Search

Background Microdermal grafting with knife-cut, partially de-epithelialized skin can regenerate color in white (hypopigmented) scars. However, the scalp has more melanocytes, and dermabrasion can preserve more melanocytes than knife cutting during partial de-epithelialization. Objectives The aim of this study was to evaluate the color regeneration results and complications of various microdermal grafting procedures for white scar color regeneration. Methods Two refinements to an existing microdermal grafting technique for treating white scars were described: dermabrasion, rather than knife cutting, was used to partially de-epithelialize skin, and melanocyte donor sites were harvested from the scalp, rather than from skin. A review was performed of 65 cases in which various combinations of these refinements were used to treat scars on the face and forearms. Results Sixty-five patients (36 forearms; 29 faces) were treated, 40 receiving 1 session, 23 receiving 2 sessions, and 2 receiving 3 sessions of treatment. The follow-up was 6.5 months (range, 4-16 months). The use of both technique refinements produced approximately 15% better color generation than the original procedure after 1 session of treatment and approximately 20% better than the original procedure after 2 sessions. Histologic immunostaining showed that the dermabrasion method preserved more melanocytes around the epidermal-dermal region, and that the scalp has richer melanocytes than skin. The complication rate was reduced. Conclusions The use of the scalp as the donor site and partial de-epithelialization by dermabrasion can be safely incorporated into a previously developed microdermal grafting procedure for better color regeneration of white scars. Level of Evidence: 4

Hospital readmission data may be a useful tool in identifying risk factors leading to higher costs of care or poorer overall outcomes. Several studies have emerged utilizing these datasets to examine the trauma and burn population, which have been unable to distinguish planned from unplanned readmissions. The 2014 Nationwide Readmissions Database was queried for 363 burn-specific ICD-9 DX codes and filtered by age and readmission status to capture the adult burn population. Additionally, burn-related excision and grafting procedures were filtered from 25 ICD-9 SG codes to distinguish planned readmissions. A total of 26,719 burn patients were identified with 781 all-cause unscheduled 30-day readmissions. Further filtering by burn-related excision and grafting procedures then identified 468 patients undergoing a burn-related excision and grafting procedure on readmission, reducing the dataset to 313 patients and identifying up to 60% of readmissions as possibly improperly coded planned readmissions. From this dataset, nonoperative management on initial admission was found to have the strongest correlation with readmission (OR 5.00; 3.33–7.14). Notably corrected data, when stratified by annual burn patient admission volume, identified a significant likelihood of readmission (OR 4.57; 2.15–9.70) of centers receiving the lowest annual number of burn patients, which was not identified in the unfiltered dataset. Healthcare performance statistics may be a powerful metric when utilized appropriately; however, these databases must be carefully applied to small and special populations. This study has determined that as many as 60% of burn patient readmissions included in prior studies may be improperly coded planned readmissions.

Surgical correction can be considered for treating patients with a chronic phase of Peyronie's disease (PD) and persistent penile curvature. In clinical practice, some patients pay too much attention to surgical complications and refuse the recommended feasible surgical types. Meanwhile, they require operations according to their preferences. This study aimed to evaluate the effects of patients' own choice of surgical type on postoperative satisfaction. This retrospective study analyzed data from 108 patients with PD who underwent surgical correction according to doctors' recommendations or patients' own demands. The objective and subjective surgical outcomes were assessed. Patients' understanding of the disease was analyzed using a questionnaire survey. Objective measurements of surgical outcomes, including penile straightening, penile length, and sexual function, in patients who received the recommended surgery, were similar to those in patients who did not accept the recommended surgery. However, subjective evaluations, including erectile pain, discomfort because of nodules on the penis, and decreased sensitivity in the penis, were more obvious in patients who did not follow doctors' recommendations. In addition, a questionnaire survey showed that understanding PD and the purpose of surgery of patients who did not follow doctors' advice were inappropriate, as they did not conform to the principle of treatment. The present study showed that surgical correction seemed to be an objectively effective option in the management of patients in the stable chronic phase of PD. Low patient satisfaction might be related to patients' lack of correct understanding of the disease and its treatment strategy as well as unrealistic expectations.

Background Peyronie's disease (PD) can be a cosmetically and functionally devastating condition. Surgical approaches have been proposed in the chronic stages of PD as plication or plaque incision/excision with grafting to preserve penile size in complex cases. Although several surgeons nowadays are inclined toward the utilization of non-autologous grafts owing to the ease of their preparation and availability, synthetic graft procedures still await more technical improvements and supporting evidence before their consideration for standard care. Objectives In this review, our goal is to facilitate an insight into the most promising grafting materials used for the management of PD and techniques associated. Materials and methods A PubMed review was conducted for all the studies on our topic within the past ten years (January 2009 until December 2019). The outcome parameters we documented and compared comprised of operative time, follow-up time, postoperative penile cosmesis and function, and, finally, overall patient satisfaction related to each technique. Results Our search yielded 23 English-written original study articles in addition to a single case report on the various grafting techniques utilized as the sole treatment for PD, each demonstrating different outcomes and points of comparison. Conclusion A successful grafting procedure for PD requires an appropriately tailored surgical modality and an experienced surgeon. Nevertheless, proper preoperative patient counseling on all aspects of his condition and opted treatment modality while setting clear and realistic expectations remains key for overall patient satisfaction.

Resumo Objetivo Avaliar os efeitos da natação na regeneração nervosa após a lesão do nervo ciático em ratos Wistar. Métodos Um total de 30 ratos Wistar foram divididos em 3 grupos: grupo Sham + Nat: animais que não foram submetidos à cirurgia de enxerto e foram submetidos à natação (n = 10); grupo Enxerto: animais que foram submetidos à cirurgia de enxerto autólogo de nervo ciático (n = 10); e grupo Enx + Nat: animais submetidos à cirurgia de enxerto autólogo de nervo ciático e à natação (n = 10). Os resultados foram analisados pelo software GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, EUA). Resultados Na primeira avaliação, todos os valores do índice funcional do ciático (IFC) foram semelhantes (p = 0.609). Após 30 dias do procedimento cirúrgico, foram observadas diferenças entre todas as comparações: Sham + Nat (−34,64 ± 13,89) versus Enxerto (−145,9 ± 26,06), grupos Sham + Nat versus Enx + Nat (−89,40 ± 7,501), grupos Enxerto (−145,9 ± 26,06) versus Enx + Nat (−89,40 ± 7,501). Nas medidas (60 e 90 dias), não houve diferença estatística entre os grupos Enxerto e Enx + Nat, com valores significativamente menores em relação ao grupo controle (p Conclusão Os animais submetidos ao protocolo de natação após o procedimento de enxerto do nervo ciático não apresentaram diferenças nos valores de IFC e nos números de motoneurônios quando comparados com grupo controle. Portanto, este tipo de protocolo não é eficiente para reabilitação de lesões nervosas periféricas que necessitam de enxerto, sendo necessários novos estudos.

