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Background: The correction of tear trough deformity poses a significant challenge in the context of facial rejuvenation. Our aim was to introduce a technique that corrects tear trough deformity during transconjunctival lower blepharoplasty using minced orbital fat grafts. Methods: The medical records of patients who underwent lower blepharoplasty from January 2019 to December 2021 were reviewed. The study included patients with various grades of tear trough deformity, who underwent lower blepharoplasty using minced orbital fat grafts and followed up for at least 6 months. Modified Barton's grading for tear trough depression, patient satisfaction, and postoperative complications were evaluated. Results: A total of ninety-eight patients, with a mean age of 48.07 ± 9.72 years, consisting of 93 (94.9%) females were included in the study. The average duration of follow-up was 7.2 months, ranging from 6 to 13 months. Tear trough depression significantly improved after the operation (preoperative tear trough depression grade mean (SD): 3.11 (0.60); postoperative tear trough depression grade mean (SD): 0.87 (0.66); P < 0.001). 78.5% of the participants reported their outcome as excellent or good, 20.4% reported as fair, and 1.0% (only one patient) reported as no improvement. None of the participants rated their outcome as worsening. No major complication was observed during the follow-up period. Conclusion: Minced orbital fat grafting during transconjunctival lower eyelid blepharoplasty has good effectiveness for correcting tear trough deformity without the risk of major complications. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Dupuytren's contracture is a hereditary disorder which causes progressive fibrosis of the palmar aponeurosis of the hand, resulting in digital flexion contractures of the affected rays. Limited fasciectomy is a standard surgical treatment for Dupuytren's, and the one with the lowest recurrence rate; however, the recurrence is still relatively high (2–39%). Adipose-derived stem cells have been shown to inhibit Dupuytren's myofibroblasts proliferation and contractility in vitro, as well as to improve scar quality and skin regeneration in different types of surgeries. Autologous adipose tissue grafting has already been investigated as an adjuvant treatment to percutaneous needle fasciotomy for Dupuytren's contracture with good results, but it was only recently associated with limited fasciectomy. The purpose of REMEDY trial is to investigate if limited fasciectomy with autologous adipose tissue grafting would decrease recurrence compared to limited fasciectomy alone. Methods: The REMEDY trial is a multi-centre open-label randomised controlled trial (RCT) with 1:1 allocation ratio. Participants (n = 150) will be randomised into two groups, limited fasciectomy with autologous adipose tissue grafting versus limited fasciectomy alone. The primary outcome is the recurrence of Dupuytren's contracture on any of the treated rays at 2 years postoperatively. The secondary outcomes are recurrence at 3 and 5 years, scar quality, complications, occurrence of algodystrophy (complex regional pain syndrome), patient-reported hand function, and hypodermal adipose tissue loss at 1 year postoperatively in a small subset of patients. Discussion: The REMEDY trial is one of the first studies investigating limited fasciectomy associated with autologous adipose tissue grafting for Dupuytren's contracture, and, to our knowledge, the first one investigating long-term outcomes of this treatment. It will provide insight into possible benefits of combining adipose tissue grafting with limited fasciectomy, such as lower recurrence rate and improvement of scar quality. Trial registration: ClinicalTrials.gov NCT05067764, June 13, 2022. [ABSTRACT FROM AUTHOR]

Background: The extracellular matrix isolated from adipose tissue, known as acellular adipose matrix (AAM), represents a novel biomaterial. AAM functions as a scaffold that not only supports stem cell proliferation and differentiation but also induces adipogenesis and angiogenesis. This study aims to investigate the volumetric effects and microenvironmental changes associated with injectable AAM in comparison to conventional fat grafting. Methods: AAM was manufactured from fresh human abdominoplasty fat using a mechanically modified method and then transformed into an injectable form. Lipoaspirate was harvested employing the Coleman technique. A weight and volume study was conducted on athymic nude mice by injecting either injectable AAM or lipoaspirate into the scalp (n=6 per group). After eight weeks, graft retention was assessed through weight measurement and volumetric analysis using micro-computed tomography (micro-CT) scanning. Histological analysis was performed using immunofluorescence staining for perilipin and CD31. Results: Injectable AAM exhibited similar weight and volume effects in murine models. Histological analysis revealed comparable inflammatory cell presence with minimal capsule formation when compared to conventional fat grafts. Adipogenesis occurred in both AAM-injected and conventional fat graft models, with no significant difference in the blood vessel area (%) between the two. Conclusions: In summary, injectable AAM demonstrates effectiveness comparable to conventional fat grafting concerning volume effects and tissue regeneration in soft tissue reconstruction. This promising allogeneic injectable holds the potential to serve as a safe and effective "Off-the-Shelf" alternative in both aesthetic and reconstructive clinical practices. No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient's factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube. [ABSTRACT FROM AUTHOR]

