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Background: Alopecia may decrease patients' quality of life and self‐confidence by limiting their social life. Therefore, the main goal of the treatment is to limit or halt the progression of inflammation, scarring, and hair loss. The promising effect of fat injection on hair regrowth, limited adverse effects, and subsiding inflammation can be proof of its efficacy and safety in treating alopecia. Aims: This review sought to assess the role of autologous fat tissue injection in scarring and non‐scarring alopecia. Methods: Accordingly, a thorough search was performed on the Web of Science, Scopus, and PubMed/Medline databases, as well as the Google Scholar search engine, for studies published from inception until September 1st, 2023, using the related keywords. Results: Autologous fat grafting (AFG) is a novel and potentially effective modality for treating alopecia, particularly primary and secondary cicatricial alopecia. AFG can be an effective semi‐invasive option for treating refractory lichen planopilaris because it induces angiogenesis, which supports hair regrowth. In addition to cicatricial alopecia, AFG held promise for treating non‐scarring alopecia, including androgenic alopecia and alopecia areata. The adipose‐derived regenerative cells (ADRCs) in adipose tissue (AT) secrete different growth factors, further supporting hair regeneration. Moreover, different anti‐inflammatory and anti‐oxidative agents are known in AT, preventing further damage to hair follicles. Conclusions: AFG can significantly control inflammatory processes, improve signs and symptoms, and increase hair density and diameter. [ABSTRACT FROM AUTHOR]

Background: Crohn's perianal fistulas are often refractory to standard management. Fat graft injections are hypothesised to improve fistula healing rates. We evaluated the treatment efficacy of fat graft injections for Crohn's perianal fistulas in a systematic review (PRISMA). Methods: We completed database searches of MEDLINE (Ovid), Embase, and PubMed. All studies published in English in full text or abstract, from January 2001 to August 2021, evaluating fat graft injections for Crohn's perianal fistulas were selected. Included randomized controlled trials, single‐arm intervention trials, cohort studies, and case series; excluded single case reports. Primary outcome was pooled clinical healing, defined as non‐draining treated fistulas, or closure, defined as closure of treated fistulas. Secondary outcomes were clinical healing, clinical closure, radiologic response, and adverse events. Results: Of 1258 publications identified, 891 articles were assessed for eligibility, and 107 relevant for manuscript review. Forty‐nine patients received fat graft injections for Crohn's perianal fistulas across four single‐arm intervention trials. Clinical healing or closure was achieved in 74% in a pooled single‐arm meta‐analysis (95% confidence interval: 57%, 85%), with moderate heterogeneity between studies. Clinical healing was achieved in 20% and 60% at 3 and 12 months, respectively. Clinical closure was achieved in 83% at 6 months. Variable parameters were used to define radiologic response, with success rates from 20% to 67%. Minimal adverse events were reported. Conclusion: Fat graft injections show promise as a novel treatment for Crohn's perianal fistulas in this systematic review and meta‐analysis. Assessment in controlled matched studies is warranted. [ABSTRACT FROM AUTHOR]

Objective: To review the results of a series of patients with glottic insufficiency caused by scarred vocal folds who underwent injection laryngoplasty with centrifuged and emulsified autologous fat. Study Design: Prospective cohort. Setting: Single center, tertiary institution. Subjects and Methods: Examination of the medical records of 21 patients operated on through injection laryngoplasty with fat grafts for the treatment of dysphonia was performed. All patients were operated on between January of 2015 and September of 2019. The voice variables measured were the GRABS (Grade, Roughness, Breathiness, Asthenia, Strain) scale, the Voice Handicap Index–10 (VHI-10), maximum phonation time, jitter, shimmer, and harmonic/noise ratio before surgery and 8 months later. Results: Twenty-six injection laryngoplasties were performed in 21 patients during the reviewed period. Seventeen were men, and 4 were women. Mean age was 57.2 (range, 18-80) years. Mean (SD) follow-up time was 20.7 (9.3) months. Etiology of dysphonia was scarring after tumor resection in 17 patients and sulcus vocalis in 4. Five patients received an additional injection laryngoplasty. Statistically significant improvements were observed in all the parameters evaluated (P <.05). Conclusions: Injection laryngoplasty with fat grafts processed through centrifugation and emulsification is an effective technique for the treatment of dysphonia caused by glottic insufficiency related to scarred vocal folds, with minimal complication rates. [ABSTRACT FROM AUTHOR]