Mandibular defects due to surgical resection of pathologies are common challenges for maxillofacial surgeons. In some clinical situations, alteration or combination of different surgical procedures is needed to reduce the size of bony defects and improve the success rate of bone grafts. In the current study, an 18-year-old female with a pathological lesion (ameloblastoma) in the mandible is presented. After tumor resection, bony defect reconstruction with autogenous bone graft was combined with a mandibular setback to facilitate the procedure. In this case, the simultaneous combination of orthognathic mandibular setback movement with tumor resection in a single surgical session helped to reduce the bony defect size. The adoption of this approach led to a decrease in the volume of graft harvesting and improved the success rate of the grafting procedure.

Background: Vitiligo is a depigmented common skin disorder. The disease may lead to social and psychological distress to the patient. Therefore, a good treatment can improve the patient’s life quality. Punch grafting is a simple and commonly used method of treating vitiligo. However, it is time consuming with the risk of post-operative cobble stoning appearance. We used motorized 0.8 - 1.3 mm micro punch grafting procedure to overcome these limitations. Objective: to evaluate the therapeutic effectiveness of using micro punch grafting to treat vitiligo and adverse events associated with this method. Methods: this was a prospective study for 20 patients with stable vitiligo. They underwent motorized 0.8 - 1.3 mm micro punch grafting from June 2019 to June 2020. Vitiligo treatment with micro punch grafting technique had promising results, and careful assessment of factors associated with the outcome was done. Results: Thirty percent of the patients showed excellent re-pigmentation ≥ 75%. Forty percent of the patients showed moderate re-pigmentation. Twenty percent of the cases showed mild re-pigmentation and only 10% showed no improvement. So overall, the therapy was tolerable. Conclusion: micro punch grafting is an effective way to treat vitiligo; it is also considered a suitable option with tolerable adverse events.

The aims of this study were to evaluate the in-hospital and mid-term outcomes of the off-pump onlay-patch grafting procedure using the left internal mammary artery (LIMA) for a diffusely diseased left anterior descending artery (LAD) and to identify the risk factors for postoperative LIMA graft failure in a single-center retrospective study.A total of 63 patients (52 males, 65.7±9.0 years) undergoing LAD arteriotomy with or without concomitant endarterectomy, followed by reconstruction using LIMA onlay-patch at the time of off-pump coronary artery bypass grafting at our institute from January 2014 to December 2016 were reviewed. The operative mortality, major postoperative morbidity, follow-up all-cause mortality, major adverse cardiac events at follow-up, and postoperative LIMA graft patency were analyzed. The risk factors for postoperative LIMA graft failure on the basis of baseline and surgical characteristics were identified by multivariable logistic regression analysis.Eighteen (28.6%) patients underwent concomitant open LAD endarterectomy. The operative mortality rate was 1.6%. Major postoperative morbidity included perioperative myocardial infarction (3.2%), low cardiac output (1.6%), and reoperation for bleeding (1.6%). During the follow-up period of 24.2±9.5 months, all-cause mortality was 1.7% and the incidence of major adverse cardiac events was 6.8%. No repeat revascularization was recorded. In total, 88.1% of LIMA grafts showed FitzGibbon grade A patency determined by noninvasive coronary computed tomography angiography during follow-up. In addition, concomitant LAD endarterectomy and intraoperative LIMA graft flow were found to be independent risk factors for mid-term LIMA graft failure by multivariable logistic regression analysis (odds ratio=2.681, 95% confidence interval: 1.314-9.856, P=0.007 and odds ratio=0.932, 95% confidence interval: 0.791-0.976, P=0.021, respectively).Revascularization of a diffusely diseased LAD using the off-pump LIMA onlay-patch technique results in encouraging clinical outcomes with favorable angiographic results. Concomitant LAD endarterectomy and intraoperative LIMA graft flow are associated with the risk of postoperative LIMA graft failure.

Guava is one of the most important tropical fruit crops; however, its cultivation has been affected by the prevalence of the nematode Meloidogyne enterolobii, which leads to a large-scale reduction in the production of fruits and restricts new plantations in the contaminated areas. The discovery of the resistance of Psidium cattleianum to this nematode has increased the possibility of its selective use as rootstock for guava; a few studies have worked on the graft; however, the rootstock exhibits a high incompatibility with the commercial varieties of guava. Therefore, the present study aimed to develop an in vitro-grafting technique of guava scions under rootstocks of P. cattleianum obtained using an in vitro seed germination method. The successful in vitro-grafting was performed using semisolid MS1/2 (Murashige and Skoog) culture medium with 0.5 mg L⁻¹ of Benzyladenine. P. cattleianum with approximately 3 cm length was used as rootstocks, and apical guava stems with 0.5 cm length were used as scions. The grafting procedure used was wedge grafting. To increase the success rate of in vitro-grafting, we used a sterile paper moistened with sterilized distilled water to prevent dehydration. The use of MS1/2 and the wedge grafting resulted in the overall success rate of 30% for the graft between P. cattleianum and Psidium guajava. In conclusion, this is the first report of successful in vitro-grafting between guava and P. cattleianum.

