Safety and Efficacy of Stromal Vascular Fraction Enriched Fat Grafting Therapy for Vulvar Lichen Sclerosus.

Background Lichen sclerosus is an inflammatory dermatosis of unknown etiology which currently has no cure. Most treatment guidelines recommend the use of ultrapotent topical corticosteroids. However, the relapse rate is usually high. Through a retrospective study we evaluated the efficacy and safety of stromal vascular fraction of adipose tissue as therapy for lichen sclerosus. Material and methods  For this retrospective review, we obtained data on patients with vulvar lichen sclerosus treated with autologous fat grafting enriched with adipose derived stromal vascular fraction cells. Data collected through a modified vulvo-vaginal symptoms questionnaire were analyzed before treatment, six months and 24 months after treatment. The 19 items questionnaire was subdivided in four categories: symptoms, signs, social functioning and sexual functioning. Global scores and partial scores for each category were analyzed using paired t-test. For all statistical analyses, a value of p ≤ 0.05 was considered statistically significant. All data are presented as mean ± SD. Results Thirty nine patients were included in the study. Thirty seven patients (94.87%) experienced a significant decrease in global score at six months and 24 months after treatment (p < 0.05). Decrease in scores were also statistically significant between pretreatment and 24 months after treatment for each of the four questionnaire categories - symptoms, signs, social functioning and sexual functioning (p < 0.05). Conclusions This retrospective study showed that the use of autologous fat grafting enriched with adipose derived stromal vascular fraction is safe and leads to significant and long lasting improvement in patients with vulvar lichen sclerosus.

Functional and Aesthetic Recovery of Congenital Muscular Torticollis with Intramuscular Stromal Vascular Fraction Enriched Fat Grafting.

Congenital muscular torticollis is a well-known pathological condition caused by the contracture and shortening of the sternocleidomastoid muscle. This condition is manifested by a neck postural deformity often accompanied by some kind of facial asymmetry. Once diagnosed, treatment by early physiotherapy is generally successful in a high percentage of patients if performed during the first year of life. Later, especially after the fourth year, conservative treatment is usually far less effective, and surgical techniques remain the only way to improve neck contour and function. The author reports two cases of adult patients affected by this condition and successfully treated with a novel therapeutic approach consisting of percutaneous myotomies and intramuscular cell-assisted fat grafting. Two cases of adult patients diagnosed with congenital muscular torticollis were analyzed after treatment with percutaneous myotomies and intramuscular fat grafting. The first patient had a history of unsuccessful treatment in infancy with bipolar release of the sternocleidomastoid muscle and was treated with two sessions of fat grafting. The second patient had a history of neglected torticollis and was treated with a single session of cell-assisted fat grafting. In both cases, facial asymmetries were simultaneously treated with the same fat grafting protocol used to treat the muscle. Improvements in muscle function and in face and neck contours were extremely good and stable in both patients. The postoperative course for both patients was uneventful and with a very short and easy recovery when compared with the techniques described to date. Neglected congenital muscular torticollis in adults, or in patients who have not responded adequately to surgical treatment, has been treated safely with percutaneous myotomies and intramuscular fat grafting. The benefit is a scarless technique that provides simultaneous recovery of neck aesthetics and muscle function together with a very short recovery time. Further studies must be conducted to properly evaluate the long-term safety and convenience of cell enrichment to achieve better and long-lasting results.

Autologous Fat Grafting in Severe Lower Extremity Asymmetries: Report of Four Cases.

BACKGROUND: Lower extremity asymmetries are challenging problems in plastic and aesthetic surgery practice. Regardless of their origin, atrophies and asymmetries can be extremely varied and difficult to solve with simple techniques. OBJECTIVES:   The author reports his experience in the treatment of four patients suffering from severe lower extremity atrophy and asymmetry of different etiologies with autologous fat grafting. METHODS: A total of four cases are presented. Patient selection was based on the severity of atrophy and asymmetry. Two patients were treated with two sessions of simple fat grafting and two patients with one session of cell-enriched fat grafting. The end point in each session was determined by tension/blanching of soft tissues. All patients were followed up for at least 12 months after the last session. During the postoperative follow-up, variables, such as objective volume improvement, objective girth loss, return to daily activities, and patient satisfaction, were analyzed. RESULTS: The initial analysis of postoperative results showed a good patient satisfaction rate with no relevant complications and an early return to daily activities. Estimated mean volume improvement for simple fat grafting cases was estimated as 44% after two treatments. Mean volume improvement in cell-enriched fat grafting cases was estimated as 25% after only one treatment. CONCLUSIONS: Autologous fat grafting is a safe, effective, and reliable technique to perform aesthetic and reconstructive reshaping of a lower extremity in cases of atrophy or severe asymmetry. Depending on the preoperative soft tissue compliance, cell-assisted fat grafting will play an important role in reducing the number of sessions to perform.

Fat grafting to the nose: personal experience with 36 patients.

BACKGROUND: Clinicians are facing an increasing trend toward nonsurgical nose reshaping using synthetic injectables, mainly for patients who refuse standard rhinoplasties. Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results as well as fewer and milder side effects. The author reports his experience with fat grafting to the nose using his personal technique for 36 consecutive patients. The experience covers primary treatments of noses not treated by surgery, treatment of post rhinoplasty deformities, and combination fat grafting and rhinoplasties. METHODS: The technique used by the author for fat grafting to the nose does not differ significantly from that used for other body or face areas. It is based in the atraumatic extraction of fat fragments using a multi-orifice cannula and injection of these fragments using 1.4- to 1.6-mm cannulas or needles. In combining rhinoplasties with fat grafting, fat grafts are used in the same location instead of a prosthesis or cartilage grafts. RESULTS: The initial analysis of postoperative results showed a good to high level of patient satisfaction, particularly in primary cases, with virtually no complications or severe side effects. Some easily corrected side effects probably were learning curve dependent. CONCLUSIONS: Autologous fat grafting is an effective and reliable technique for aesthetic and reconstructive nose reshaping for patients who refuse surgical treatments. Although optimal results can be achieved with this technique, they are not comparable with those obtained by surgical rhinoplasties, and this is an important issue to discuss with the prospective patient.

Fat tissue as a permanent implant: new instruments and refinements.

The author presents guidelines and new instruments for transplanting autologous fat. He describes this procedure as effective, predictable, and reliable when performed with careful donor-zone preparation, atraumatic fat extraction, anaerobic sterility, and precise placement in a properly prepared receiving zone. (Aesthetic Surg J 2003;23:213-216.).