Abstract Background Dupuytren’s contracture is a hereditary disorder which causes progressive fibrosis of the palmar aponeurosis of the hand, resulting in digital flexion contractures of the affected rays. Limited fasciectomy is a standard surgical treatment for Dupuytren’s, and the one with the lowest recurrence rate; however, the recurrence is still relatively high (2–39%). Adipose-derived stem cells have been shown to inhibit Dupuytren’s myofibroblasts proliferation and contractility in vitro, as well as to improve scar quality and skin regeneration in different types of surgeries. Autologous adipose tissue grafting has already been investigated as an adjuvant treatment to percutaneous needle fasciotomy for Dupuytren’s contracture with good results, but it was only recently associated with limited fasciectomy. The purpose of REMEDY trial is to investigate if limited fasciectomy with autologous adipose tissue grafting would decrease recurrence compared to limited fasciectomy alone. Methods The REMEDY trial is a multi-centre open-label randomised controlled trial (RCT) with 1:1 allocation ratio. Participants (n = 150) will be randomised into two groups, limited fasciectomy with autologous adipose tissue grafting versus limited fasciectomy alone. The primary outcome is the recurrence of Dupuytren’s contracture on any of the treated rays at 2 years postoperatively. The secondary outcomes are recurrence at 3 and 5 years, scar quality, complications, occurrence of algodystrophy (complex regional pain syndrome), patient-reported hand function, and hypodermal adipose tissue loss at 1 year postoperatively in a small subset of patients. Discussion The REMEDY trial is one of the first studies investigating limited fasciectomy associated with autologous adipose tissue grafting for Dupuytren’s contracture, and, to our knowledge, the first one investigating long-term outcomes of this treatment. It will provide insight into possible benefits of combining adipose tissue grafting with limited fasciectomy, such as lower recurrence rate and improvement of scar quality. Trial registration ClinicalTrials.gov NCT05067764, June 13, 2022.

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Introduction: Dimethyl sulfoxide (DMSO) is a well-known organic solvent that possesses a wide spectrum of properties. DMSO has been shown to possess vasodilative and antioxidative properties as well as increase tissue oxygenation. The use of DMSO in the clinical setting for skin and flap perfusion is not well reviewed or understood. The aim of this article is to review the current use of DMSO and its potential role in improving reconstructive outcomes. Methods: Publications on the use of DMSO in plastic and reconstructive surgery were collected from the PubMed, OVID, Scopus, Embase and Google Scholar databases. MeSH terms related to DMSO, topical DMSO, skin flaps, wound healing, graft preservation, reconstructive and plastic surgery were used to conduct this search. Recent relevant studies were reviewed. Results: Data on DMSO's effect on flap perfusion, wound healing, tissue expansion, and fat graft tissue were investigated. Results revealed improvement in skin flap survival, preservation of fat graft tissue, enhanced skin expansion, and significant stimulation of the wound healing process. Conclusions: This review highlights the therapeutic effects of topical DMSO in clinical and animal studies. The use of DMSO on threatened or poorly perfused skin has promising results and may be an additional adjunct. Further studies should highlight the mechanism of its action as well as compare DMSO to nitroglycerin-containing paste, a more commonly used agent by plastic surgeons. Level of Evidence: Not gradable [ABSTRACT FROM AUTHOR]

