The Application Of Autologous Fat Granule Injection In The Treatment Of Progressive Hemifacial Atrophy

Objective:Progressive hemifacial atrophy is a rare disease of unknown etiology,characterized by unilateral facial atrophy.The range of involvement mainly includes the subcutaneous tissue,fat,muscle and bone structure.PHA patients often require surgical intervention to improve the appearance of atrophic deformities,due to their facial defects in morphology and function.According to the severity of facial atrophy,the surgical treatment of PHA can be divided into soft tissue augmentation and hard tissue reconstruction.The facial morphological defects can be corrected by filling the tissue.As the rapid development of technology,there are a variety of materials used in soft tissue transplantation,and one of the most widely used is autologous fat granule.This paper aims to review the cases of PHA patients with autologous fat granule grafting in our department,then summarize the experience of the surgical treatment further to make a reasonable evaluation.Methods:From January 2015 to April 2017,we totally conducted abdominal fat extraction and facial autologous fat granule grafting surgery for 4 patients with PHA.Before the operation,the patients were asked to collect the medical history,and taken facial photos with different angles under natural light.According to the principle of symmetry the facial contours are labeled.A certain amount of fat granules was extracted from the abdomen under local anesthesia,and then filled with fat in the affected area.After fat grafting,the images of patients were collected again.These patients have to review within six months after surgery.We evaluate the effect of surgery and postoperative complications in each case by comparing with preoperative and postoperative images of patients and directly asking patients in outpatient or in telephone.At the same time,both patients and surgeons were asked to evaluate the operation,and the degree of satisfaction was divided into "very satisfied","general satisfied" and "not satisfied".Results:All patients were successfully completed the autologous fat extraction and grafting by the preoperative design and the postoperative appearance were significantly improved.Additionally,no complications were found after the operation.All the surgeons were satisfied with the results of the surgery.PHA patients at different severity show different degrees of satisfaction about fat filling operation in a short-term follow-up.One patient with mild atrophy was very satisfied with the outcome of the operation,and two patients with moderate atrophy were both generally satisfied with the fat grafting surgery.However,one patient with severe atrophy was not satisfied with the operation owing to significant fat absorption.Conclusion:Soft tissue augmentation is the main surgical treatment for PHA patients to improve their facial atrophy.Autologous fat granule is an ideal material for facial depression in soft tissue transplantation.The advantage of autologous fat is abundant,convenient to extraction,trauma small,with good biocompatibility and good filling shape.Autologous fat grafting is a safe and ideal surgical method for the reconstruction of facial atrophy,which makes a satisfied appearance in short time after the operation.The operation time is short and complication rate is low.While this method also has the main disadvantages of easy absorption.Therefore,how to reduce the absorption rate and improve the survival rate of autologous fat after fat grafting can provide a better way to get better treatment effect.