As the storage time of the fat tissue passes by, lipid peroxidation and creation of by‐products may take place. The objective of this study was to evaluate the cell viability and functional changes of adipose‐derived stem cells (ADSCs) in the cryopreserved lipoaspirates at different temperatures in accordance with lipid peroxidation. Lipoaspirates acquired from liposuction were divided into four different temperature groups and stored at 4°C, −20°C, −80°C, and −196°C. After isolating ADSC from each sample, gross cell morphology and cell viability were compared with doubling time and colony‐forming unit (CFU) formation ability. Acid value, that is, thiobarbituric acid value was measured to assess lipid peroxidation. No viable ADSC was observed in −20°C and −196°C samples for past 1 week and a superior number of the live cells were detected in the 4°C group compared with the −80°C group. However, the persistence of cell division and CFU formation after 1 week was only observed in adipocytes stored at −80°C. Lipid peroxidation mainly occurred at 4°C and −20°C storage samples. If the lipoaspirates were planned to be cryopreserved, it is advised to store at −80°C. However, the number of actually functional ADSCs is very low. Furthermore, even in the cryopreserved status, continuous lipid peroxidation and by‐product creation took place, suggesting shorter preservation period as possible in the clinics. [ABSTRACT FROM AUTHOR]

Background: Parry‐Romberg syndrome (PRS) is a rare condition involving self‐limited progressive facial hemiatrophy. Aims: To analyze esthetic results of fat graft used for correcting soft‐tissues atrophy in PRS patients, in the aspect of volume restoration and skin rejuvenation, to present our experience in redefining facial contours in PRS and modification of fat graft accusation technique (based on Coleman's technique). Patients/Methods: A prospective evaluation study was designed to analyze esthetic results (contour and skin condition), complications, and subjective satisfaction of eight patients with PRS treated with fat graft. Results: All patients underwent two (n = 6) or three (n = 2) procedures in 3 months intervals (the mean 3.7 months). No major postoperative complications were observed. The authors evaluated their esthetic results concerning face contour and symmetry as good (in four patients) and very good (in four patients). Subjective assessment showed high patients' satisfaction with the final result of face contouring (the mean VAS [0‐5]‐4.75). Conclusions: Our experience shows that fat grafting in patients with PRS is safe and gives satisfactory results in the aspect of volume restoration and skin quality improvement. Modified technique of graft preparation (112 g for 3 minutes) enables to obtain less dense fat graft, which is more appropriate in case of PRS patients with thin atrophic skin. [ABSTRACT FROM AUTHOR]

Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre- and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated. Results Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9 kg/m2; P < .05), incidence of super-morbid obesity (45% vs 7.6%; P = .015), anticoagulation usage (36% vs 0%; P = .004), cardiac risk scores (1.2 vs 0.1 dB; P < .0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow-up was 30.8 ± 8.6 months. Conclusion Middle ear and mastoid obliteration with blind-sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated. [ABSTRACT FROM AUTHOR]

