A case of autologous microfat grafting in lip reconstruction of a whistle deformity following cancer treatment

Abstract

A 61-year-old man developed a squamous cell carcinoma on his left lower lip, which was initially excised with positive margins. He subsequently developed lymphadenopathy within the left neck and was referred to the Division of Otolaryngology -Head and Neck Surgery at the Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia). He underwent a second wedge resection of the left lower lip with an ipsilateral functional neck dissection. The patient received postoperative radiotherapy to the lip and neck at a total dose of 66 Gy. As a result of his combined modality treatment, he developed a whistle deformity, marked by lip incontinence and an asymmetric smile, and was referred to another member of the head and neck team who was an expert in facial plastic surgery for potential fat augmentation and reconstruction of his lower lip (Figure 1).It was decided that the patient would receive hyaluronic acid-based injectable tissue filler for temporary augmentation, followed by treatment with autologous microfat transplantation to the lip for definitive augmentation. Following the tissue filler injection, it was noted that the patient had closure of the lateral lip margin, improvement in lip competence and a pleasing aesthetic result. However, on reassessment three months later, the patient reported having issues of lip incompetence, once again, due to the relatively premature degradation of the tissue filler and subsequent reformation of his whistle deformity.A decision was then made to proceed with autologous microfat transplantation to the lip. The donor site chosen by the senior author was the abdomen, and a series of three injections was A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient's whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy -both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site. Key Words: Autologous fat grafting; Postoperative radiotherapy; Whistle deformityUn cas de microgreffe de graisse autologue dans la reconstruction d'une déformation du vermillon de la lèvre après un traitement oncologique La déformation du vermillon se définit comme une anomalie de la partie vertica...

Hyaluronic Acid Dermal Fillers for Treatment of Congenital and Acquired Lip Asymmetries and Deformities

“…Associated to this, the volume increase with HA can be performed gradually (in different sessions), so that the patient can more accurately assess their satisfaction with the result and also allows repairs easily performed by additional applications of the filler (Kandhari et al, 2017;Serdar & Karabay, 2018). Another advantage is related to application reversibility, either through the natural degradation of HA by the body over time or through the administration of hyaluronidase, in case of dissatisfaction or adverse effects (Belyea et al, 2010;Chang et al, 2018;Vidic & Bartenjev, 2018;Rauso et al, 2020).…”

“…Despite the advantages, this treatment offers a temporary solution, which is conditioned to the time of HA degradation by the body, require consultations for new applications every 3 or 4 months (Belyea et al, 2010;Chang et al, 2018;Rauso et al, 2020). Therefore, from the beginning, the patient must be aware of the need for maintenance appointments (Schweiger et al, 2008).…”