Autologous fat transfer effective, safe for facial reconstruction
Autologous fat transfer (AFT) appears to be an effective approach for soft-tissue deformities during facial reconstruction, with high rates of patient satisfaction and low rates of complications, a recent study has shown.
The researchers performed a systematic review and meta-analysis of 52 studies corresponding to 1,568 patients. For inclusion, studies had to have evaluated the safety and efficacy of AFT in facial reconstruction. Main outcomes were surgeon and patient satisfaction, number of AFT sessions, incidence of related complications and graft survival.
After a mean follow-up of 2.0 years after AFT, the meta-analysis reported a 91.1 percent patient satisfaction rate, which was highest in studies with patients with mixed deformities (95.9 percent). Satisfaction was also very high in patients with HIV-associated lipodystrophy (93.6 percent) and congenital defects (92.2 percent). In contrast, satisfaction was lowest in patients with acquired deformities (81.5 percent). [JAMA Facial Plast Surg 2018;doi:10.1001/jamafacial.2018.0102]
In terms of visual analogue scale (VAS) scores, the average patient satisfaction rating was 7.9 points (95 percent CI, 7.5–8.2), with little variation among individual studies or patient groups.
Surgeon satisfaction for AFT was likewise high. After a mean follow-up of 1.2 years, 88.6 percent of plastic surgeons were satisfied with the procedure, the highest of which was in congenital deformities (95.1 percent). In contrast to patient feedback, surgeons were mostly satisfied with AFT for acquired deformities (87.1 percent).
The overall surgeon satisfaction score was 7.8 points (7.3–8.3), with little heterogeneity.
“Our results demonstrate a clear trend toward a very high rate of patient and surgeon satisfaction, confirmed by high satisfaction scores of 7.9 and 7.8, respectively,” said researchers.
In addition to being effective, AFT also seems to be safe. The overall rate of AFT-related complications was only 4.8 percent (3.3–6.9), which rose slightly to 6.9 percent in patients with HIV-associated lipodystrophy.
Patients with HIV-related lipodystrophy also showed conflicting patterns of volume changes. In some studies, volume retention dropped to 50.9 percent (37.2–66.2) while in others, it jumped to 238.1 percent (201.5–264.3). Fluctuations in volume retention were also detected in patients with congenital deformities, but to a lesser degree as rates ranged from 40 percent to 80 percent.
The drastic fluctuations in patients with HIV-related lipodystrophy may “be attributed to extreme lipohypertrophy of grafted fat, which has been commonly reported as an adverse event in studies of patients with HIV,” said researchers, however noting that the underlying causal mechanisms have to be further investigated in future studies.
Additional studies will likewise lead to better data that may help in making more informed clinical decisions, according to researchers.
“It is clear that future studies will play a crucial role in providing higher quality evidence that would allow for more nuanced recommendations regarding specific subgroups or indications, evaluating factors influencing the volume retention, as well as the added value of supplements,” they said.