Background:Spinal fusion is a commonly used procedure in spinal surgery. To ensure stable fusion, bone graft materials are used. ABM/P-15 (commercial name i-FactorTM Flex) is an available synthetic bone graft material that has CE approval in Europe. This peptide has been shown to improve bone formation when used in devices with fixation or on bone defects. However, the lack of external stability and large graft size make posterolateral lumbar fusion (PLF) a most challenging grafting procedure. This prospective randomized study was designed to evaluate early spinal fusion rates using an anorganic bovine-derived hydroxyapatite matrix (ABM) combined with a synthetic 15 amino acid sequence (P-15) – ABM/P-15 bone graft, and compared with allograft in an uninstrumented PLF model in sheep. The objective of this study was to assess fusion rates when using ABM/P-15 in uninstrumented posterolateral fusion in sheep.Methods: Twelve Texas/Gotland mixed breed sheep underwent open PLF at two levels L2/L3 and L4/L5 without fixation instruments. The levels were randomized so that sheep received an ABM graft either with or without P15 coating. Sheep were euthanized after 4.5 months and levels were harvested and evaluated with a micro-CT scanner and qualitative histology. Fusion rates were assessed by 2D sections and 3D reconstruction images and fusion was defined as intertransverse bridging.Results: There was 68% fusion rate in the allograft group and an extensive migration of graft material was noticed with a fusion rate of just 37% in the ABM/P-15 group. Qualitative histology showed positive osteointegration of the material and good correlation to scanning results. Conclusions: In this PLF fusion model, ABM/P15 demonstrated the ability to migrate when lacking external stability. Due to this migration, reported fusion rates were significantly lower than in the allograft group. The use of ABM/P15 as i-FactorTM Flex may be limited to devices with fixation and bone defects.

Surgical methods are favorably used for treatment of stable vitiligo, and platelet-rich plasma (PRP) can be added to augment the effect. The additive value of PRP, however, remains elusive. Basic fibroblast growth factor (bFGF) is released from activated platelets with a capacity for stimulating melanocyte proliferation and migration. The treatment outcomes for the mini-punch grafting (MPG)/phototherapy treatment with and without PRP were assessed and the relation between bFGF and the obtained results were evaluated. Thirty-four vitiliginous patches, two per each patient with stable vitiligo, were enrolled in this intrapatient-controlled study and treated with autologous MPG and subsequent exposure to phototherapy with and without enhancement via PRP procedure at the time of the procedure, and monthly for the subsequent 3 months. Re-pigmentation assessment via vitiligo scores as well as measurement of lesional bFGF were done. PRP assistance to MPG/phototherapy treatment resulted in earlier re-pigmentation at week 8. However, this enhancement effect vanished at the study end (week 20) as ideal re-pigmentation (>75% re-pigmentation) was encountered in 10 patches (58.8%) treated with MPG/phototherapy modality, and in 12 patches (70.6%) treated with PRP-assisted method without significant difference between them. Lesional bFGF increased after both treatments with a higher expression with PRP assistance but without clinical reflection on the final outcome. PRP can speed the re-pigmentation response for MPG/phototherapy procedure without any significant effect on the final outcome.

Background: In facial reanimation surgery, higher donor facial nerve axonal load yields a superior outcome. Nerves supplying the zygomaticus major muscle are primary donors for the grafting procedure; however, their topography has not been studied in detail. This study identified potential donor nerves by quantifying axon loads of the zygomaticus major muscle through histological analysis of cadaveric specimens. Materials and Methods: Forty-three hemifaces from 26 fresh human cadavers were studied. Branching patterns of nerves were classified according to their shapes. All branches of interest were sectioned and stained for an axon count. The potential donors were mapped into each tributary of nerves supplying the zygomaticus major. Results: Branching patterns were categorized into five types: Y-type (28%), X-type (28%), H-type (19%), E-type (14%), and F-type (11%). The mean number of axons in the most superiorly and proximally located main branches was 1387.33 ± 406.59 in Y-type, 1021.42 ± 187.79 in X-type, 1222.75 ± 193.82 in H-type, 1496.17 ± 364.567 in E-type, and 1353.40 ± 256.07 in F-type (P > 0.05). A topographic relation between facial nerves supplying the zygomaticus major muscle and their mean axonal load was illustrated. The zygomatic/buccal branches were found within 5 mm from Zuker's point in 100% of X-, Y-, H-, and E-type and 75% of F-type specimens. Conclusions: Most proximal facial nerve branches supplying the zygomaticus major, arising at the anterior border of a parotid gland, contained over 900 axons in all five branching types. The primary subbranches may be used in selected cases if donor weakness is a concern. Further, our study provides evidence that demonstrates the precision of Zuker's point.

The periosteum is a rich source of osteoprogenitor cells and periosteal grafts can be used as an alternative method to replace bone grafts. The low-intensity pulsed ultrasound (LIPUS) has often been used as a noninvasive method to stimulate osteogenesis and reduce the fracture healing time. The aim of this study was to evaluate the effects of the ultrasound exposure on the rat tibia periosteum. Group I (7 animals) received LIPUS therapy on the left tibia for 7 days and group II (7 animals) on the left tibia for 14 days. After euthanasia, the tibias were processed. Number of periosteal cells and vessels and thickness of the periosteum were analyzed. The number of periosteal cells was higher in stimulated periosteum compared to controls at 7 and 14 days, but the number of vessels and the thickness only were higher in the group stimulated at 14 days. Furthermore, the ultrasound treatment for 14 days was more effective than 7 days. The ultrasound stimulation of the periosteum prior to grafting procedure can be advantageous, since it increases periosteal activity, and LIPUS may be an alternative method for stimulating the periosteum when the use of periosteal grafts in bone repair is needed.

Silica–graphite filler was prepared via two-step grafting procedure by grafting silica particles onto the expanded graphite. In the first step, isocyanatopropyltriethoxysilane was chemically introduced onto the silica aggregates, which was followed by grafting onto the expanded graphite via urethane linkage in the second step. Successful grafting of silica aggregates onto the graphite was corroborated using Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The presence of a thin graphene layer on silica aggregates corroborated using transmission electron microscopy confirmed the grafting of silica aggregates onto the graphite surface. Styrene–butadiene rubber (SBR) composites with various silica–graphite loadings were prepared by melt processing technique to generate pristine silica and silica–graphite-filled elastomeric composites. Rheometric cure studies revealed that the torque difference (Δ S) increased with pristine silica loading, when compared to the unfilled SBR system, and this effect is more pronounced on loading silica–graphite filler. Improvements in mechanical properties such as modulus and tensile strength were observed with increasing loading of silica particles and this effect is more pronounced on loading silica–graphite fillers, indicating that this is due to the rise in the elastomer–filler interactions in the silica–graphite-loaded SBR systems. This fact was further corroborated using bound rubber content and equilibrium swelling ratios of the unvulcanized and vulcanized SBR composites.