Background: Surgical blepharoplasty has traditionally been used to rejuvenate the periorbita by removing excess tissue. While this often enhances appearance, it does not address the volume loss associated with aging. Hyaluronic acid (HA) fillers have been used to address volume loss; however, issues such as the Tyndall effect, chronic edema, and the cost of repeated injections make them less than ideal. Advances in contemporary surgery have made autologous fat a natural alternative for filling volume loss in the periorbita. Fat grafting, whether using macrofat, microfat, or nanofat, can provide excellent results, but a separate procedure is required to harvest the fat from the patient. Objectives: The aim of this study was to analyze and describe complications and patient satisfaction by comparing blepharoplasty alone with blepharoplasty combined with lipofilling. Methods: A retrospective review of a single surgeon's private practice cases was performed on 45 consecutive patients who underwent surgical blepharoplasty alone and 64 patients who had surgical blepharoplasty combined with lipofilling from 2002 to 2021. Complications, pain scores, and patient satisfaction reports were assessed. Results: Upon comparing the blepharoplasty alone group to the blepharoplasty with lipofilling group, the 109 patients did not differ significantly in age. Both groups were predominantly female. There were no major complications, only minor ones, and though the blepharoplasty alone group had a higher complication rate, this was not statistically significant. Lipofilling added approximately 30 minutes to the 60-minute blepharoplasty procedure, but pain scores were higher in the combination group. However, pain dissipated quickly and, while statistically significant, was not clinically significant. Patient satisfaction with the additional lipofilling was high, which resulted in lipofilling being added to all blepharoplasty procedures. Conclusions: Traditional surgical blepharoplasty can be combined with fat grafting techniques to address tissue loss and descent. Lipofilling integrated with blepharoplasty is a safe procedure. It is well tolerated by patients and provides high satisfaction with good aesthetic outcomes. The use of autologous fat offers an economical and effective advantage for patients. [ABSTRACT FROM AUTHOR]

Striae distensae (SD) present in women undergoing further breast surgery such as augmentation or mastopexy, can impact dramatically on outcomes both aesthetically and functionally. No technique has been described to address these. We describe our novel technique for management including intra-dermal nano-fat graft at the time of breast augmentation or mastopexy, followed by post-operative CO2 laser. Twenty patients have been treated with this technique in order to improve aesthetic outcomes and reduce complications such as SD worsening, poor scarring and ptosis. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Fat grafting is a popular procedure that provides a physician with a range of aesthetic, reconstructive, and regenerative clinical applications. It involves the harvest of fat tissue from one region of the body and transfer to another. The indications and techniques of fat grafting have undergone dramatic changes over time and. This review revisits the important milestones in the historical evolution of fat grafting. [ABSTRACT FROM AUTHOR]

Introduction: Autologous fat graft survival depends on many variables such as vascularization and inflammation. Fat grafts are also frequently used in breast reconstructions. Objective: The objective is to investigate the effect of tamoxifen (TAM), which is frequently used in hormonal therapy after breast cancer, on fat graft survival and to determine the possible benefits of local and systemic deferoxamine (DFO) applications with TAM. Materials and Methods: Thirty-two female Wistar Albino rats were randomly divided into four groups. Fat graft from the inguinal region was transferred to the left subscapular area, suprafascial plan on the back of the rats. No application was made to the control group after fat grafting. Group 2 received TAM by oral gavage, Group 3 received TAM + local (L) DFO application to the fat graft area, and Group 4 received TAM + intraperitoneal (IP) DFO application. The grafted adipose tissue was excised 2 months after surgery. Macroscopic and histopathologic analysis was performed. Results: In the 2nd postoperative month, the weight and volume of fat grafts were significantly higher in the TAM + L DFO and TAM + IP DFO groups compared to the control group, whereas there was no statistically significant difference in the TAM-only group. Furthermore, vascularization and vascular endothelial growth factor (VEGF) expression were significantly increased in the TAM + L DFO and TAM + IP DFO groups compared to the control and TAM groups. Conclusions: Local DFO application to the fat graft recipient site and systemic DFO application increased fat graft survival in TAM-treated rats. VEGF expression was shown to increase with DFO and fat graft survival was also increased accordingly. The use of DFO is promising in improving fat graft survival in breast reconstruction patients using TAM.

