Facial Plast Surg 2023; 39(02): 185-189
DOI: 10.1055/a-1942-2225
Original Research

The Role of Autologous Fat Grafting in Rhinoplasty

1   Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
2   Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
3   Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Mannheim, Mannheim, Germany
,
Mario G. Solari
1   Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
J. Peter Rubin
1   Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
› Institutsangaben

Abstract

Rhinoplasty is one of the most popular aesthetic surgeries worldwide and often includes grafting techniques to achieve optimal results. One of these grafting techniques is autologous fat transfer, which has been used to increase volume, camouflage irregularities, and/or improve the quality of the nasal skin–soft tissue envelope. Moreover, minimally invasive approaches for altering the nasal appearance have recently increased and become known as “liquid” or “nonsurgical rhinoplasty.” These nonsurgical approaches include altering the nasal appearance with filler injection to induce volumetric changes in lieu of extensive surgery. The use of fat grafting as a filler is favorable to achieve well-balanced aesthetic results without compromising the nasal skin–soft tissue envelope. This capability is partly because of the regenerative potential of fat grafts, serving to improve the quality of surrounding soft tissues. In contrast, commercial injectable fillers are inert. This article highlights the role of fat grafting in surgical and nonsurgical rhinoplasty to provide surgeons with an overview of the potential of these vastly abundant, biocompatible, and cost-effective grafts.