A hiperpneumatização do seio maxilar é um fator complicador para a instalação de implantes na região posterior de maxila. O levantamento do assoalho do seio maxilar é uma alternativa para possibilitar a instalação de implantes nestes casos. Entretanto, complicações transcirúrgicas podem ocorrer, sendo a perfuração da membrana de Schneider a mais comum. Diversas manobras são descritas na literatura no manejo das perfurações da membrana sinusal, possibilitando o reparo e a execução do procedimento de enxertia no mesmo momento cirúrgico. Dentre as formas de reparo, a utilização de membranas de Fibrina Rica em Plaquetas e Leucócitos (L-PRF) tem sido apresentada como uma opção de tratamento com resultados interessantes e promissores para se alcançar o reparo. Este trabalho descreve um caso clínico onde a perfuração da membrana de Schneider foi reparada com membranas de L-PRF e o procedimento realizado sem intercorrências pós-operatórias, possibilitando a posterior instalação de implantes e o sucesso da reabilitação.

PURPOSE The aim of this retrospective case-control study was the evaluation of the split bone technique with regard to the occurrence of early complications, implant survival rate, and peri-implant bone resorption. The effect of patient-related factors (gender, age, tobacco consumption), implant location, and the implant system used on bone resorption was analyzed. MATERIALS AND METHODS Patients treated by means of the split bone technique with autologous bone blocks from the external oblique line in a two-stage grafting procedure were observed for up to 5 years after implant placement. The control group was a randomly selected group of patients with implants inserted without any augmentation procedures. Vertical bone resorption was measured radiographically, implant survival was calculated by means of the Kaplan-Meier procedure, and complications were recorded numerically. RESULTS A total of 194 augmentations in 164 patients were performed in the 10-year period. One graft was lost due to exposure and infection of the recipient site, and in four cases, severe resorption of the graft prior to implant placement made a second augmentation necessary. Eighty-seven patients with 100 grafts and 173 implants in the study group and 91 patients with 173 implants in the control group participated in the follow-up. Implant survival was 100% in the study group and 98.5% in the control group (P = .262; log-rank test). The median vertical peri-implant bone resorption after 5 years was 0.7 mm in the study group and 0.6 mm in the control group (P = .371; Mann-Whitney U test). In the study group, the difference between male (0.4 mm) and female (0.9 mm) patients was significant at the end of the follow-up period (P = .022). Significant differences were also found between smokers (2.8 mm) and nonsmokers (0.6 mm) after 5 years (P = .002). CONCLUSION The split bone technique using autogenous bone represents a reliable therapy method with a very low complication rate and an implant survival rate of 100% after 5 years. The technique did not result in any increase in peri-implant bone resorption during the follow-up period. Smoking and gender may negatively influence peri-implant bone resorption when using this technique.

Purpose: The grafting procedure for the anthropic ridges of jaws represents a surgical technique for increasing the bone volume to permit the placement of dental implants for oral rehabilitations. The aim of this study was to evaluate a hydroxyapatite (HA) porous scaffold produced via a sponge replica method for the treatment of maxillary bone defects in a human model. Methods: A total of thirteen patients were treated for sinus lifting in the posterior maxilla for a total of 16 defects treated with cylindrical HA Block. The experimental sites were evaluated by a 3D Cone Beam Computer Tomography scan (CBCT), and the histological analysis was performed after 3 months of healing. Results: After the 3 months healing period, the histological outcome of the investigation showed a high level of biological osteoconduction of the HA. Microscopical evidence of new bone formation was also observed in the central portion of the graft block. The samples were composed of different tissues: 39 &plusmn, 1% new bone, 42 &plusmn, 3% marrow space, 17 &plusmn, 3% residual HA Block and 4.02 &plusmn, 2% osteoid tissue were present. The new bone formation in the block was 8 &plusmn, 3%. Conclusions: The study findings support that HA porous scaffolds produced by sponge replica were effective for the treatment of maxillary bone defects in humans.

Nowadays implant-prosthetic rehabilitations are one of the best solutions for rehabilitating our patients. These allow obtaining rehabilitations with optimal functional and aesthetic performances. Often patients, who undergo implant-prosthetic therapy, have the conditions of edentulias, single or multiple, that have been going on for some time. This, according to the literature, produces resorption of the alveolar bone, a process that is complicated in the posterior area of the upper arch by a pneumatization of the maxillary sinuses. The loss of vertical height, so that the implant fixtures can be inserted, requires a maneuver called maxillary sinus floor elevation. This procedure, now safely performed with piezoelectric instruments, allows increasing bone height through bone grafting. In this study, the tissue obtained from a patient, after 15 years from the intervention, was evaluated by histological and SEM analyses. The bone healing in the patient has led to a perfect integration between the patient&rsquo, s bone and the fresh frozen allograft used, however still present and detectable after 15 years.

Seeds and skins from grape pomaces of Pecorello and Mantonico cv underwent extraction (ultrasound–assisted or maceration), in order to obtain added‐value ingredients for the production of a functional pear jam. The antioxidant features of the extracts were tested by in vitro colorimetric assays. Among seeds, Mantonico by maceration (MSC) showed the best results, as well as Mantonico by ultrasound‐assisted extraction (MBs) among skin extracts. The selected extracts were fully characterised by NMR and MS techniques, confirming the presence of many polyphenols, flavonoids and tannins among others. Pectin was then derivatised by the grafting procedure with the active molecules of MBs and MSC. The latter produced the best antioxidant polymer also without toxicity evaluated using Caco‐2 cells and was used for the jam preparation. The functional pear jam showed improved antioxidant performances in comparison with its non‐functional counterparts as well as its maintenance over time (15 days).

Surgical correction can be considered for treating patients with a chronic phase of Peyronie's disease (PD) and persistent penile curvature. In clinical practice, some patients pay too much attention to surgical complications and refuse the recommended feasible surgical types. Meanwhile, they require operations according to their preferences. This study aimed to evaluate the effects of patients’ own choice of surgical type on postoperative satisfaction. This retrospective study analyzed data from 108 patients with PD who underwent surgical correction according to doctors’ recommendations or patients’ own demands. The objective and subjective surgical outcomes were assessed. Patients’ understanding of the disease was analyzed using a questionnaire survey. Objective measurements of surgical outcomes, including penile straightening, penile length, and sexual function, in patients who received the recommended surgery, were similar to those in patients who did not accept the recommended surgery. However, subjective evaluations, including erectile pain, discomfort because of nodules on the penis, and decreased sensitivity in the penis, were more obvious in patients who did not follow doctors’ recommendations. In addition, a questionnaire survey showed that understanding PD and the purpose of surgery of patients who did not follow doctors’ advice were inappropriate, as they did not conform to the principle of treatment. The present study showed that surgical correction seemed to be an objectively effective option in the management of patients in the stable chronic phase of PD. Low patient satisfaction might be related to patients’ lack of correct understanding of the disease and its treatment strategy as well as unrealistic expectations.

