Correction of Lower Face Asymmetry using Dermofat Graft

진피-지방 이식술을 이용한 하안면부 비대칭의 교정

  • Lee, Joo Hong (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Tark, Kwan Chul (Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
  • 이주홍 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 유대현 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실) ;
  • 탁관철 (연세대학교 의과대학 인체 조직 복원 연구소 연세대학교 의과대학 성형외과학 교실)
  • Published : 2009.07.15

Abstract

Purpose: To correct the facial asymmetry and to achieve symmetry and balance, not only the soft tissue restoration of deficits but also creation and facial contour line such as mandible border and angle is important. Micro fat graft has limitation such as high resorption rate and somewhat limited ability to emphasize the rigid bony characteristics of the mandible angle due to its innate soft consistency. We have investigated the advantages of dermal fat graft over micro fat graft to correct asymmetry of the lower face in patients who had undergone mandibular reconstruction or distraction, using comparative analysis. Methods: Total of 12 patients were enrolled in our study: 6 micro fat graft and 6 dermal fat graft. Postoperative results were compared and analyzed at immediate postoperative period and more than 1 year later in each group with photographs, and analysised with image J program. Result: No complications were noted both in the micro fat type and the dermal fat type of procedures such as fat necrosis or micro calcifications. All of the patients who received micro fat graft, however had considerable amount of fat resorption after the procedure which led to two additional fat graft procedures. Although minor contour obliteration due to contracture was seen in patients who had undergone dermal fat graft procedure, no definite resorption was found even after more than one year follow-up. Results of dermal fat graft patients were satisfactory in terms of mandible angle symmetry. Secondary revision was necessary in one case due to overcorrection using dermal fat graft. Conclusion: The dermal fat graft has many advantages over the conventionally more popular micro fat graft to correct asymmetry of the lower face following mandible reconstruction owing to its lower resoption rate, more effective in emphasizing the natural curvilinear anatomical contours of the mandible angle and body and lower complication rates such as fat necrosis or micro calcifications.

Keywords

References

  1. Achauer BM: A serious complication following medical grade silicone injection of the face. Plast Reconstr Surg 71: 251, 1983 https://doi.org/10.1097/00006534-198302000-00020
  2. Wells JH, Edgerton MT: Correction of severe hemifacial atrophy with a free dermis-flap from the lower abdomen. Plast Reconstr Surg 59: 223, 1977
  3. Moscona R, Ullman Y, Har-Shai Y, Hirshowitz B: Free-fat injections for the correction of hemifacial atrophy. Plast Reconstr Surg 84: 501 discussion 508, 1989 https://doi.org/10.1097/00006534-198909000-00020
  4. Chajchir A, Benzaquen I: Fat-grafting injection for soft- tissue augmentation. Plast Reconstr Surg 84: 921; discussion 935, 1989 https://doi.org/10.1097/00006534-198912000-00009
  5. Jurkiewicz MJ, Nahai F: The use of free revascularized grafts in the amelioration of hemifacial atrophy. Plast Reconstr Surg 76: 44. 1985 https://doi.org/10.1097/00006534-198507000-00007
  6. Longaker MT, Siebert JW: Microvascular free-flap correction of severe hemifacial atrophy. Plast Reconstr Surg 96: 800, 1995 https://doi.org/10.1097/00006534-199509001-00006
  7. Terenzi V, Leonardi A, Covelli E, Buonaccorsi S, Indrizzi E, Fenicia V, Perdicchi A, Fini G: Parry-Romberg syndrome. Plast Reconstr Surg 116: 97e, 2005 https://doi.org/10.1097/01.prs.0000182402.58757.b9
  8. Coleman SR: Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 118: 108S, 2006 https://doi.org/10.1097/01.prs.0000234610.81672.e7
  9. Niechajev I, Sevcuk O: Long-term results of fat transplantation: clinical and histologic studies. Plast Reconstr Surg 94: 496, 1994 https://doi.org/10.1097/00006534-199409000-00012
  10. Illouz YG: Present results of fat injection. Aesthetic Plast Surg 12: 175, 1988 https://doi.org/10.1007/BF01570929
  11. Billings E Jr, May JW Jr: Historical review and present status of free fat graft autotansplantation in plastic and reconstructive surgery. Plast Reconstr Surg 83: 368, 1989 https://doi.org/10.1097/00006534-198902000-00033
  12. Chiu DTW, Edgerton BW: Repair and grafting of dermis, fat and fascia. In J.G. McCarthy (Ed.), Reconstructive Plastic Surgery, Vol.1, 3rd Ed. Philadelphia: Saunders, 1996
  13. Kempf KK, Seyfer AE: Facial defect augmentation with a dermal-fat graft. Oral Surg Oral Med Oral Pathol 59: 340, 1985 https://doi.org/10.1016/0030-4220(85)90054-4
  14. Drommer RB, Mende U: Free fat transplantation in the face. J Craniomaxillafac Surg 23: 228, 1995 https://doi.org/10.1016/S1010-5182(05)80212-4
  15. Reich J: The application of dermis grafts in deformities of the nose. Plast Reconstr Surg 71: 772, 1983 https://doi.org/10.1097/00006534-198306000-00005