Robert A. Glasgold

Autologous Fat Grafting: Long-term Evidence of Its Efficacy in Midfacial Rejuvenation

OBJECTIVE To provide quantitative objective data demonstrating the longevity and amount of volume augmentation in the midface obtained with autologous fat grafting. METHODS A prospective analysis of all patients who underwent autologous fat transfer to the midface region at our private practice and were followed up for at least 1 year. Three-dimensional imaging was performed with a Canfield Scientific Vectra camera and software, with quantitative volume measurements evaluating the amount of postoperative volume change. RESULTS Thirty-three patients (66 hemiface-midface regions) were included in the study. The mean follow-up time was 16 months. The mean amount of autologous fat injected into each midface region was 10.1 mL. Overall, the mean absolute volume augmentation measured at their last postoperative visit was 3.3 mL (31.8% take). There was variability between patients in the volume amount and percentage that remained. Touch-up procedures were performed in 8 patients. CONCLUSIONS To our knowledge, this study is the first clinical quantification of autologous fat transfer and/or grafting in the literature that provides definitive evidence on the amount as well as the resultant longevity in the midface. Autologous fat transfer to the midface has definite long-term volume augmentation results. On average, approximately 32% of the injected volume remains at 16 months. However, some variability exists in the percentage of volume that remains that may require a touch-up procedure.

Volume loss versus gravity: new concepts in facial aging.

Purpose of reviewThe earliest techniques of facial rejuvenation have been continuously adapted to reflect changes in the understanding of the aging face. Significant, paradigm-shifting advances in this understanding have been made in recent years which have allowed application of specific therapeutic modalities, resulting in dramatically improved results over those achieved with traditional facial rejuvenation. Recent findingsPioneering work by several authors has shown that gravity is not the sole determinant of the aging face. These authors have demonstrated that volume loss, including that of soft tissue and bone, is at least equally important in the pathogenesis of the stigmata of aging. Rejuvenative techniques developed to reverse these atrophic changes have exhibited outstanding results. The consequence is an increasing emphasis on the use of volume restoration procedures to address the aging face. SummaryRecent improvements in the understanding of the facial aging process have brought about newly refined techniques for facial rejuvenation, ushering in a new era of plastic surgery for the aging face which is being manifested by increasingly natural results.

Quantitative evaluation of volume augmentation in the tear trough with a hyaluronic Acid-based filler: a three-dimensional analysis.

BACKGROUND Despite the prevalent use of hyaluronic acid-based filling materials for facial soft-tissue augmentation and favorable reports of durability in the infraorbital region, no quantitative data exist on the long-term durability of these products following injection. This study represents the first attempt to use three-dimensional imaging to quantify augmentation achieved and duration of effect with one hyaluronic acid product in the tear trough. METHODS The authors conducted a prospective, blinded case series in a clinical setting. One non-animal stabilized hyaluronic acid material was used to augment 20 tear troughs to address cosmetic deficiency in this region. Patients were followed long term with three-dimensional imaging. Posttreatment and pretreatment images were compared, volume change was calculated at each time point, and percentage change between immediate and long-term posttreatment was evaluated. All measurements and calculations were performed independent of the injector. RESULTS Residual effect from the hyaluronic acid product was demonstrable on three-dimensional imaging in 100 percent of tear troughs augmented in this study at the final follow-up visit. Average follow-up was 14.4 months (range, 8.5 to 22.75 months). Average initial augmentation measured by three-dimensional imaging was 0.21 cc per site. Average maintenance of effect for patients at the final follow-up visit was 85 percent. CONCLUSIONS The long-term durability of a small gel particle-based hyaluronic acid in the tear trough is substantiated for the first time in an objective, quantitative fashion using three-dimensional imaging for evaluation of volumetric facial rejuvenation. Three-dimensional photographic imaging offers clinicians a precise and expeditious method for quantitatively evaluating volumetric changes in the face, and represents a significant advance in technology for studying the effects of facial aging.

Tissue autofluorescence as an intermediate endpoint in NMBA-induced esophageal carcinogenesis

The capacity to identify subclinical neoplastic disease of the upper aerodigestive tract (UADT) using tissue auto-fluorescent spectroscopy would significantly contribute to cancer screening. Rats received N-nitrosomethyl benzylamine (NMBA), a carcinogen shown to cause esophageal malignancies. Following sacrifice at early weekly intervals, gross assessment of esophageal mucosa of NMBA-exposed rats was indistinguishable from saline-treated controls. Histopathologic evaluation, however, revealed NMBA-induced preneoplastic changes in the epithelium. Concurrent with these changes, the NMBA-exposed rats demonstrated specific alterations in autofluorescence. These results demonstrate that NMBA-induced esophageal premalignancy can be distinguished by autofluorescent properties. The capacity to detect alterations in autofluorescence may allow more sensitive screening of UADT mucosa at risk for cancer development.

Fat harvesting techniques for facial fat transfer.

Fat grafting has become popular as a stand-alone technique or as part of a combined procedure for facial rejuvenation, as volume restoration has increasingly become recognized as an important component in overall facial aging. Many facial plastic surgeons who are experienced in operating only in the head and neck region are unaccustomed to working elsewhere in the body. Accordingly, this article sets out to detail the specific technique for safe and effective lipoharvesting for facial fat transfer. In addition, site-specific considerations for the lower abdomen, inner/anterior/outer thighs, triceps, inner knee, buttock, and lower back are also discussed.

Analysis of Facial Aesthetics as Applied to Injectables

Summary: Understanding the role of volume loss in the aging face has resulted in a paradigm shift in facial rejuvenation techniques. Injectable materials for volume restoration are among the most widespread cosmetic procedures performed. A new approach to the aesthetics of facial aging is necessary to allow the greatest improvement from volumetric techniques while maintaining natural appearing results. Examining the face in terms of facial frames and facial shadows provides the fundamental basis for our injectable analysis.

Fat Grafting: A Volumetric Approach to Midfacial Rejuvenation

The youthful-appearing midface plays a very important role in establishing the impression of vitality, energy, and attractiveness. Its central position plays a major influence to this end. What exactly is the midface? In order to discuss it, we need to define it. Several anatomic definitions exist to describe its borders, which can make communication and comparison difficult. In this chapter, the authors define the upper border of the midface by the lower eyelid/inferior orbital rim; the medial border by lateral sidewall of the nose; laterally by a vertical plane dropped down from the mid-zygoma; and inferiorly by a line drawn across the oral commissure.