Abstract Background Autologous fat grafting is hampered by unpredictable graft survival, which is potentially regulated by ferroptosis. Glutathione (GSH), a powerful antioxidant used in tissue preservation, has ferroptosis-regulating activity; however, its effects on fat grafts are unclear. This study investigated the effects and mechanisms of GSH in fat graft survival. Methods Human lipoaspirates were transplanted subcutaneously into the backs of normal saline-treated (control) or GSH-treated nude mice. Graft survival was evaluated by magnetic resonance imaging and histology. RNA sequencing was performed to identify differentially expressed genes and enriched pathways. GSH activity was evaluated in vitro using an oxygen and glucose deprivation (OGD) model of adipose-derived stem cells. Results Compared with control group, GSH induced better outcomes, including superior graft retention, appearance, and histological structures. RNA sequencing suggested enhanced negative regulation of ferroptosis in the GSH-treated grafts, which showed reduced lipid peroxides, better mitochondrial ultrastructure, and SLC7A11/GPX4 axis activation. In vitro, OGD-induced ferroptosis was ameliorated by GSH, which restored cell proliferation, reduced oxidative stress, and upregulated ferroptosis defense factors. Conclusions Our study confirms that ferroptosis participates in regulating fat graft survival and that GSH exerts a protective effect by inhibiting ferroptosis. GSH-assisted lipotransfer is a promising therapeutic strategy for future clinical application.

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/Aim: Fat grafting has been widely used for soft-tissue augmentation. External volume expansion (EVE) is a favorable tool for improvement in the rate of fat graft retention. However, few studies have focused on the most appropriate time for its implementation. In this study, BALB/c nude mice were used to investigate the effective time for the implementation of external volume expansion to improve the rate of fat retention. Materials and Methods: Sixteen mice were divided into four groups, and EVE was performed at different time points before or both before and after fat grafting. Fat tissue from a human donor was injected into the mice following EVE. Visual assessment, micro-computed tomography analysis, and histopathological evaluation were used to assess fat retention. Results: After 10 weeks, the group that underwent EVE 5 days before fat grafting demonstrated a significantly higher preserved fat volume, as determined by micro-computed tomography (p<0.05). Moreover, the group that received additional EVE after fat grafting exhibited a higher retention rate compared to the groups receiving EVE only before grafting (p<0.05). Histopathological analysis indicated that swelling, edema, and inflammation were more pronounced in the group with EVE immediately before grafting, while angiogenesis and lipogenesis were more active in the group with additional EVE after grafting. Conclusion: EVE is a safe and effective approach for improving the rate of fat graft retentions. Furthermore, the timing of external tissue expansion plays a crucial role in fat retention. Based on our animal study, performing EVE immediately before and after fat grafting may be an effective strategy for enhancing the rate of fat graft retentions. [ABSTRACT FROM AUTHOR]

