Endara Matthew R, Allred Lindsay Jones, Han Kevin D, Baker Stephen B
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
Aesthet Surg J. 2014 Mar;34(3):363-73. doi: 10.1177/1090820X14525964.
Aesthetic skeletal surgery of the face is a powerful tool to alter the facial skeleton; the facial form is enhanced through the use of alloplastic implants and osteotomies of the facial bones. However, the ultimate aesthetic appearance is dictated by how the soft tissue envelope drapes over the altered skeletal foundation. Intraoperative and postoperative fat grafting enhances the final aesthetic result in patients who undergo skeletal aesthetic procedures.
The authors describe cases in which selective fat grafting has been successful in optimizing facial soft tissue symmetry in patients undergoing skeletal aesthetic surgery of the face.
A retrospective chart review of all patients who underwent aesthetic skeletal surgery of the face between November 1, 2003, and October 31, 2011, in the Department of Surgery at Georgetown University Hospital was performed, and any patient who required fat grafting either at the time of aesthetic facial skeletal surgery or in the postoperative period was identified (n = 21). Common indications for fat grafting and the surgical plans are reviewed and presented in this article.
Twenty-one patients were identified who required 37 fat grafting procedures either at the time of aesthetic skeletal surgery of the face or in the postoperative period. The procedures most frequently requiring fat grafting were genioplasty, facial shape modifications, and facial symmetry improvement. Fat grafting most commonly corrected irregularities or asymmetries and improved the soft tissue contour overlying repositioned bone or alloplastic implants. Most patients were female (72%) with a mean age of 42 years (range, 4-58 years). There were 4 complications in total: 3 surgical site infections (managed conservatively in 1 patient and with incision and drainage in the remaining 2) and 1 hematoma requiring drainage and closure on the day of surgery.
Knowledge of which procedures are likely to require fat grafting and the techniques for doing so can improve the plastic surgeon's ability to provide optimal aesthetic results following facial skeletal alterations.
面部美学骨骼手术是改变面部骨骼的有力工具；通过使用异体植入物和面部骨骼截骨术来改善面部形态得以改善。然而，最终的美学外观取决于软组织包膜如何覆盖改变后的骨骼基础。术中及术后脂肪移植可提升接受骨骼美学手术患者的最终美学效果。
作者描述了在接受面部骨骼美学手术的患者中，选择性脂肪移植成功优化面部软组织对称性的病例。
对2003年11月1日至2011年10月31日在乔治敦大学医院外科接受面部美学骨骼手术的所有患者进行回顾性病历审查，确定在面部美学骨骼手术时或术后需要脂肪移植的任何患者（n = 21）。本文回顾并介绍了脂肪移植的常见适应症和手术方案。
确定了21例患者，他们在面部美学骨骼手术时或术后需要进行37次脂肪移植手术。最常需要脂肪移植的手术是颏成形术、面部形状改变和面部对称性改善。脂肪移植最常用于纠正不规则或不对称，并改善重新定位的骨骼或异体植入物上方的软组织轮廓。大多数患者为女性（72%），平均年龄42岁（范围4 - 58岁）。总共发生4例并发症：3例手术部位感染（1例患者保守治疗，其余2例切开引流）和1例血肿，需要在手术当天进行引流和缝合。
了解哪些手术可能需要脂肪移植以及相关技术，可以提高整形外科医生在面部骨骼改变后提供最佳美学效果的能力。
