Background: Left clefts occur twice as frequently as right ones. The sidedness has been suggested to influence certain outcomes. Some surgeons consider a right cleft more challenging to repair. This is often attributed to their reduced prevalence. The authors question whether this may be caused by morphologic differences. The authors' hypothesis is that there are anthropometric differences between left and right complete cleft lips. Methods: Patients with complete unilateral cleft lip, with or without cleft palate, operated on at the age of 3 to 6 months, between 2000 and 2018, by a single surgeon, were included. Eight standardized anthropometric measurements of the cleft lip, collected just before cleft lip repair, compare lip and vermillion dimensions and ratios between left and right clefts. Results: One hundred thirty-nine left and 80 right unilateral cleft lips were compared. A significant difference was found between left and right clefts for cleft-side to non-cleft-side ratios comparing the lateral lip element vertical heights and vermillion heights. Conclusions: Patients with right cleft lips have a greater degree of lateral lip element hypoplasia, demonstrating greater deficiencies of lateral lip element vertical height and vermillion height when compared to patients with left clefts. This has clinical implications for preoperative assessment, choice of surgical technique, and postoperative and long-term outcomes.

Background Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. We present the case of a patient who died due to massive cerebral micro fat embolism after facial fat grafting. Objectives Raising awareness and providing more evidence on prevention and treatment of this potentially lethal complication of facial fat grafting. Methods A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurological and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures. Results Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 ml fat was injected. The main complications are visual impairment, of which 88.5 % remained blind, and neurological symptoms, who never fully recover. Seven cases were fatal. Fat embolism can occur in veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but lack evidence. Several different preventive measures are described. Conclusions Although facial fat grafting is considered a safe procedure, one should be aware of the risk for fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcome, preventive measures are of utmost importance to improve patient safety.