Lee Saem, Lee Jung Hye, Choi Hye Sun
Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2015 Nov;68(11):1498-503. doi: 10.1016/j.bjps.2015.07.002. Epub 2015 Jul 21.
The aim of this study was to evaluate the clinical features of patients with a periorbital palpable mass or swelling after autologous fat injection for facial augmentation.
This retrospective case study included 50 patients who developed a periorbital palpable mass or swelling after undergoing autologous fat injection for facial augmentation performed by various plastic surgeons. The patients' medical records were reviewed for clinical history, radiological findings, and treatment outcomes.
All patients were female with a mean age of 43.18 ± 12.04 (range, 19-63) years. After fat injection, the average time of symptom onset was 9.09 ± 8.45 (1-36) months, and the mean follow-up duration was 13 ± 1 (4-36) weeks. Majority of patients complained of eyelid swelling or periorbital palpable mass. All patients had received fat injection in the forehead area, except for the following patients: Five patients who were unaware of the site of fat injection and one patient who had received the injection in the upper eyelid area with simultaneous double-fold surgery. In addition, 39 patients had received a second injection of cryopreserved autologous fat tissue. Forty-five patients developed a mass in the upper eyelid area, four were found to have the mass in the lower eyelid area, and one patient developed the mass in both eyelids. Computed tomography and magnetic resonance imaging revealed isolated fat tissue, periorbital inflammation, or a soft tissue mass with fat density. Oral steroids were used to treat 41 (82.0%) patients; 31 (75.6%) showed satisfactory outcomes, nine (22.0%) patients did not return to the clinic after the first oral steroid treatment, and the periorbital mass persisted in one patient (2%) even after the oral steroid treatment. The patient with the periorbital mass underwent surgical removal and tissue biopsy. Asymptomatic patients (eight; 16%) underwent observation without treatment. As a first treatment, one patient (2%) requested an immediate surgical removal of the periorbital mass. Therefore, surgical excision and biopsy were performed in two patients (4%). During surgery, a granulomatous mass was found in the preseptal region, with liquefied necrotic fat flowing out. Histological examination revealed a lipogranuloma with granulomatous inflammation.
Clinicians should confirm a history of autologous fat injection and be aware of the clinical features in patients who present with a periorbital palpable mass or swelling. Oral steroid therapy should be considered before surgery because it may prove to be effective. Further studies with long-term follow-up periods are necessary.
本研究旨在评估自体脂肪注射面部填充后出现眶周可触及肿块或肿胀患者的临床特征。
这项回顾性病例研究纳入了50例在不同整形外科医生进行自体脂肪注射面部填充后出现眶周可触及肿块或肿胀的患者。查阅患者病历以了解临床病史、影像学检查结果及治疗效果。
所有患者均为女性，平均年龄43.18±12.04（范围19 - 63）岁。脂肪注射后，症状出现的平均时间为9.09±8.45（1 - 36）个月，平均随访时间为13±1（4 - 36）周。大多数患者主诉眼睑肿胀或眶周可触及肿块。除以下患者外，所有患者均在前额区域接受了脂肪注射：5例患者不清楚脂肪注射部位，1例患者在上眼睑区域接受注射同时进行了双眼皮手术。此外，39例患者接受了第二次冷冻保存的自体脂肪组织注射。45例患者在上眼睑区域出现肿块，4例在下眼睑区域发现肿块，1例患者双眼睑均出现肿块。计算机断层扫描和磁共振成像显示为孤立的脂肪组织、眶周炎症或具有脂肪密度的软组织肿块。41例（82.0%）患者使用口服类固醇进行治疗；31例（75.6%）治疗效果满意，9例（22.0%）患者在首次口服类固醇治疗后未复诊，1例患者（2%）即使在口服类固醇治疗后眶周肿块仍持续存在。眶周肿块患者接受了手术切除及组织活检。8例无症状患者（16%）未接受治疗，仅进行观察。作为首次治疗，1例患者（2%）要求立即手术切除眶周肿块。因此，2例患者（4%）接受了手术切除及活检。手术中，在眶隔前区域发现肉芽肿性肿块，有液化坏死脂肪流出。组织学检查显示为伴有肉芽肿性炎症的脂肪肉芽肿。
临床医生应确认患者自体脂肪注射史，并了解出现眶周可触及肿块或肿胀患者的临床特征。手术前应考虑口服类固醇治疗，因为其可能有效。有必要进行长期随访的进一步研究。
