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Review confirms value of fat transfer during facial reconstruction



Autologous fat transfer (also known as lipofilling or fat transplantation) in plastic surgery to correct severe facial deformities is effective with high patient satisfaction, but durability remains a problem, found a systematic review

For 266 patients, 91, 1% to be satisfied with their new appearance, according to Todor Krastev, MD, from Maastricht University in the Netherlands, and colleagues in JAMA Facial Plastic Surgery

Surgeons were also pleased with the results, where 88.6% of the 365 operators are satisfied with the reports included in the review.

However, researchers have noted a number of reservations about these procedures. Results that were considered successful required an average of 1

.5 procedures, and fat resorption from the grafts seems to start quickly: volume retention at 1 year averaged 59% in the studies reviewed, with some showing retention of only 40% [19659002] Nevertheless, the team wrote, "autologous fat transfer appears to be an effective procedure that satisfies the vast majority of patients and surgeons after about one year of clinical follow-up." Among the conditions most useful for such procedures are progressive hemifacial atrophy (Parry-Romberg syndrome), craniofacial microsomia and lipodystrophy in HIV patients caused by antiretroviral drugs. The authors also noted that adhesive scars and even burns are increasingly the subject of fat transfer.

Krastev and colleagues said that they had carried out the study because the current literature "comprised a large number of small studies that examined a variety of endpoints. Different patient populations produce a wealth of evidence that is highly fragmented and difficult to analyze "

In addition, the uncertainties surrounding the durability of fat grafts have led to divergent and even polarized opinions among plastic surgeons regarding the procedure

In an accompanying editorial, Samuel M. Lam, MD, who practices in Plano, Texas, the review as "very necessary" as such methods have become very popular in the literature without much rigorous support. He also credited Krastev and colleagues for their separate analyzes of autologous fat transfer in key patient subgroups, including congenital and acquired deformities and HIV-associated lipodystrophy.

Krastev et al. The phenomenon of postoperative fetal hypertrophy, where grafts become more important than losing volume, was identified as a problem, especially in a subgroup of patients with HIV-associated lipodystrophy.

Lam said, however, that this effect is not limited to this group, and cited another report that states the prevalence of the problem in connection with patients "The overall weight gain."

"The lesson should be that transplanted fat should not be considered as a bio-inert substance such as a commercial filler. It is metabolically active and a live implant, "he wrote, adding these severe cases B. The hypertrophy of facial fat can be very difficult to treat.

Lam also found that it would be useful to use data from a longer follow-up period.

The study was supported by the Dutch Society of Plastic Surgeons in Guideline Development

The authors of the study and the publisher stated that they had no relevant competing interests

1969-12-31T19: 00: 00-0500

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