Tom D. Wang

Histopathologic evaluation of adipose autografts in a rabbit ear model.

Injection of autologous adipose tissue removed via liposuction has been used clinically for facial contouring, the aging face, furrows, facial atrophy, acne scars, nasolabial folds, chin, and various other surgical defects. Survival rates for autografts of fat have been quoted anywhere from 30% to 80%. Our study uses a reproducible rabbit animal model for autotransplantation of adipose tissue and examines the histopathologic changes that occur to the graft over time. Autogenous subcutaneous fat was removed from a dorsal scapular donor site, treated to stimulate cannula damage as in liposuction, then reinjected at the base of the ear. Histologic examination of the grafts were made at 5, 10, 15, 20, 40, and 100 days after transplantation. Hematoxylin-eosin sections were graded on degree of fibrosis present (0 to 4+), viable fat (1 to 10), degree of inflammation (0 to 4+), and neovascularization (+ or -). Viability of fat decreased from 8.5 to 10 at 5 days to 2 viability at 40 days. Acute inflammation peaked at 10 days, followed by the chronic inflammatory response with macrophages and multinucleated giant cells scavenging the dying fat graft. Neovascularization began at 5 days, peaked at 10 days, and remained constant thereafter only at the edge of the graft. Microcysts appeared at 15 days and increased in number in proportion to the decrease in viable fat. In summary, the temporal histologic events are progressive fibrosis; decreased amount of viable fat; inflammation beginning with a neutrophilic response, later a macrophage and giant cell response; and neovascularization at the periphery of the graft insufficient to maintain graft viability. In our animal model, autografts of fat appear to have limited long-term viability and are replaced by fibrous tissue. This may have clinical implications in autografting of fat in facial plastic and reconstructive surgery.

Aesthetic structural nasal augmentation

This article addresses the authors preferred technique in the reconstruction of moderate and severe saddle nasal deformities. The prevailing concept is the provision of adequate structural support for the overlying nasal soft tissue coverage for an aesthetically pleasing outcome. All reconstructive efforts are undertaken via the external rhinoplasty approach. Detailed descriptions of the individual steps involved in the reconstructive sequence are included. Representative patient cases are included to demonstrate the versatility of techniques.

Surgical Rejuvenation of the Aging Forehead and Brow

Educational objectives: To evaluate patient for surgery of the upper aging face and to select the appropriate surgical approach to perform surgery of the upper aging face.