Publikationsverlauf

Accepted Manuscript online:
13. September 2022

Artikel online veröffentlicht:
30. November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Egro FM, Coleman SR. Facial fat grafting: the past, present, and future. Clin Plast Surg 2020; 47 (01) 1-6
  • 2 Neuber F. Fettransplantation. Chir Kongr Verhandl Dsch Gesellch Chir 1893; 22: 66
  • 3 Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg 1997; 24 (02) 347-367
  • 4 Abu-Ghname A, Perdanasari AT, Reece EM. Principles and applications of fat grafting in plastic surgery. Semin Plast Surg 2019; 33 (03) 147-154
  • 5 Bourin P, Bunnell BA, Casteilla L. et al. Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the International Federation for Adipose Therapeutics and Science (IFATS) and the International Society for Cellular Therapy (ISCT). Cytotherapy 2013; 15 (06) 641-648
  • 6 Minteer DM, Marra KG, Rubin JP. Adipose stem cells: biology, safety, regulation, and regenerative potential. Clin Plast Surg 2015; 42 (02) 169-179
  • 7 Brayfield C, Marra K, Rubin JP. Adipose stem cells for soft tissue regeneration. Handchir Mikrochir Plast Chir 2010; 42 (02) 124-128
  • 8 James IB, Coleman SR, Rubin JP. Fat, stem cells, and platelet-rich plasma. Clin Plast Surg 2016; 43 (03) 473-488
  • 9 Zuk PA. The adipose-derived stem cell: looking back and looking ahead. Mol Biol Cell 2010; 21 (11) 1783-1787
  • 10 Tsuji W, Rubin JP, Marra KG. Adipose-derived stem cells: implications in tissue regeneration. World J Stem Cells 2014; 6 (03) 312-321
  • 11 Philips BJ, Marra KG, Rubin JP. Healing of grafted adipose tissue: current clinical applications of adipose-derived stem cells for breast and face reconstruction. Wound Repair Regen 2014; 22 Suppl 1 (01) 11-13
  • 12 Zuk PA, Zhu M, Ashjian P. et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 2002; 13 (12) 4279-4295
  • 13 Coleman SR. Structural fat grafts: the ideal filler?. Clin Plast Surg 2001; 28 (01) 111-119
  • 14 Marten TJ, Elyassnia D. Fat grafting in facial rejuvenation. Clin Plast Surg 2015; 42 (02) 219-252
  • 15 Strong AL, Rubin JP, Kozlow JH, Cederna PS. Fat grafting for the treatment of scleroderma. Plast Reconstr Surg 2019; 144 (06) 1498-1507
  • 16 Cherubino M, Rubin JP, Miljkovic N, Kelmendi-Doko A, Marra KG. Adipose-derived stem cells for wound healing applications. Ann Plast Surg 2011; 66 (02) 210-215
  • 17 Gentile P, De Angelis B, Pasin M. et al. Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face. J Craniofac Surg 2014; 25 (01) 267-272
  • 18 Kenny EM, Egro FM, Ejaz A, Coleman SR, Greenberger JS, Rubin JP. Fat grafting in radiation-induced soft-tissue injury: a narrative review of the clinical evidence and implications for future studies. Plast Reconstr Surg 2021; 147 (04) 819-838
  • 19 Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg 2013; 132 (04) 1017-1026
  • 20 Rihani J. Microfat and nanofat: when and where these treatments work. Facial Plast Surg Clin North Am 2019; 27 (03) 321-330
  • 21 Yang Z, Jin S, He Y, Zhang X, Han X, Li F. Comparison of microfat, nanofat, and extracellular matrix/stromal vascular fraction gel for skin rejuvenation: basic research and clinical applications. Aesthet Surg J 2021; 41 (11) NP1557-NP1570
  • 22 Tonnard P, Verpaele A, Carvas M. Fat grafting for facial rejuvenation with nanofat grafts. Clin Plast Surg 2020; 47 (01) 53-62
  • 23 Charles-de-Sá L, Gontijo-de-Amorim NF, Maeda Takiya C. et al. Antiaging treatment of the facial skin by fat graft and adipose-derived stem cells. Plast Reconstr Surg 2015; 135 (04) 999-1009
  • 24 Kakagia D, Pallua N. Autologous fat grafting: in search of the optimal technique. Surg Innov 2014; 21 (03) 327-336
  • 25 American Society of Plastic Surgeons. Plastic surgery statistics report 2020. Accessed April 14, 2022 at: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
  • 26 Jiang A, Chamata ES, Bressler FJ. Revision rhinoplasty: with introduction of a novel preoperative assessment classification system. Semin Plast Surg 2021; 35 (02) 78-87
