preoperation and 1-year postoperation. RESULTS: A systematic review on PubMed, Cochrane, and Embase databases included 13 studies analyzing the data of 472 patients, that had fat injection laryngoplasty for treatment of GI. The causes of GI varied substantially across studies. Considerable heterogeneity across studies was found, including technique for harvest, processing the fat, site of injection, and acoustic analysis. In the studies that measured maximum phonation time (MPT) there was a significant improvement in a follow-up of at least 1 year after the injection. The patient's perception of vocal quality, measured by the Voice Handicap Index, also showed significant improvement in several studies after fat injection laryngoplasty. CONCLUSION: Fat injection laryngoplasty seems to be safe and effective for GI for at least 12 months. Multiple studies show favorable outcomes, but the lack of control groups, the heterogeneity in inclusion criteria, nonstandardized techniques, and objective voice evaluations limit this evaluation.

Autologous fat injection for empty-nose syndrome.

AIMS: Inferior meatus augmentation by injection or implants is one of the treatments for empty-nose syndrome (ENS), but levels of evidence of efficacy are low. We present the technique and evaluate our experience. The primary objective was to analyze changes in Empty Nose Syndrome 6-item Questionnaire (ENS6Q) scores after treating patients with ENS by autologous fat injection. Secondary objectives were the analysis of the evolution of each of the six ENS6Q items and identification of complications. Eleven patients underwent a minimally invasive approach to limit nasal airflow using fat injection between March 2021 and December 2022. RESULTS: Ten of the 11 patients showed a decrease in overall ENS6Q score (P=0.0058); 6 had a final ENS6Q score<11. Ten were satisfied with the procedure, but remained symptomatic. The procedure did not result in any complications. CONCLUSION: These encouraging results confirm the data in the literature suggesting that fat injection improves symptomatology in empty nose syndrome. However, like other minimally invasive approaches to limit nasal airflow, it does not eliminate all symptoms. These results need to be confirmed by studies on larger cohorts with longer follow-up, preferably in a multicenter setting.

Long-term Outcome of Autologous Lipoinjection Medialization Laryngoplasty versus Type I Thyroplasty.

Glottic insufficiency is incomplete or soft closure of the true vocal folds during phonation and is a common cause of dysphonia. Treatment includes voice therapy, type I thyroplasty, vocal fold injection augmentation (with materials such as autologous fat), arytenoid cartilage repositioning, or a combination of treatment modalities. The present study aimed to compare long-term outcomes of lipoinjection medialization with type I thyroplasty for patients with glottic insufficiency. METHODS: Adult voice center patients who had undergone surgical vocal fold medialization with autologous lipoinjection or with type I thyroplasty for glottic insufficiency were included in this retrospective study. The primary outcome measures were the need for further medialization surgery and improvement in the glottic gap. RESULTS: There were 172 subjects included in this study: 100 subjects underwent type I thyroplasty and 72 subjects underwent autologous lipoinjection medialization. Neither age nor gender differed significantly between thyroplasty and lipoinjection groups. The rate of further medialization surgery did not differ significantly between thyroplasty and lipoinjection groups, but further medialization surgery was performed longer after the initial operation in the thyroplasty group Baseline glottic gap did not differ significantly between thyroplasty and lipoinjection groups. When improvement from baseline was compared between thyroplasty and lipoinjection subjects, the improvement from baseline was similar for both groups at 6 months and at 12 months. Voice handicap index scores improved significantly after thyroplasty or after lipoinjection, and the improvement from baseline was similar in both cohorts. CONCLUSION: Both autologous lipoinjection medialization and type I thyroplasty provide effective medialization for patients with glottic insufficiency. Both techniques yield similar reoperation rates, and the benefit of surgery appears to last for at least 1 year for most patients.

Outcomes of Autologous Fat Graft Injection(s) in Treating Sequelae of Digital Trauma: A Case Series.