Aim Many techniques have been described to correct craniofacial depression defect to achieve satisfactory result but they involve complicated reconstruction and considerable donor site morbidities. The result of fat grafting in correction of the defects is demonstrated in this study. Methods Six patients were treated during the period of November 2005 to August 2009. Median age was 47 years old. Diagnosis included post craniectomy forehead depression, lupus folliculitis, lymphoma panniculitis and Parry Romberg disease. Fat graft was harvested from abdomen, processed and then injected percutaneously to correct the defects. Total 13 procedures were performed, 9 under local anaesthesia, 3 under general anaesthesia and 1 under intravenous sedation. Standard facial photographs were taken before and at 4 months after the last treatment for comparison. The patients and 2 independent surgeons then score their level of satisfaction by using a score system from 0 to 10. Results The median hospital stay and operation time are 1 day and 67.5 minutes respectively. The treatment session ranges from 1 to 6 with median of 1 session. Median volume of fat graft injected is 15.5cc. The patients and the two plastic surgeons rank moderate to high level of satisfaction. The median satisfaction scores are 8.0, 8.5 and 8.5 out of 10 in these groups accordingly. Injection site haematoma and transient facial nerve palsy happened in one patient each. The morbidities resolved spontaneously. Conclusion Fat grafting is demonstrated to be safe and effective to correct craniofacial depression with high level of satisfaction and minimal morbidities. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate the effect of hyaluronic acid (HA) associated to fat graft on growth factors expression during the healing process of tympanic membrane (TM) perforations in guinea pigs using the hyaluronic acid fat graft myringoplasty (HAFGM) technique. Study Design Prospective randomized animal study. Methods Thirty guinea pigs were divided equally into three groups: group I (control group), group II (fat graft myringoplasty technique), and group III (HAFGM technique). TMs were perforated on day 1 and then sampled on days 0, 3, 8, and 21 and tested for the expression of: epidermal growth factor (EGF), insulin-like growth factor (IGF), tumor necrosis factor α (TNF α), vascular endothelial growth factor (VEGF), and keratinocyte growth factor (KGF). Five perforated TMs were taken at day 0 from group I to serve as a reference level. Results Group III showed an increased expression of all tested growth factors, except for KGF. EGF was highest in the early healing process; then IGF peaked at day 8 with statistically significant increase compared to groups I and II. TNF α in group III was significantly higher than group I throughout the study, with a peak level at day 21. VEGF was significantly higher in group III compared to group I at days 3 and 21. Neovascularization and scarless TM closure was obtained in group III, while spontaneous closure was associated with thin-layered and scarred TM in group I. Conclusions HA association to fat graft in perforated TM increases the expression of the endogenous growth factors, suggesting that such an association is advantageous for healing. Level of Evidence N/A. Laryngoscope, 124:E224-E230, 2014 [ABSTRACT FROM AUTHOR]

Objective. (1) To evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. (2) To evaluate the long-term viability of the free fat graft following parotidectomy for benign and malignant disease, including in the postradiation setting. Study Design. Prospective study of consecutive patients. Setting. Academic tertiary care medical center. Subjects and Methods. Thirty-one consecutive patients underwent parotidectomy with SMAS flap and free fat graft reconstruction from 2006 to 2012. Data were compiled through a manual chart review. Results. Twenty-three of the 31 total patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. The 8 remaining patients (9 parotidectomies) underwent surgery for malignant disease, followed by postoperative radiation. The average age was 56 years (range, 16-84 years). The mean follow-up was 22.5 months. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. Magnetic resonance imaging confirmed long-term fat graft viability in the postradiation setting. There was 1 case of Frey syndrome and no cases of unexpected, permanent facial nerve weakness among the patients. Conclusion. The combined technique of SMAS flap and free fat graft is effective for immediate reconstruction of the parotidectomy defect with minimal morbidity and low complication rates. This study demonstrates long-term viability of the free fat graft even in the setting of postoperative radiation. [ABSTRACT FROM AUTHOR]

Objectives: Hyaluronic acid fat graft myringoplasty (HAFGM) is a new technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aim to evaluate the HAFGM on different TMP sizes, to compare the success rate of HAFGM with the underlay and overlay techniques, and to assess the hearing improvement at one year postoperatively. Study Design: Prospective study. Methods: Patients were divided into three groups depending on the patient's choice of technique: HAFGM (group I), underlay technique (group II), and overlay technique (group III). Perforations were classified into four grades. Postoperatively, the status of the eardrum, the improvement of hearing, and the incidence of complications were the main criteria for measuring outcome. Results: Distribution of TMP was 131, 63, and 52 in group I, II, and III, respectively. Global successful rate and successful closure of the grade I, II, III, and IV were the same for the three groups. Postoperatively, no worsening of bone conduction threshold was noted. Air-bone gap (ABG) was statistically similar for the three groups. No complications were noted for group I. The mean duration of the operative procedures was 16, 65, and 74 minutes for group I, II, and III, respectively (P =.02). The mean postoperative follow-up was 18.7, 20.6, and 15.5 months for groups I, II, and III, respectively. Conclusions: HAFGM success rate is comparable to that of the underlay and overlay techniques. Furthermore, it requires no hospitalization and avoids the difficulty of overlay and underlay tympanoplasty. [ABSTRACT FROM AUTHOR]