The aim of this work was to investigate vacuum residues hydroconversion using acid-modified catalysts. To achieve this goal, silicon was incorporated by a grafting procedure. The catalysts with different silicon amounts in the support or hydrogenating actives phases were evaluated performing hydrotreatment of a Safaniya vacuum residue at 370 °C. A multi-techniques set of analyses was used, in order to characterize both the sulphided active phase and acidity. It can be concluded from this study that acidity is beneficial for conversion of asphaltenes but the hydrogenation active phase does not seem to be the main way to improve the transformation. The proposed mechanism is the following: with short reaction time, acidity promotes cracking of naphthenic and alkyl units but hydrogenation is not completed. Then, with longer reaction times, asphaltenes reveal a loss of aromatic rings which demonstrates that the hydrogenation pathway is enhanced and a significant loss of molecular weight is observed. This new way of transformation opens the way to a complete change of reactivity over the whole HDT processes. If used as a pretreatment of petroleum residues, this type of catalyst could drastically improve the conversion yield of heavy feeds in order to develop sustainable refining processes.

Mango plants are propagated by sexual and asexual methods; however, for true-to-type production of the commercial varieties/genotypes various asexual propagation methods are recommended, viz., grafting, cutting, layering and budding in the world. Among these asexual methods, various grafting techniques are being used to raise the mango seedlings under diverse agro climatic conditions. Veneer grafting technique is being adopted substantially due to high rate of success under North Indian conditions. Apart from veneer grafting, wedge grafting is the easiest and rapid method of mango propagation and it is effectively used for a large scale multiplication of mango grafted seedlings throughout the country. the studies were investigated to assess the best suitable time for wedge grafting procedure to produce healthy saleable plants in the shortest time span. Grafting was performed at different time intervals starting from the month of June to October at significant intervals of fifteen days. Mango desi seedlings grafted between end-July to end-August took 14-20 days to sprout, showed maximum bud intake success, survival of scion (%), plant height and number of leaves/seedling to the tune of 80.3-90.0 %, 83.3-91.6 %, 56.2-59.6 cm and 18.3-19.6, respectively. Among different cultivars i.e. Dashehari, Langra, Amrapali, Mallika, Alphonso, Chausa, GN-6 and GN-19, Dashehari responded better and bud intake success, survival of scion percentage, plant height and number of leaves were ranged from 50.8 to 87.0 %, 48.6 to 89.6%, 40.4 to 58.8 cm and 14.4 to 18.9, respectively. The present studies signifies, wedge grafting performed from end July to end August is economical viable and is easier method for propagation of mango plants under sub mountane zone of North India.

Guided bone regeneration follows the principles of guided tissue regeneration, where an occlusive membrane is utilized to provide a barrier and allow bone regeneration to occur at a specific oral defect. Particulate bone substitutes are utilized to provide a scaffold and direct bone formation, which will occur by subsequent remodeling of the graft material. The success of the grafting procedure is directly dependent on a number of factors, including the host’s ability to heal, the proper execution of the procedure, and the materials utilized. Adequate postoperative management, including administration of antibiotics and regular follow-ups, will minimize the incidence of complications. With a success rate above 90%, guided bone regeneration procedures have become a predictable approach to regenerate deficient sites for the dental implant patient.

Background The purpose of this study was to evaluate the safety and effectiveness of the hyperdry amniotic membrane transplantation compared with conjunctival autografting for the treatment of primary pterygium. Methods One hundred and forty-one eyes from 130 patients with primary pterygium were treated with excision followed by hyperdry amniotic membrane or conjunctival autografting after random selection. Seventy-nine eyes from 71 patients received hyperdry amniotic membrane transplantation (HD-AM group), and 62 eyes from 59 patients received conjunctival autografting (CG group). Patients were followed up at one week and one, three, six, and 12 months post-surgery. Recurrence rate, postoperative complications, and final follow-up patient visits were prospectively evaluated. Results The mean follow-up duration was 12.56 ± 4.35 months in the HD-AM group and 12.85 ± 3.90 months in the CG group. Recurrences were detected in four eyes (5.06%) in the HD-AM group and 13 eyes (20.97%) in the CG group. A statistically significant difference in frequency of recurrence between the two groups (P = 0.003) was observed. The cumulative non-recurrence rates at six and 12 months in all patients stratified by age and sex were not significantly different (P = 0.642 and P = 0.451, respectively, by log-rank test). Graft retraction and necrosis were not detected in the two groups during the follow-up period. Conclusion Hyperdry amniotic membrane transplantation was effective in preventing pterygium recurrence when compared with conjunctival autografting and can be considered a preferable and safe grafting procedure for primary pterygium. Trial registration Current Controlled Trials ISRCTN16900270, Retrospectively registered (Date of registration: 3 May 2018).

Introduction. Orofacial clefts are congenital malformations characterized by an incomplete shaping of structures that separate the nasal from the oral cavity and can affect the right, left, or both sides. The aim of the present study is to assess, with clinical, radiographical, and histological evaluations, the efficacy of piezoelectric devices compared to traditional rotating instruments in the bone harvesting in patients with history of cleft. Materials and Methods. We have conducted a retrospective analysis on 20 patients with a history of orofacial clefts that were operated on from February 2014 to June 2017. The patients were divided into two groups: Group R in which bone graft was harvested using a burr and Group P in which the bone graft was obtained by a piezoelectric device. After a healing period of 8 months from the grafting procedure, clinical and radiographic evaluations were performed. Results and Discussion. The use of the piezoelectric devices in bone harvesting allows a slight improvement in the final volume. This supports a faster integration into the receiving site. Conclusions. The use of piezoelectric device in patients with history of orofacial cleft that needed bone graft represents a method to be taken into consideration because it has interesting advantages. Introduction. Orofacial clefts are congenital malformations characterized by an incomplete shaping of structures that separate the nasal from the oral cavity and can affect the right, left, or both sides. The aim of the present study is to assess, with clinical, radiographical, and histological evaluations, the efficacy of piezoelectric devices compared to traditional rotating instruments in the bone harvesting in patients with history of cleft. Materials and Methods. We have conducted a retrospective analysis on 20 patients with a history of orofacial clefts that were operated on from February 2014 to June 2017. The patients were divided into two groups: Group R in which bone graft was harvested using a burr and Group P in which the bone graft was obtained by a piezoelectric device. After a healing period of 8 months from the grafting procedure, clinical and radiographic evaluations were performed. Results and Discussion. The use of the piezoelectric devices in bone harvesting allows a slight improvement in the final volume. This supports a faster integration into the receiving site. Conclusions. The use of piezoelectric device in patients with history of orofacial cleft that needed bone graft represents a method to be taken into consideration because it has interesting advantages.