Background: Fat grafting is commonly utilized in breast surgery, and since it was first described, clinicians and researchers have stridden towards improvement of graft retention. Current advancements include adding adipose-derived mesenchymal stem/stromal cells (MSC(AT)s), which have demonstrated promise for improved graft retention. Objectives: This study reports outcomes for the first twenty-two patients undergoing breast augmentation (Stemform BA) or artificial implant replacement (Stemform AIR) with MSC(AT)-enriched fat in a real-world setting. Methods: Autologous MSC(AT)s were isolated and expanded ex vivo, then mixed with lipoaspirate and injected as enriched fat for Stemform BA and AIR. The breast volume was measured preoperatively and at 3 and 12 months postoperative using a 3D Infinity Dual-Lens Camera and LifeVizApp software. Additionally, independent plastic surgeons evaluated clinical images, and patient satisfaction was obtained at equal time points. Results: Twenty-two patients were included. All completed 3 and 12 months clinical follow-up and 3 months volume measurements. Nineteen patients completed 12 months volume measurements. The median fat graft retention at 12 months was 95.7% (IQR = 82.44–103.12%) for Stemform BA patients and 113.0% (IQR = 94.8–131.2%) for Stemform AIR patients. The Stemform BA patients had a median breast enlargement of 172.0% (IQR = 156.7–241.0%). The implant replacement volume of Stemform AIR patients was 102% (IQR = 85.1–130.3%). The patient reported 92.8% and 100% would elect to repeat treatment if they had the opportunity for Stemform BA and Stemform AIR, respectively. Conclusion: Breast augmentation and breast implant replacement patients receiving ex vivo-expanded MSC(AT)-enriched fat grafts had high graft retention and patient satisfaction scores. The paper confirms the clinical efficacy of using ex vivo-expanded MSC(AT)s. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Actinic elastosis is a non-curable skin condition manifesting with wrinkling, reduction of elasticity, pigmentation, and roughness of the skin. Many aesthetic treatments aimed at reducing its aesthetic impact have been suggested. The aim of this study is to compare fat grafting, fractioned CO2 laser resurfacing, and hybrid filler in order to detect which one is more effective in improving actinic elastosis. Methods: Patients meeting the following criteria were included in the study: dermatological diagnosis of elastosis, primary surgical or non-surgical treatment for elastosis, at least 1 year follow-up, pre- and post-operative photo-documentation, proficiency in Italian language, and signed consent for study participation. The study was performed with a randomized design; patients were randomly divided in three groups: group 1, fat grafting; group 2, hybrid filler; and group 3, CO2 laser resurfacing. All patients were asked to answer the FACE-Q satisfaction with the face post-operative module. Two plastic surgeons, blinded to the treatment method used, were selected to examine pre- and post-operative photographs, rating the outcomes on a 1–5 VAS scale. Results: Seventy-five patients were enrolled, 4 males and 71 females, aged between 50 and 80 years. Both the FACE-Q and VAS scores were higher in groups 1 and 2. No major complications were reported in any of the groups. Conclusions: Elastosis remains a genetically based skin condition, which cannot be considered curable. Hybrid filler and adipose tissue transfer can be both considered valid options to improve skin elastosis both in terms of patient satisfaction and enhancement of skin quality. Level of evidence:Level II, Therapeutic study2229 [ABSTRACT FROM AUTHOR]

Background: Autologous adipose tissue often experiences ischemia and hypoxia after transplantation, leading to low retention rates and unstable operative impacts due to necrotic absorption. Platelet-rich plasma (PRP) can enhance fat regeneration and increase the fat retention rate after transplantation. However, the quick release of growth factors (GFs) in PRP decreases therapeutic efficiency. This study aimed to achieve a slow release of PRP to promote fat retention. Methods: We prepared a dual-network hydrogel (DN gel) based on FDA-approved PRP and sodium alginate (SA) through a simple "one-step" activation process. In vivo study, adipose tissue with saline (control group), SA gel (SA gel group), PRP gel (PRP gel group), and DN gel (DN gel group) was injected subcutaneously into the dorsum of nude mice. At 4 and 12 weeks after injection, tissues were assessed for volume and weight. Hematoxylin and eosin staining (HE) and immunofluorescence staining were performed for histological assessment. Results: DN gel exhibits long-lasting growth factor effects, surpassing conventional clinical PRP gel regarding vascularization potential. In fat transplantation experiments, DN gel demonstrated improved vascularization of transplanted fat and increased retention rates, showing promise for clinical applications. Conclusions: DN gel-assisted lipofilling can significantly improve the retention rate and quality of transplanted fat. DN gel-assisted lipofilling, which is considered convenient, is a promising technique to improve neovascularization and fat survival. No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Introduction:Autologousfat graftsurvival depends on many variablessuch as vascularization and inflammation. Fat grafts are also frequently used in breast reconstructions. Objective: The objective is to investigate the effect of tamoxifen (TAM), which is frequently used in hormonal therapy after breast cancer, on fat graft survival and to determine the possible benefits of local and systemic deferoxamine (DFO) applications with TAM. Materials and Methods: Thirty‑two female Wistar Albino rats were randomly divided into four groups. Fat graft from the inguinal region was transferred to the left subscapular area, suprafascial plan on the back of the rats. No application was made to the control group after fat grafting. Group 2 received TAM by oral gavage, Group 3 received TAM + local (L) DFO application to the fat graft area, and Group 4 received TAM + intraperitoneal (IP) DFO application. The grafted adipose tissue was excised 2 months aftersurgery. Macroscopic and histopathologic analysis was performed. Results: In the 2nd postoperative month, the weight and volume of fat grafts were significantly higher in the TAM + L DFO and TAM + IP DFO groups compared to the control group, whereas there was no statistically significant difference in the TAM‑only group. Furthermore, vascularization and vascular endothelial growth factor (VEGF) expression were significantly increased in the TAM + L DFO and TAM + IP DFO groups compared to the control and TAM groups. Conclusions: Local DFO application to the fat graft recipient site and systemic DFO application increased fat graft survival in TAM‑treated rats. VEGF expression was shown to increase with DFO and fat graftsurvival was also increased accordingly. The use of DFO is promising in improving fat graftsurvival in breast reconstruction patients using TAM. [ABSTRACT FROM AUTHOR]