  • 27 Sharif-Askary B, Carlson AR, Van Noord MG, Marcus JR. Incidence of postoperative adverse events after rhinoplasty: a systematic review. Plast Reconstr Surg 2020; 145 (03) 669-684
  • 28 Saadoun R, Riedel F, D'Souza A, Veit JA. Surgical and nonsurgical management of the nasal skin-soft tissue envelope. Facial Plast Surg 2021; 37 (06) 790-800
  • 29 Saadoun R, Veit JA. Revision septorhinoplasty: an illustrative case report. Ear Nose Throat J 2021; 100 (10 suppl): 924S-929S
  • 30 Rohrich RJ, Gunter JP, Friedman RM. Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 1995; 95 (05) 795-799 , discussion 800–801
  • 31 Saadoun R, Risse EM, Crisan D, Veit JA. Dermatological assessment of thick-skinned patients before rhinoplasty-what may surgeons ask for?. Int J Dermatol 2022; (e-pub ahead of print) DOI: 10.1111/ijd.16341.
  • 32 Sorg H, Tilkorn DJ, Hager S, Hauser J, Mirastschijski U. Skin wound healing: an update on the current knowledge and concepts. Eur Surg Res 2017; 58 (1–2): 81-94
  • 33 Davis RE, Hrisomalos EN. Surgical management of the thick-skinned nose. Facial Plast Surg 2018; 34 (01) 22-28
  • 34 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397
  • 35 Chu E, Davis RE. SMAS debulking for management of the thick-skinned nose. JAMA Facial Plast Surg 2015; 17 (04) 305-306
  • 36 Hacker S, Pollock J, Gubisch W, Haack S. Differences between primary and revision rhinoplasty: indications, techniques, grafts, and outcomes. Plast Reconstr Surg 2021; 148 (03) 532-541
  • 37 Thomas WW, Bucky L, Friedman O. Injectables in the nose: facts and controversies. Facial Plast Surg Clin North Am 2016; 24 (03) 379-389
  • 38 Bayat M, Bahrami N, Mesgari H. Rhinoplasty with fillers and fat grafting. Oral Maxillofac Surg Clin North Am 2021; 33 (01) 83-110
  • 39 Bertossi D, Magagnotto N, Chirumbolo S, D'Souza A, Nocini R. Nonsurgical rhinoplasty: long-term follow-up of high G′ HA nasal injections. Facial Plast Surg 2022; 38 (02) 96-101
  • 40 Keyhan SO, Ramezanzade S, Bohluli B, Fallahi HR, Mirzahoseini S, Nahai F. Autologous fat injection for augmentation rhinoplasty: a systematic review. Aesthet Surg J Open Forum 2021; 3 (02) ojab010
  • 41 Ghavami A, Janis JE, Acikel C, Rohrich RJ. Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg 2008; 122 (04) 1229-1241
  • 42 Sterodimas A. Stromal enriched lipograft for rhinoplasty refinement. Aesthet Surg J 2013; 33 (04) 612-614
  • 43 Kao WP, Lin YN, Lin TY. et al. Microautologous fat transplantation for primary augmentation rhinoplasty: long-term monitoring of 198 Asian patients. Aesthet Surg J 2016; 36 (06) 648-656
  • 44 Ciloglu S, Duran A, Yigit AK, Buyukdogan H, Keskin E. Keutel syndrome: augmentation of the nose with serial fat grafting. Ann Maxillofac Surg 2015; 5 (02) 287-288
  • 45 Lin S, Hsiao Y-C, Huang J-J. et al. Minimal invasive rhinoplasty: fat injection for nasal dorsum contouring. Ann Plast Surg 2017; 78 (3, Suppl 2): S117-S123
  • 46 Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006; 118 (3, Suppl): 108S-120S
  • 47 Brooker JE, Rubin JP, Marra KG. The future of facial fat grafting. J Craniofac Surg 2019; 30 (03) 644-651
  • 48 Hörl HW, Feller AM, Biemer E. Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg 1991; 26 (03) 248-258
  • 49 Fontdevila J, Serra-Renom JM, Raigosa M. et al. Assessing the long-term viability of facial fat grafts: an objective measure using computed tomography. Aesthet Surg J 2008; 28 (04) 380-386
  • 50 Yu NZ, Huang JZ, Zhang H. et al. A systemic review of autologous fat grafting survival rate and related severe complications. Chin Med J (Engl) 2015; 128 (09) 1245-1251
  • 51 Nguyen A, Pasyk KA, Bouvier TN, Hassett CA, Argenta LC. Comparative study of survival of autologous adipose tissue taken and transplanted by different techniques. Plast Reconstr Surg 1990; 85 (03) 378-386 , discussion 387–389
  • 52 Poon R, Badawy MK. Radiation dose and risk to the lens of the eye during CT examinations of the brain. J Med Imaging Radiat Oncol 2019; 63 (06) 786-794
  • 53 Erol OO. Microfat grafting in nasal surgery. Aesthet Surg J 2014; 34 (05) 671-686