Vertical bone augmentation of the posterior mandible followed by delayed implant placement and restoration remains a clinical challenge in dentistry. Commonly, a 2- stage approach is performed where first, a grafting procedure is performed with a typical xenograft/autograft mixture and an expected healing period of 9 months. Only thereafter can implant placement and restoration accomplished with a total treatment time upwards of 1-1.5 years. In the present case report, a novel approach that combines three-dimensional guided implant planning/surgery via digital software, the use of novel atelo-collagen based xenografts/membranes with improved biocompatibility, and immediate implant placement with simultaneous vertical guided bone regeneration (GBR) is described where the patient treatment protocol was significantly reduced. Highlighted within this case report is the effective use of guided surgery via digital software, as well as the use of biomaterials that feature atelo-collagen. Since xenografts are typically devoid of all collagen and growth factor content, the recent development of natural bovine bone mineral containing atelo-collagen type I have been proposed as grafts with greater biocompatibility, thus favoring optimized bone regeneration. This article describes the protocol in detail and emphasizes the necessary requirements to optimize bone regeneration in a predictable manner.

Implant placement is often necessitated for replacement of teeth with pathologically damaged alveolar bone due to periodontitis or traumatic injury. Surgical augmentation of resorbed bone has many limitations, including lower efficacy of vertical augmentation than horizontal augmentation, as well as morbidity associated with grafting procedure. Orthodontic therapy has been proposed as a useful method for augmenting the resorbed alveolar bone and reforming aesthetically appealing gingival margin, prior to implant placement. This narrative review summarizes the available evidence for the application of orthodontic strategies that can be used as adjunct in selected cases to augment bone volume for the future implant site and maintain space for the prosthetic parts of the implant. These are (1) orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture, (2) tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site, (3) orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and (4) the provision of a rigid fixed-bonded retainer to maintain the implant site. Although there are no randomized controlled clinical trials to evaluate the efficacy of orthodontic therapy for implant site development, clinical case reports and experience document the efficacy of orthodontic therapy for this application.

A method has been developed that permits the highly selective functionalization of the interior and exterior surfaces of the ubiquitous mesoporous material, SBA-15. The key step is reloading the as-synthesized material with structure-directing agent, Pluronic® P123, prior to selective functionalization of the external surface with a silylating agent. This new approach represents a significant improvement over literature procedures. Results from physisorption analyses as well as solid-state NMR permit a detailed, quantitative assessment of functionalized SBA-15. This work also provides insight into the stability of the silyl layer during extraction procedures – an issue often neglected in other studies but of significant importance as decomposition of this layer could result in the introduction of new silanols and reduce the effectiveness of any selective grafting procedure.

Background: Periodontal regeneration has been the goal over the past few years in the treatment of various periodontal defects. Various traditional surgical and nonsurgical approaches were found to produce the minimal amount of new periodontal attachment apparatus. It was further suggested that the addition of various graft materials might increase the amount of new bone, periodontal ligament, and cementum generated. Hence, this clinical study was undertaken to evaluate the efficacy of porous hydroxyapatite in the treatment of interproximal vertical bony defects in human beings as a regenerative implant material. Materials and Methods: A total of 16 sites from eight patients in the age group of 30-60 years were selected. Out of the two sites from each patient, one was control site-flap surgery without porous hydroxyapatite graft material and the other was experimental site-flap surgery with porous hydroxyapatite graft material. At 3 months, 6 months, and 9 months postoperatively, each site was subjected to clinical parameters such as pocket depth, attachment gain, gingival recession, and osseous fill. Results: Significant mean attachment gain was observed at 6 months and 9 months after surgery. The mean original defect was significant at 3 months and 6 months postsurgically. Mean percentage fill was significant at 3 months postsurgically. All other parameters were nonsignificant. Conclusion: Radiographic assessment showed a greater defect fill at the grafted site indicating the superiority of grafting procedure to nongraft procedure. Hence, porous hydroxyapatite crystals are an effective graft material in elimination of interproximal vertical defects.

The total removal of a lesion via excisional biopsy causes gingival recession, resulting in dentin hypersensitivity and esthetical problems. In this case report, a gingival recession defect resulting from an excisional biopsy was treated with a free gingival grafting procedure performed during the same appointment, and its 12-year follow-up was presented. A 44-year-old female patient was presented to our clinic with a firm, pedunculated, red gingival enlargement located on the labial surface of lower incisors. The exposed root surface, after the excisional biopsy, was covered with a free gingival graft. The lesion was pathologically diagnosed as pyogenic granuloma, and in the early postoperative phase, no recurrence was observed, but partial root coverage was determined. At 6-month follow-up, root coverage resulting from "creeping attachment" was observed, and this situation was maintained throughout the 12-year follow-up period. Repetitious postoperative discomfort and emotional stress for the patient may be avoided with a timesaving single appointment performing excisional biopsy and free gingival graft. Free gingival grafting procedure was used for this purpose not only to cover exposed root surfaces but also to eliminate dentin hypersensitivity and make oral hygiene procedures more effective. © 2016 European Journal of Dentistry | Published by Wolters Kluwer-Medknow.