Les complications des réductions mammaires peuvent entraîner des séquelles esthétiques, qui sont réputées difficiles et délicates à traiter, et peu d'articles traitent de ce sujet. Le but de cet article et de présenter et d'analyser notre expérience du lipomodelage dans le traitement des séquelles esthétiques faisant suite à une complication d'une chirurgie de réduction mammaire. Une série consécutive de 22 patientes, opérées de décembre 2003 à mars 2019 par le dernier auteur, par lipomodelage, pour corriger des séquelles esthétiques de complications secondaires après réduction mammaire, a été étudiée en analysant l'efficacité et la tolérance de la technique. Les résultats ont montré 86,4 % de très bons résultats, et 13,6 % de bons résultats. Les patientes ont été très satisfaites dans 17 cas (77,3 %), et satisfaites dans 5 cas (22,7 %). Le nombre d'interventions de lipomodelage allait de 1 à 3 : 15 patientes (68,2 %) ont bénéficié d'une séance de lipomodelage, 5 patientes (22,7 %) de deux séances, et 2 patientes (9,1 %) de 3 séances. Le délai moyen entre les interventions était de quatre mois (3–12). Aucune patiente de cette série n'a engagé de procédure médicojuridique envers le premier chirurgien. À la suite de cette étude, le lipomodelage associé aux gestes annexes apparaît être une solution efficace et sûre pour la correction des séquelles esthétiques des complications de réduction mammaire. Il devrait prendre une place centrale dans la correction de ces séquelles. La prise en charge, efficace et bienveillante, de ces patientes permet de les guider vers un bon résultat, et d'obtenir une satisfaction finale, permettant d'éviter un problème médicojuridique toujours mal vécu par les patientes, et par le premier chirurgien. Complications of reduction mammoplasty can lead to aesthetic sequelae, which are known to be difficult and delicate to treat, and only a few articles deal with this subject. The objective of this article is to present and analyze our experience of lipomodeling for the secondary management of aesthetic sequelae occurring after a complication of reduction mammoplasty. An uniform and consecutive series of 22 female patients, operated with the lipomodeling technique from December 2003 to March 2019 by the last author, to correct aesthetic sequelae after secondary complications of reduction mammoplasty was studied analyzing the efficiency and the tolerance of this technique. The results showed 86.4% of very good results and 13.6% of good results. Seventeen patients (77.3%) were highly satisfied with the postoperative outcome, and 5 patients were satisfied (22.7%). The number of procedures varied from 1 to 3: 15 patients (68.2%) underwent only one session of lipomodeling, 5 patients (22.7%) underwent two sessions, and 2 patients (9.1%) underwent three sessions. The mean time between two interventions was 4 months (3–12). No patient of this series initiates any medico-legal proceeding towards the first surgeon. After this study, lipomodeling, in association with ancillary procedures, seems to be an effective and safe solution to correct aesthetic sequelae following secondary complications of reduction mammoplasty. It should have a key role for the correction of these sequelae. An effective and appropriate care of these patients leads to good results and patients' final satisfaction, and manages to avoid any medico-legal proceeding, always badly lived as much for the patient as for the first surgeon. [ABSTRACT FROM AUTHOR]