Objectives: Free abdominal fat transfer (FAT) grafts have been used after superficial parotidectomy to restore facial contour. We reviewed our experience with the use of FAT reconstruction of total parotidectomy defects to determine the safety and efficacy of this procedure. Study Design: Non-randomized retrospective analysis. Materials and Methods: The medical records of all patients who underwent total parotidectomy with the harmonic scalpel at the Medical College of Georgia from September 2004 to June 2007 were retrospectively reviewed. Patients with a prior bleeding disorder, facial nerve weakness, or who had undergone concurrent neck dissection were excluded. Results: Twenty-two patients met the study criteria; nine patients underwent FAT reconstruction. There was a greater percentage of malignancy in the FAT group (44%) compared with controls (15%), and a larger tumor size in the FAT group (3.8 ± 2.1 cm) compared with controls (2.6 ± 1.2 cm), but these differences did not achieve significance. FAT reconstruction was associated with increased length of surgery (324.6 ± 86.9 minutes vs. 206.6 ± 61.8 minutes for controls, P = .0013) and intraoperative blood loss (138.9 ± 95.3 mL vs. 50.1 ± 30.9 mL, P = .0052). There were no significant differences between FAT and control groups with respect to postoperative drain output (42.0 ± 35.0 mL vs. 52.5 ± 41.3, P > .05), duration of drainage (32.0 ± 12.0 h vs. 34.8 ± 15.1 h, P > .05), or facial nerve function. All patients who underwent FAT reconstruction were satisfied with their postoperative appearance, compared to 70% of control patients who reported some degree of dissatisfaction postoperatively. Conclusions: FAT reconstruction of the total parotidectomy defect is associated with greater blood loss from the FAT donor site and increased surgical time, but is safe and highly effective. These data suggest that the benefits of FAT reconstruction outweigh the additional increment in operative time and blood loss observed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Children's Hospital of Pittsburgh from 2000 to 2005. Study Design: Retrospective chart review at an academic tertiary-care children's hospital. Methods: Charts were reviewed for 604 children, ages 1 to 18 years old, with complete records who underwent myringoplasty by the pediatric otolaryngology practice at Children's Hospital of Pittsburgh of UPMC from 2000 to 2005, totaling 777 procedures. Results: Significant variables include patient age, number of prior tubes, perforation etiology ( P < .000), presence of a retained tube ( P < .000) as well as tube type ( P = .016), graft material ( P = .001), and history of Down syndrome ( P = .035). Nonsignificant variables include season of procedure ( P = .599), status of adenoid tissue ( P = .910), prior otorrhea ( P = .175), as well as perforation location ( P = .318) and duration ( P = .150). Conclusions: Proper patient and graft material selection can affect the outcome of myringoplasty procedures. Practical implications from these data suggest that Gelfoam myringoplasty is more successful than either paper patch or fat graft closures, with a 90.8% success rate ( P = .001). Myringoplasty should not be deferred during the winter months as the season of procedure does appear to not affect the success of closure ( P = .60). Similarly, the presence or absence of adenoid tissue did not affect the success of closure ( P = .91). [ABSTRACT FROM AUTHOR]

Introduction Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. Study Design A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. Methods Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. Results In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA ( P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly ( P <.05) in all patients after fascia augmentation. Conclusions Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency. [ABSTRACT FROM AUTHOR]

Objectives To describe a new endoscopic technique for medialization of the laterally fixed arytenoid. The surgical technique, endoscopic arytenoid repositioning, is described, and the results of a series of cases are discussed. Study Design Retrospective chart review. Methods Eight patients underwent the procedure. Six patients were available for long-term follow-up. Preoperative and postoperative voice ratings were compared to evaluate the success of the procedure. Follow-up ranged from 3 to 64 months (mean follow-up, 31.5 mo). Results Long-term follow-up in six cases revealed that 67% (4 of 6) patients had normal or near-normal postoperative voices and one patient experienced moderate improvement. The mean preoperative voice score was 4.24, and the mean postoperative voice score was 1.83 (range, 1-5). The difference was statistically significant ( P <0.001). Conclusions Endoscopic arytenoid repositioning is a newly described procedure with a very specific indication: a unilateral, laterally fixed arytenoid complex resulting in a severely dysphonic voice. Though technically demanding, this procedure provides a promising option for medialization of the posterior glottis in a scarred larynx. [ABSTRACT FROM AUTHOR]