  • 54 Monreal J. Fat grafting to the nose: personal experience with 36 patients. Aesthetic Plast Surg 2011; 35 (05) 916-922
  • 55 Cárdenas JC, Carvajal J. Refinement of rhinoplasty with lipoinjection. Aesthetic Plast Surg 2007; 31 (05) 501-505
  • 56 Baptista C, Nguyen PS, Desouches C, Magalon G, Bardot J, Casanova D. Correction of sequelae of rhinoplasty by lipofilling. J Plast Reconstr Aesthet Surg 2013; 66 (06) 805-811
  • 57 Challita R, Sleiman Z, Bazzi N, Ghanime G. Our experience with lipofilling in secondary rhinoplasty, into a new era. Dermatol Ther 2021; 34 (04) e14989
  • 58 Lo S, Sinrachtanant C. Immediate autologous fat graft augmentation rhinoplasty after removal of extruding or infected silicone implant. Clin Otolaryngol 2012; 37 (04) 333-334
  • 59 Firat C, Bekircan K, Algan MF. Use of an autologous diced cartilage graft and fat graft combination to improve regeneration in rhinoplasty. Aesthetic Plast Surg 2021; 45 (06) 2837-2848
  • 60 Gabrick K, Walker M, Timberlake A, Chouairi F, Saberski E, Steinbacher D. The effect of autologous fat grafting on edema and ecchymoses in primary open rhinoplasty. Aesthet Surg J 2020; 40 (04) 359-366
  • 61 Kovacevic M, Kosins AM, Göksel A, Riedel F, Bran G, Veit JA. Optimization of the soft tissue envelope of the nose in rhinoplasty utilizing fat transfer combined with platelet-rich fibrin. Facial Plast Surg 2021; 37 (05) 590-598
  • 62 Barone M, Cogliandro A, Salzillo R. et al. The role of skin thickness in the choice of a rhinoplasty technique for thin-skinned patients: analysis of long-term results and patient satisfaction. Aesthetic Plast Surg 2020; 44 (05) 1742-1750
  • 63 Toriumi DM. Dorsal augmentation using autologous costal cartilage or microfat-infused soft tissue augmentation. Facial Plast Surg 2017; 33 (02) 162-178
  • 64 Gowda AU, Pourtaheri N, Park KE. et al. Crushed cartilage and autologous fat for dorsal nasal refinement. Aesthetic Plast Surg 2021; 45 (05) 2271-2277
  • 65 Toriumi DM. Invited discussion on: use of an autologous diced cartilage graft and fat graft combination to improve regeneration in rhinoplasty. Aesthetic Plast Surg 2021; 45 (06) 2849-2851
  • 66 Ahn TH, Lee W, Kim HM, Cho SB, Yang EJ. Use of autologous adipose-derived stromal vascular fractions in revision rhinoplasty for severe contractures in Asian patients. Plast Reconstr Surg 2021; 147 (03) 401e-411e
  • 67 Yan D, Li SH, Zhang AL, Xiao Y, Huang ZC. A clinical study of platelet-rich fibrin combined with autologous high-density fat transplantation in augmentation rhinoplasty. Ear Nose Throat J 2021; (e-pub ahead of print) DOI: 10.1177/01455613211016902.
  • 68 Liao HT, James IB, Marra KG, Rubin JP. The effects of platelet-rich plasma on cell proliferation and adipogenic potential of adipose-derived stem cells. Tissue Eng Part A 2015; 21 (21–22): 2714-2722
  • 69 Liao HT, Marra KG, Rubin JP. Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review. Tissue Eng Part B Rev 2014; 20 (04) 267-276
  • 70 Oh YH, Seo JW, Oh SJ. et al. Correction of severely contracted nose. Plast Reconstr Surg 2016; 138 (03) 571-582
  • 71 Rubin JP, D'Amico RA, Rodriguez R. et al. Regulatory advocacy update: American Society of Plastic Surgeons comments in response to the U.S. Food and Drug Administration draft guidance documents on human cell and tissue products. Plast Reconstr Surg 2017; 139 (05) 1259-1261
  • 72 Rodriguez RL, Frazier T, Bunnell BA. et al. Arguments for a different regulatory categorization and framework for stromal vascular fraction. Stem Cells Dev 2020; 29 (05) 257-262
  • 73 Jasin ME. Nonsurgical rhinoplasty using dermal fillers. Facial Plast Surg Clin North Am 2013; 21 (02) 241-252
  • 74 Xing L, Almeida DR, Belliveau MJ. et al. Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat. Retina 2012; 32 (10) 2175-2176
  • 75 Surucu Y, Saadoun R, Loder S, Guneren E. Platelet Rich Fibrin (PRF) Enhances Scar Resolution of High-tension Wounds in Rats. Plastic and Reconstructive Surgery – Global Open: October 2022. 10. (10S):54. Doi: 10.1097/01.GOX.0000898592.19055.3c