Objectives: To evaluate bone allograft associated to bone marrow aspirate concentrate (BMAC), in maxillary reconstructions. Materials and Methods: Ten patients with alveolar bone deficiency in the anterior maxilla were randomly divided into control group (CG) and test group (TG). A bone block allograft was placed in both groups, but the graft was impregnated with BMAC only in TG. Computed tomography was performed 7 days (T1) and 6 months (T2) after the grafting procedure, and volume and bone density measurements were carried out. Histomorphometric analysis was performed at T2. Results: Bone volume loss from T1 to T2 was significant only in TG. The bone density in the buccal region of the graft was significantly higher in TG than in CG. There was no significant difference between the groups, in respect to mineralized tissue (MT) and nonmineralized tissue (NMT), in that MT values were 37.77% ± 15.19% and 43.85% ± 10.94%, and NMT values were 62.15% ± 14.90% and 56.30% ± 10.72%, respectively, for CG and TG. The intragroup difference for the MT/NMT ratio was statistically significant in CG but not significant in TG. Conclusions: The use of BMAC resulted in an improved pattern of bone formation, with higher bone density in the peripheral regions of the graft.

A 68-year-old female underwent Descemet membrane endothelial keratoplasty (DMEK) in her right eye using a 3D visualization system with the surgeon looking directly to a digital screen instead of through the eyepieces of the surgical microscope. The procedure was uneventful. Five weeks after the surgery the DMEK graft was in good position and totally adhered, the cornea clear and uncorrected distance visual acuity 20/50. This is the first reported case of DMEK using 3D augmented reality visualization system. It seems to offer advantages for the corneal surgeon in critical steps of the endothelial grafting procedure.

The purpose of this study was to compare microcomputed tomography (microCT) and histologic analysis outcomes of a periodontal regeneration of a human defect treated with a polylactic- and polyglycolic-acid copolymer. At 11 months following the grafting procedure, the root with the surrounding periodontal tissues was removed and analyzed using microCT and histologic techniques. The results suggest that microCT three-dimensional analysis may be used in synergy with two-dimensional histologic sections to provide additional information for studying the regeneration outcomes normally reported by histologic biopsies in humans. Additional data is needed to validate these findings.

Objective. The aim of this study is to evaluate the results of inlay butterfly tympanoplasty technique in large central tympanic membrane perforations. Methods . The files of the patients who underwent inlay butterfly cartilage tympanoplasty for large central tympanic membrane perforations were reviewed. Patients were followed with otoscopy and audiometry. Preoperative and postoperative pure-tone audiometry results were calculated and analyzed to evaluate the hearing gain. The grafting procedure was considered successful if no perforations were observed during postoperative microscopic or endoscopic evaluation during the follow-up period. Results . Twenty-nine patients with large central tympanic membrane perforation who were operated by inlay butterfly tympanoplasty technique were included in the study. Twenty-one (72.4%) ears were operated with endoscope and 8 (27.6%) under microscope. The mean duration of surgery was 30.5±3.77 minutes. The mean follow-up time was 69.6±21.6 (range; 24-112 weeks). Graft take rate was 89.7% (26/29). Conclusion. Inlay butterfly cartilage tympanoplasty is a minimal invasive and effective technique for repairing large central tympanic membrane perforations.

Maxillary sinus augmentation through a lateral window is reported as one of the most predictable bone augmentation procedures before implant placement. The elevation of the membrane represents a delicate and crucial step that allows the creation of the space for the bone graft material. If the elevation is not completed, the regenerated bone might be inadequate for the implant placement. In this case, a new intervention will be necessary to complete the bone augmentation. Reaccessing from a lateral window, however, would be challenging due to thickness of the buccal boney wall because of the first grafting procedure; therefore, a different approach has to be used. The aim of this case report is to present the palatal window technique for treating incompletely augmented maxillary sinus. The detailed step-by-step diagnostic and surgical procedures are described, and the advantages and limitations of the technique are discussed through a review of the literature.

Hybrid organic–inorganic SBA-15 silicas functionalized with increasing amounts of amino groups were studied in this work aiming to evaluate the effects of their physico-chemical properties on CO2 capture ability. Three different amino-silane species were used: 3-aminopropyltriethoxysilane (APTS), 3-(2-aminoethyl)aminopropyltrimethoxysilane (EAPTS) and 3-[2-(2-aminoethyl)aminoethyl] aminopropyltrimethoxysilane (PAPTS). More specifically, samples were prepared by using two methods, following a post-synthesis grafting procedure and a one-pot preparation method. Experimental and computational techniques were used to study the structural and textural properties of the obtained samples and their surface species in relation to the adopted preparation method. For the most reactive samples, additional hints on the interactions of organosilane species with the silica surface were obtained by a combination of IR and SS-NMR spectroscopy, with particular emphasis on the effects of the silane chain length on the mobility of the organic species. Advanced complementary solid-state NMR techniques provided deeper information on the interactions of organosilane species with the silica surface. Finally, the amount of CO2 adsorbed was estimated by comparing the classical microcalorimetric analysis method with a new type of screening test, the Zero Length Column analysis, which is able to evaluate small amounts of samples in a very short time and the adsorption properties of the adsorbents. The reactivity of the amino-modified silica samples is deeply influenced by both the preparation route and by the type of organosilane used for the functionalization of the materials. In particular, samples prepared by the post-synthesis grafting procedure and containing higher amount of amino groups in the chain are more reactive, following the order PAPTS > EAPTS > APTS.

This paper presents a technical description of the inlay technique performed with an allograft block in the reconstruction of a severely atrophic posterior mandible. It includes a histologic case series of five patients treated with the same grafting procedure and rehabilitated with dental implants 2 months after placement of the graft. The histologic analysis showed large amounts of newly formed bone in tight connection with the allograft and large marrow spaces with intense cellular activity and the presence of osteocytes. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique.

The importance of rare-earth elements (REEs) in the global economy is booming as they are used in numerous advanced technologies. Industrially, the extraction and purification of REEs involve multiple liquid–liquid extraction (LLE) steps as they exhibit very similar complexation properties with most common ligands. In order to substantially improve this process and provide a greener alternative to LLE, functional porous hybrid materials, demonstrating enhanced selectivity towards heavier REEs compared to commercially-available products, are proposed. In addition, because of the grafting procedure used in the synthesis, the proposed materials demonstrate a higher degree of reusability, increasing their marketable potential.

