Current state of the art in fat grafting: paradigm shift in surgical techniques and refinements in cleft and craniofacial reconstruction

Abstract

Purpose of review The purpose of this review is to provide an update on current practice and trends in fat graft surgery. The present review covers postoperative fat graft survival and phases, recipient bed and fat tissue enrichment issues, the spectrum of clinical applications in the cleft-craniofacial field, surgical techniques, and predictive factors for different outcomes. Recent findings Current investigations have led to a better understanding of fat graft survival and postoperative clinical progress. Fat grafting has been successfully adopted in a broad spectrum of cleft-related, craniofacial contour-related, burn-related, and radiation-related indications. Many variations on harvesting, processing, and delivery techniques and the use of recipient-site preconditioning and cell-enriched methods to increase the efficiency of fat grafting have been described, but little consensus exists about which technique is optimal. The development of predictors for fat grafting-related outcomes can aid multidisciplinary teams in providing better preoperative counseling, selecting the most suitable candidates for treatment, and establishing patient-specific postoperative care profiles. Summary The addition of modern fat graft surgery to the surgeon's toolbox revolutionized the delivery of surgical cleft and craniofacial care. Further investigation is necessary to assist surgeons in selecting the best candidates and optimal techniques.

Refining Orthognathic Surgery Results by Synchronous Cheek Fat Compartment Augmentation with Fat Grafting in Adult Females with Class III Skeletal Profiles

“…Unlike alloplastic implants or modified osteotomy lines, the attributes of fat tissue (complete biocompatibility, versatility, availability, natural integration into recipient bed, and improvement in tissue quality) 39,40 permit that the synchronous procedure not only enhances midface volume but also produces a smoothened transition of the nasomidface and malar-midface regions and blend the lower eyelid–cheek junction, with potential reduction of postoperative edema. 28 We hope that other centers may test the impact of different orthognathic surgery techniques on the volumetric and postoperative cheek mass positional changes for the midface.…”

Pyramidal multiple‐theory (multi‐type, multi‐method and multi‐layer) for facial fat grafting

“…In addition to cosmetic field of practice, the facial fat grafting has widely been adopted in a broad spectrum of cleft-related, craniofacial contourrelated, burn-related, and radiation-related indications. 1 Autologous fat grafting began to gain popularity and become widely accepted in the late 1990 s. This followed Coleman's description of his modified techniques for liposuction, lipofilling, and the long-term outcomes of facial fat grafting with lipoaspirates. 2 Theoretical and technical advances have contributed significantly to the increasing application of facial fat grafting over the last 20 years.…”

“…Fat grafting has been used to treat facial deformities for over a century. In addition to cosmetic field of practice, the facial fat grafting has widely been adopted in a broad spectrum of cleft‐related, craniofacial contour‐related, burn‐related, and radiation‐related indications 1 …”

To wait or not for stabilization of disease progression before asymmetry correction in Parry‐Romberg syndrome

“…Thus, pediatric patients with facial asymmetry are at risk of a lifetime of psychosocial difficulties, including anxiety, depression, and poor social functioning. 1 Some multidisciplinary teams have then successfully advocated for autologous facial reconstruction, [2][3][4] that is, microsurgical free flap (eg, circumflex scapular or superficial inferior epigastric flaps) or fat grafting (ie, fat tissue harvested from the donor areas such as abdomen and inner thigh, prepared, and grafted into the deformed facial region), 5 for treating mild to severe forms of PRS, regardless of the age of the patient at disease onset or the level of disease activity (treat-and-follow surgical approach). [2][3][4] Patients younger than 3 years (range: 2-69 years) with and without extracutaneous manifestations have been included in these reconstructive protocols with the goal of achieving facial symmetry before they enter school, 3 a stressful environment with the possibility of teasing by their peers.…”

“…While free flaps can potentially provide more tissue in a unique surgical intervention, the use of fat grafts decreases operative time and donor-site morbidity. [3][4][5] Despite these findings, patients with PRS receive topical or systemic therapy while waiting for the disease to stabilize before undergoing any facial asymmetry-focused intervention (wait-andtreat surgical approach). [6][7][8][9] Now seems to be a good time to think Evidence from large multicenter collaborative randomized controlled trials that compare wait-and-treat and treat-and-follow surgical approaches using a core outcome set (combining clinician-centered and patient-reported outcome measures such as hospital stay and risk of surgery-induced disease progression and iatrogenic psychological trauma) is needed for data-driven clinical decision-making in this challenging scenario.…”