Objective: To evaluate an improved treatment of an autologous fat injection for hemifacial atrophy to increase the survival rate of the fat graft and decrease complications including colliquation, necrosis, and absorption of the graft fat.
Methods: From March 1999 to October 2004, 31 patients with hemifacial atrophy underwent an improved treatment by an autologous fat injection for their diseases. There were 12 males and 19 females aged 19-28 years (average, 23.5 years). The patients were divided into the following 3 groups according to the atrophy extent: the mild group (n=9), the moderate group (n=19), and the severe group (n=3). Based on the previous researches on the fat transplantation techniques, the improved treatment combined the following strategies that were simply called "3L3M": low position for the fat donation, low pressure for the fat harvesting, and low-speed centrifugation for purification of the fat; multi-point, multi-tunnel, and multi-plane for injections of the fat graft. The preoperative and the postoperative photos were taken and the findings were compared to make clear whether the hard and firm masses and cysts existed; then, the decision was made about whether the patients needed another operation according to whether the patients had a natural facial expression and whether the patients had comfortable feelings as well as the X-ray findings.
Results: All the patients had a satisfactory symmetrical face after 1 injection of the fat in 15 patients, 2 injections in 13 patients, and 3 injections in 3 patients. The effect of the 3rd injection was better than that of the 2nd injection; the effect of the 2nd injection was better than that of the 1st injection; the fat volume for the injection could be gradually decreased. The fat volumes for injections were as follows: 8-14 ml (average, 11 ml) in the submaxillary region, 15-25 ml (average, 20 ml) in the buccal region, 5-10 ml (average, 7.5 ml) in the zygomatic region, and 18-20 ml (average, 19 ml) in the forehead region. The follow-up for 3-5 years revealed that there was no infection, hard and firm mass, cyst or other complications. The pigmentation in the affected face was significantly improved.
Conclusion: Compared with the traditional treatments, the improved treatment of an autologous fat injection for hemifacial atrophy can achieve a satisfactory symmetry of the face with no injury to the donor site or complications in the recipient site. This improved method is an ideal treatment for hemifacial atrophy.