Background: Sequelae of digital trauma, such as painful scars adherent to tendons and bones, pain of neural origin, cold intolerance, skin and pulp atrophy, occur frequently. Autologous fat graft injections is an interesting option to treat these sequelae. The aim of this study is to describe the outcomes of autologous fat graft injections to treat sequelae of digital trauma. Methods: This retrospective study included all adult patients with digital trauma who underwent an autologous fat grafting procedure at our hospital between 2015 and 2019. The procedure was done at least 6 months after the initial trauma. Outcomes were assessed at least 9 months after the injection and included 2-point epicritic discrimination by Weber test (2-PD) and pulp circumference of the affected finger compared with the contralateral finger, a satisfaction questionnaire concerning the improvement of symptoms, aesthetic aspects and pain related to the operation, evaluation of pain by visual analogue scale, quality of life by SF-36 score and quick disabilities of the arm, shoulder and hand questionnaire (QuickDASH) score. We also assessed whether the patients had reintegrated a previously excluded finger. Results: The study included 14 patients. All patients received one session except for one patient who received two sessions. The average 2-PD of the injured finger was 7 mm compared to 3.57 mm for the contralateral finger. There was no difference in pulp circumference between the treated and contralateral fingers. The mean satisfaction score for symptom improvement and aesthetic improvement was 3.36/5, and the mean score for procedure-related pain was 2.36/5. The mean VAS of the patients was 2.91/10, the mean SF-36 was 60.42/100 and the mean QuickDASH was 40.09/100. Five of the nine patients who had a previously excluded finger were able to reintegrate it. Conclusions: Autologous fat transfer seems to offer some benefit in patients with adherent scars and pulp atrophy. It has little effect on neuropathic pain. Level of Evidence: Level IV (Therapeutic).

Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Report.

BACKGROUND: The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. METHODS: We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. RESULTS: guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively. CONCLUSIONS: The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

Application of infraorbital rim augmentation with pocket fat filling to correct tear trough deformity.

Background: Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years. Objectives: This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation. Methods: In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton's grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough. Results: The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique. Conclusions: This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective. Evidence-based medicine EBM level: Level II.

Type I Thyroplasty or Fat Injection Laryngoplasty Versus Arytenoid Adduction: Effects of Surgery on Voice Recovery in Patients With Unilateral Vocal Fold Paralysis.

Objective: Type I (medialization) thyroplasty (MT), fat injection laryngoplasty (FIL), and arytenoid adduction (AA) are the 3 most common surgical treatments for unilateral vocal fold paralysis (UVFP). While MT and FIL involve medialization of the paralyzed vocal fold, the goal of AA is to reduce the glottal-level difference. The current study compared the effects of these surgical treatments on voice quality in patients with UVFP. Methods: This retrospective study included 87 patients with UVFP who underwent MT (n = 12), FIL (n = 31), AA (n = 6), or AA with MT (n = 38). Patients who underwent the former 2 surgical treatments were included in the thyroplasty (TP) group, while those who underwent the latter 2 were included in the AA group. Maximum phonation time (MPT), pitch period perturbation quotient (PPQ), amplitude perturbation quotient, and harmonic-to-noise ratio (HNR) were evaluated in all patients before and 1 month after surgery. Results: The TP group exhibited significant improvements in MPT (P < .001) and PPQ (P = .012), while the AA group exhibited significant improvements in all parameters (P < .001). Before surgery, voice quality was significantly worse in the AA group than in the TP group for all measures. However, there were no significant differences between the groups after treatment. Conclusion: Surgeries in both groups were effective for voice recovery in patients with UVFP under the appropriate surgical selection. Our results also highlight the importance of preoperative evaluation and the potential value of etiology for selecting the appropriate procedure.

Long-Term Effects of Fat Injection Laryngoplasty in Relation to the Injected Fat Volume in Patients With Unilateral Vocal Fold Paralysis.

