Autologous Fat Injection for Augmentation Rhinoplasty: A Systematic Review

Abstract

Background Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. Objectives This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. Methods We searched PubMed/Medline, and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. The reference list of included studies were also hand searched for potential studies. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet and two authors supervised the accuracy. Results The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as: an insufficient volume or decreased volume by resorption, tip excess and supra-tip fillness, and mild displacement. More than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. Conclusions Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Although clinical expertise is essential to have a safe injection and to minimize the potential complications. Preserving the excess fat for further fat injection (if needed) is recommended.

The Role of Autologous Fat Grafting in Rhinoplasty

“…Previous studies showed high satisfaction with rates that range from 63% to 100% in this group of patients after the primary lipofilling of the nasal soft tissue 37,40,43,55 . This application of fat grafting is limited to non-major nasal deformities, and it has no known impact on the nasal respiratory function 37,38,40,57 .…”

“…This aspirated fat is centrifuged and concentrated before injecting into the nasal SSTE. However, various planes for fat injection to the nose (e.g., at the periosteum and in the SMAS, subcutaneous, intradermal) and canula sizes have been described in the literature 40,43,54,55 .…”

“…The use of fat grafting for dorsal augmentation showed some efficacy. However, the extent of this augmentation is still under debate considering the grafts' unpredictable resorption in the long term 40,45,63,66 .…”

“…Injecting fat regardless of primary or secondary after rhinoplasty surgery in the nose seems to be a safe, minimally invasive procedure in most cases 40,55,57,58 . However, rare complications such as brain infarction, blindness, or nasal skin infarction can be devastating 37,74,75 .…”

“…These serious complications can happen because of the distinctive nasal perfusing network, which involves anastomosis between the internal and external carotid arteries 38,55 . These anastomoses are most common in the so-called nasal danger zones, including the glabella, the nasolabial folds, the alar crease, and the area for the angular artery 38,40,55 .…”