In this report, we present a case study of a rare human bacterium, Corynebacterium bovis, which caused an infection in a patient who had undergone autologous fat-based breast augmentation using cryopreserved fat. This infection occurred during a secondary fat grafting procedure. To identify the bacteria causing the infection, we used high-throughput DNA sequencing technology since this bacterium is seldomly reported in human infections. The patient was successfully treated with intravenous imipenem. We also discuss potential factors that may have contributed to this unusual bacterial infection and propose that DNA sequencing can be a useful tool in cases where standard culture techniques fail to identify the causative agent. Additionally, we highlight the importance of further research on the cryopreservation of fat. In summary, this case highlights the possibility of rare bacterial infections occurring after fat grafting procedures and emphasizes the importance of identifying the causative agent through advanced techniques such as DNA sequencing. Further research is needed to improve our understanding of the risks associated with cryopreservation of fat and to identify ways to prevent these types of infections in the future. [ABSTRACT FROM AUTHOR]

Background: Fat injection has become increasingly popular in aesthetic surgery, but there is a sparsity of literature regarding its role during genioplasty. In this study, we present the largest series of patients receiving fat injections to the chin for various indications. Methods: Data were collected from January 2016 to December 2021 for patients who underwent chin fat injection for a variety of chin refinements. Patients with chin fat injection were divided into isolated genioplasty with fat injection (CF), combined facial and chin fat injection (CFC) and combined chin fat injection and osseous genioplasty (CFG). Complication rates and reoperations were compared using Fischer's exact test between each cohort. Results: 181 patients were included in final analysis, with 14 patients in CF cohort, 130 patients in CFC cohort, 24 patients in CFG cohort, and 13 patients who underwent genioplasty alone. Repeat fat injections were required in 17 (9.4%) patients overall, which included 14 patients (10.8%) of CFC subcohort and three patients (12.5%) of CFG subcohort (p > 0.05). No patients who underwent genioplasty alone or CF required reoperation. There were no significant differences in complications between genioplasty alone group (0%) in comparison to CF (7.1%; p = 1.00), CFC (6.2%; p =.53), or CFG cohorts (7.7%; p = 1.00). Conclusion: Fat injection can safely correct minor chin deficiency or asymmetry, as either an isolated procedure or in combination with osteotomies. Additionally, fat injection enables advancement of the caudal segment to achieve superior outcomes by preventing unaesthetic deepening of labiomental groove which will not be advanced during sliding osteotomy. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Photoaging, the primary cause of exogenous skin aging and predominantly caused by ultraviolet radiation, is an essential type of skin aging characterized by chronic skin inflammation. Recent studies have shown that oxidative stress, inflammation, skin barrier homeostasis, collagen denaturation and pigmentation are the main contributors to it. As a composite tissue rich in matrix and vascular components, adipose tissue derivatives have been recently gaining attention as potential therapeutic agents for various human diseases with fat-processing technology upgrades. This review analyzes both 'minimally treated' and 'nonminimally treated' fat derivatives to give an overview of the preclinical and clinical relevance of adipose tissue derivatives for antiphotoaging application, highlighting their good clinical prospects as well as discussing their safety and potential risks. This review analyzes both 'minimally treated' and 'nonminimally treated' fat derivatives to provide an overview of the preclinical and clinical relevance of adipose tissue derivatives for photoaging applications. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if there is any evidence to support ADSC use in VLU patients, a systematic review was conducted. Methods: A systematic review was conducted following the PRISMA guidelines. PubMed and Embase databases were searched for relevant papers. References from retrieved papers were reviewed to identify any extra eligible studies. Results: After duplicate removal, 950 papers were screened for eligibility of which 932 were excluded based on title and abstract. Four papers were included in the final analysis (one randomised study and three non-randomised studies). 66 patients in total received ADSCs for VLU treatment. The only randomised paper reported 6-month healing rates of 75% with ADSCs compared to 50% in controls. 100% healing was achieved in one study. The remaining 2 studies reported 25% and 58% healing; however, they included patients with relatively large VLUs. Pain scores decreased after ADSCs application where reported. No serious procedure related complications were reported. Conclusion: ADSCs may enhance ulcer healing in patients with chronic VLU and appears safe based on initial reports. Large, randomised trials are needed to definitively establish the technique's role in VLU patients. [ABSTRACT FROM AUTHOR]