OBJECTIVE: To evaluate the improvements in vocal function and glottal form before and after autologous fat injection laryngoplasty in relation to the injected total fat volume in patients with unilateral vocal fold paralysis. DESIGN: Clinical study. METHODS: Seventy-three patients with unilateral vocal fold paralysis received fat injection laryngoplasty and were divided into low-volume injection (<3 mL; average, 2.0 mL) and high-volume injection (≥3 mL; average, 4.3 mL) groups. Voice function before and after fat injection laryngoplasty were examined by aerodynamics evaluations, pitch and intensity measurements, and acoustic analyses. The glottal form before and after fat injection laryngoplasty was determined by measuring the ratio of vocal fold bowing (bowing ratio) and the ratio of lengths between bilateral vocal process (width ratio) at an easy phonation under laryngeal endoscopic examination. The postoperative parameters were evaluated for a median period of four years after fat injection laryngoplasty. The differences between pre- and postoperative parameters were examined separately for each group by the paired t-test. For each variable, a comparison of the effects of surgery was conducted using an analysis of covariance model with the change between the pre- and postoperative values as a dependent variable and the preoperative value as a covariate. RESULTS: In both groups, all parameters of voice function and glottal form after surgery significantly improved in comparison to those before surgery. Maximum phonation time, amplitude perturbation quotient, and normalized noise energy for 0 to 4 kHz in the high-volume group improved more significantly in comparison to those in the low-volume group. CONCLUSIONS: As a rough guide for males, injection of more than 3 mL of autologous fat to the vocal muscle layer is recommended for reliable improvement of voice function in patients with unilateral vocal fold paralysis.

Fat Injection and Its Clinical Applications.

Fat injection has been in application for more than two decades, and its usefulness has been well documented. In our article, we want to highlight the various applications and usefulness of this versatile technique. We also want to showcase the methods to ensure good results and maximize the uptake of fat grafts with minimal absorption. Our results in our series of 110 consecutive cases have been very encouraging, with excellent patient satisfaction.

Injection of freshly collected autologous adipose tissue in complicated pilonidal disease: a prospective pilot study.

BACKGROUND: Pilonidal sinus disease (PSD) is a frequent disorder. Treatment failure and recurrence are common, leading to significant morbidity. The aim of this study was to investigate the impact and need for repeated treatment of injected autologous adipose tissue into non-healing PSD wounds and primary anal-near PSD or anal-near recurrence. METHODS: At the Department of Surgery, Randers Regional Hospital, Denmark, a prospective pilot study was conducted on consecutive PSD patients with lack of healing 3 months after surgery (Bascom's cleft lift) or with primary or recurrent anal-near pilonidal sinus disease from December 2018 to March 2020. The primary endpoint was time to healing. Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision. Patients were examined 2 and 12 weeks after surgery. Patients with lack of healing after 12 weeks (undermining or no skin coverage) were offered re-injection. RESULTS: We included 30 patients [26 men and 4 women, median age 24 years (range 18-59 years)]. Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9-96.7)]. Two patients had recurrence (6.7%). The median time to complete healing was 159 (189) days. The mean operation time was 70.6 ± 23.7 min and the mean amount of injected autologous adipose tissue was 19 ± 10 ml. There were no major complications. CONCLUSION: Freshly collected autologous adipose tissue injected into chronic non-healing or primary and recurrent PSD lesions near the anal verge is safe and efficient.

The investigation of the efficacy and safety of stromal vascular fraction in the treatment of nanofat-treated acne scar: a randomized blinded controlled clinical trial.