Dermal substitutes are used as dermal regeneration templates to reduce scar formation and improve wound healing. Unlike autografts, dermal substitutes lack normal vascular networks. The increased distance required for diffusion of oxygen and nutrients to the autograft following interpositioning of the substitute dramatically affects graft survival. To evaluate the effect of collagen-chitosan scaffold thickness on dermal regeneration, single-layer collagen-chitosan porous scaffolds of 0.5-, 1- and 2-mm thicknesses were fabricated and used to treat full-thickness wounds in a one-stage grafting procedure in a rat model. Skin-graft viability, wound contraction, histological changes, and wound tensile strength were evaluated. The results indicated that the distance for the diffusion of oxygen and nutrients to the autograft in the 2-mm-thick scaffold provided less support for graft take, which resulted in graft necrosis, extensive inflammatory reaction, marked foreign-body reaction (FBR), rapid scaffold degradation, and abnormal collagen deposition and remodeling. In contrast, the thinner scaffolds, especially of that 0.5-mm thickness, promoted earlier angiogenesis, ensuring skin-graft viability with a mild FBR, and ordered fibroblast infiltration and better collagen remodeling. It can be concluded that collagen-chitosan porous scaffolds with a thickness of

Introduction Autogenous bone block grafting is used for both vertical and horizontal augmentation of the upper and lower jaw. The bone block could be provided using extraoral or intraoral donor location. Aim The aim of this study was to observe the survival rate, the marginal bone level and the bleeding on probing (BOP) for a period of 4 to 6 years of implants, inserted in autogenous bone block graft. Materials and Methods We considered advanced horizontal bone loss, where guided bone regeneration with simultaneous implant placement could not be performed and/or vertical bone loss, where vertical augmentation of the alveolar bone of more than 3 to 6 mm is required, as indications for the bone block grafting procedure. As an intraoral donor site was used the mental area. Results and Discussion The mean observation period was 4.81 years. The mean marginal bone loss was 0.442 mm, as bone resorption was established in 48% of all cases, BOP was observed in 17.7 % of the cases. No correlation was found between BOP and bone loss. The survival rate of the implants placed into bone augmented using autogenous bone block graft was 98.7 %. Conclusion For an implant placement we considered a period of 4 months after the procedure enough to provide high survival rate of the implants. The implants placed in bone augmented using autogenous bone block grafting according to our methodology demonstrated high survival rate and unstable marginal bone level.

The grafting process used for pearl production in pearl oysters triggers a significant haemocyte response which has an influence on the quality of pearls formed. One hundred and ten selected healthy adult Pinctada margaritifera were grafted for pearl production. Beginning two days after grafting, oysters were sacrificed regularly until the 48th day and the pearl-sacs of sampled oysters were sectioned for histological analysis. The level of haemocytes present in the pearl-sacs decreased overtime with the samples from day 2 showing the highest levels. Haemocyte levels also varied between samples from a particular day. The exact cause(s) of varying levels of haemocyte accumulation during pearl-sac development in P. margaritifera is not known. However, it is reasonable to assume that haemocyte production is positively related to the degree of damage caused to host oyster tissues during the grafting procedure. While haemocytes have an important wound healing role in pearl oysters, excessive haemocyte presence may be detrimental to maximizing pearl quality.

We give an explicit construction of the increasing tree-valued process introduced by Abraham and Delmas using a random point process of trees and a grafting procedure. This random point process will be used in companion papers to study record processes on Lévy trees. We use the Poissonian structure of the jumps of the increasing tree-valued process to describe its behavior at the first time the tree grows higher than a given height, using a spinal decomposition of the tree, similar to the classical Bismut and Williams decompositions. We also give the joint distribution of this exit time and the ascension time which corresponds to the first infinite jump of the tree-valued process.

Aim The aim of this study was to assess the success and survival rate of dental implants placed with simultaneous hard tissue grafting. Material and methods All patients treated in Royal Dental Hospital of Melbourne who had implant placement with and without guided bone regeneration (GBR) procedures were identified. Seventy-three attended a follow-up appointment. These patients were examined recording probing depth, bleeding on probing, plaque accumulation and radiographic bone loss by one examiner. Clinical and radiographic findings were compared in grafted and non-grafted groups and also analysed for years in function. Results Approximately 50% of implants were placed simultaneous guided bone regeneration technique. In the majority of cases, defects were filled by deproteinized bovine bone mineral and covered with collagen membrane. The range of time in function was 20-88 months with a mean 34.8 (±1.7). Seventy-nine per cent of the implants placed in anterior maxilla were placed with GBR, while only 18% in posterior mandible needed grafting procedure. The cumulative implant survival rates at the time of examination was 97.95% for both GBR and non-GBR group. The mean PPD, BOP, and Plaque index were not statistically significantly different in GBR vs. non-GBR groups two to seven years in function. However, bone loss is significantly less in GBR group 2-7 years after function. The overall success rate was around 90% after 2-7 years in function with the GBR group slightly less than the non-GBR group, but not statistically significant. Conclusions For the subjects included in this retrospective study, the data demonstrate that GBR is a predictable procedure. The survival and success rates of the implants inserted with simultaneous GBR were similar, if slightly lower, to the non-grafted implants.

Background: Volume loss in the upper and lower eyelids and in the malar area is now considered a major component of periorbital aging. As classical resection blepharoplasty does not address this loss, filling procedures are becoming increasingly common. Objectives: The authors present their experience with periorbital fat grafting in conjunction with routine blepharoplasty to address periorbital aging. Methods: Outcomes were retrospectively reviewed for 500 consecutive patients who underwent blepharoplasty in conjunction with the authors’ periorbital augmentation technique from January 2008 to September 2011. The augmentation technique was a fine particle fat (microfat) grafting procedure that involved the use of small-diameter cannulae for transfer of autologous fat to the medial part of the upper eyelid, the orbitomalar groove, and the malar area. Results: Clinical evaluation and review of patient photographs revealed favorable, natural-looking, and long-lasting improvement of the treated areas. Shortcomings of classical resection blepharoplasty, such as hollowing of the upper eyelids, incomplete blending of the eyelid-cheek junction, and persistent deflation of the midface, were avoided; the full and crisp aspect of the upper and lower eyelids seen at a younger age was regained; and the technique was not associated with the complications seen in an earlier patient series. No major complications occurred. Minor complications included bruising and swelling. Conclusions: Augmentation of the upper and lower eyelids through microfat grafting can be a useful alternative to existing blepharoplasty techniques. This study documents very natural and pleasing results that avoid the shortcomings of classical resection. Microfat grafting appears to be a valuable and safe alternative to complicated, difficult, and potentially dangerous eyelid and midface rejuvenation techniques. Level of Evidence: 4