Postoperative temporal hollowing is a complication that can occur after craniectomy or cranioplasty. It is caused by the disinsertion or displacement of the temporalis muscle and atrophy of the superficial temporal fat pad. We introduce a case of temporal hollowing correction using polydioxanone thread-lifting and fat grafts. A 28-year-old man presented with right temporal hollowing and asymmetric bulging of the zygomatic region. The patient wanted an aesthetically favorable correction with a short recovery period, without using a permanent implant. We performed a two-stage procedure. In the first stage, 21 mL of centrifuged fat was obtained, of which 7 mL was injected into the temporal region. A month later, another 4 mL of the stored fat was injected, and thread-lifting was performed through the temporal region after identifying the deep temporal fascia. Four threads were inserted, pulled toward the entry point, and tied. The anchoring of the thread-lifted tissue remained stable, and the volume of grafted fat was well preserved at the 4-month follow-up. The patient was satisfied with the cosmetic results. In this case, temporal hollowing was effectively managed with fat grafting and thread lifting. We recommend this method as an option for reconstruction of temporal hollowing with a short recovery period and high patient satisfaction.

(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients. [ABSTRACT FROM AUTHOR]

The fat-augmented latissimus dorsi myocutaneous flap can overcome the volume insufficiency of latissimus dorsi flaps by immediate fat grafting into the flap. When breast skin supplementation is unnecessary, latissimus dorsi flaps can be harvested as a muscle flap to avoid an additional back incision. Here, we compared the efficacy of fat-augmented latissimus dorsi myocutaneous and muscle flaps in total breast reconstruction. We retrospectively reviewed 94 cases of unilateral total breast reconstruction using fat-augmented latissimus dorsi flaps (muscle: 40, myocutaneous: 54) at our hospital from September 2017 to March 2022. The muscle flap group had a significantly shorter operative time than the myocutaneous flap group (p < 0.0001). Mastectomy specimen weight did not differ between the 2 groups, but total flap weight in the muscle flap group was significantly lower (p < 0.0001). Conversely, total fat graft volume, fat graft volume to the latissimus dorsi flap, and fat graft volume to the pectoralis major muscle were significantly greater in the muscle flap group (p < 0.0001, p < 0.0001, and p = 0.02, respectively). The percentage of cases requiring additional fat grafting was significantly higher in the muscle flap group, but postoperative esthetic evaluation did not significantly differ between the 2 groups. Both groups scored high on each BREAST-Q item, but the muscle flap group scored significantly higher for "Satisfaction with Back." Although the frequency of additional fat grafting was higher than with fat-augmented latissimus dorsi myocutaneous flaps, total breast reconstruction with fat-augmented latissimus dorsi muscle flaps is a viable technique with a short operative time and high patient satisfaction. [ABSTRACT FROM AUTHOR]

Fat grafts are widely used as natural fillers in reconstructive and cosmetic surgery. However, the mechanisms underlying fat graft survival are poorly understood. Here, we performed an unbiased transcriptomic analysis in a mouse fat graft model to determine the molecular mechanism underlying free fat graft survival. We conducted RNA-sequencing (RNA-seq) analysis in a mouse free subcutaneous fat graft model on days 3 and 7 following grafting (n = 5). High-throughput sequencing was performed on paired-end reads using NovaSeq6000. The calculated transcripts per million (TPM) values were processed for principal component analysis (PCA), unsupervised hierarchically clustered heatmap generation, and gene set enrichment analysis. PCA and heatmap data revealed global differences in the transcriptomes of the fat graft model and the non-grafted control. The top meaningful upregulated gene sets in the fat graft model were related to the epithelial-mesenchymal transition, hypoxia on day 3, and angiogenesis on day 7. Mechanistically, the glycolytic pathway was upregulated in the fat graft model at days 3 (FDR q = 0.012) and 7 (FDR q = 0.084). In subsequent experiments, pharmacological inhibition of the glycolytic pathway in mouse fat grafts with 2-deoxy- D -glucose (2-DG) significantly suppressed fat graft retention rates, both grossly and microscopically (n = 5). Free adipose tissue grafts undergo metabolic reprogramming toward the glycolytic pathway. Future studies should examine whether targeting this pathway can enhance the graft survival rate. [ABSTRACT FROM AUTHOR]