BACKGROUND: Acne is the most common skin disorder which is known as a chronic inflammatory disease with psychological burden and reduced quality of life. Adipose tissue-derived stromal vascular fraction (SVF) is recognized as a source of regenerative cells and improves the quality of skin by increasing collagen content. To date, a few studies have been performed on the therapeutic role of SVF in the treatment of acne scars. METHODS: This randomized, single-blinded clinical trial was performed on 7 patients with acne scars. In all patients, the initial grade of acne (volume, area and depth) was evaluated and ultrasound of the relevant scar was performed to evaluate neocollagenesis. As a spilt face study, for treating the scars, we used nanofat subcutaneously on one side of the face (control group) and combination of nanofat subcutaneously and SVF intradermally on the opposite side (intervention group). The patients were evaluated for severity of acne by visioface after one month, also for thickness of epidermis and dermis by ultrasound after one month and three months. RESULTS: All of the apparent findings of scars improved in two groups after one month, but these changes were significant just for the group treated with SVF (p value < 0.05). Epidermal, dermal and complete thicknesses during the first month in both control and intervention groups were significantly increased (p value < 0.05) but between the first and third months, there was no significant difference in the variables (p value > 0.05). The findings showed that dermal and complete thicknesses of the skin in the first month were different between two groups significantly (p value: 0.042 and 0.040, respectively). CONCLUSION: The use of SVF in the treatment of patients with acne scars accelerates the improvement of volume, area and depth of the scar by increasing collagen content and the dermal thickness, so it can be used as a potentially effective treatment for these patients.

Tear Trough Ligament Release and Autologous Fat Injection as a New Method for Tear Trough Deformity Correction.

BACKGROUND: Even though the tear trough (TT) deformity is only 2 cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect. METHODS: Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients' and investigators' global aesthetic improvement scale. RESULTS: 152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months. CONCLUSION: Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Oral administration of megestrol acetate can increase fat graft survival in a rat model.

Insufficient and inconsistent survival is a significant shortcoming of fat grafts. Reportedly, megestrol acetate (MA) could induce proliferation, migration, and adipogenic differentiation of adipose-derived stem cells in vitro. Thus, we tested whether MA could promote fat graft survival in a rat model. Twenty-eight Sprague-Dawley rats (8 weeks old, male) were divided into two groups: experimental (MA group, n = 14) and control (n = 14). The inguinal fat pad (1 g) was extracted en bloc and re-implanted under the scalp in both groups. MA (100 mg/kg/day) was administered orally for 14 postoperative days in the experimental group. After 6 weeks, the volume and weight of the grafted fat were measured. Histologic examination with hematoxylin and eosin (HE) and real-time polymerase chain reaction (PCR) for vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), and CCAAT/enhancer-binding protein alpha (C/EBP-α) were performed. Perilipin staining was performed to check the viability of grafted fat. Graft fat volume was greater in the MA group, compared with that in the control (P = 0.023). The MA group also had more viable cells, including more adipocytes, and less fibrosis or vacuoles than the control on HE and perilipin staining. MA upregulated the expression of FGF2 (P<0.001), VEGF (P = 0.008), and C/EBP-α (P = 0.002) at the second postoperative week. MA increased survival of grafted fat in an animal model. Increased vascularization and adipogenesis were related to these results. Further human clinical trials are necessary to evaluate adjunctive oral administration of MA after fat grafting to promote graft survival.

Corrective treatment for tear trough deformity in a young population utilizing two-dimensional fat injections.

OBJECTIVES: Tear trough deformity (TTD) is becoming a growing concern for those seeking facial rejuvenation, and various treatment strategies have been reported. Among treatment options is micro-autologous fat injection, which appears to be an effective approach to recontour the tear trough in the young. The study we present here investigated the reliability and effectiveness of two-dimensional fat injections (TDFI) in the treatment of young patients with TTD. METHODS: This study evaluated patients with TTD who underwent TDFI between December 2018 and December 2020. The proposed procedure involved ligament releasing and fat injection into the tear trough in two different directions. RESULTS: The average age of the 102 enrolled patients was 25.9 ± 3.8 years. Significant improvement and maintenance of TTD were observed during the follow-up period (13.2 months average) with no major complications being observed. Improvement of dark cycles and enhanced aegyo sal were observed. Patient satisfaction based upon self-administered post-procedure questionnaires disclosed that 58.8% were very satisfied, 38.2% were satisfied, and 2.9% neutral with the results. CONCLUSIONS: Two-dimensional fat injections is an effective and reliable method with high satisfaction and low risk of complication. Long-term results demonstrated its utility for young-type TTD.