Tringale Kathryn Ries, Lance Samuel, Schoenbrunner Anna, Gosman Amanda A
From the *School of Medicine, and †Division of Plastic Surgery, University of California, San Diego, CA.
Ann Plast Surg. 2017 May;78(5 Suppl 4):S217-S221. doi: 10.1097/SAP.0000000000000973.
Autologous fat grafting is a valuable tool in the correction of facial soft tissue asymmetry and volume deficits. Pubertal growth and fluctuations in body mass present unique challenges to achieving satisfactory results after autologous fat transfer in the pediatric population. Few studies exist describing the outcomes and complications of pediatric facial fat grafting. The objective of this study is to identify the complication profile and outcomes after autologous fat grafting for the correction of facial asymmetry and volume deficits in the pediatric population.
Retrospective chart review was performed identifying 19 patients having undergone autologous fat grafting to the face for correction of facial volume deficits or asymmetry. Intraoperative variables were analyzed including blood loss, tumescent volume, lipoaspirate volume, graft volume transferred, donor fat processing technique, and donor site. Patient growth parameters were evaluated using body mass index (BMI) at the time of grafting and most recent follow up. Outcomes were evaluated based on adequacy of the graft, number of revisions or corrections, and complications.
A total of 19 patients were identified. The median age at the time of primary fat graft was 17 years. The average change in BMI from preoperative to the latest recorded date was +0.60 ± 1.90. The average time from primary procedure to most recent follow up was 1.7 years. Abdomen was the most common donor site utilized. Adequate correction was achieved with an average of 1.4 graftings. Complications included contour irregularity (n = 1) and persistent overcorrection (n = 3). One patient required lipoaspiration for treatment of overcorrection. An unpaired t test demonstrated no significant difference in preoperative BMI (P = 0.58), postoperative BMI (P = 0.28), or change in BMI after grafting (P = 0.56) between adequately corrected and overcorrected patients.
Fat transfer is a safe and viable method for the correction of facial asymmetry in the pediatric population. Repeat fat grafting procedures may be required to achieve adequate correction; however, postoperative overcorrection is unlikely to resolve spontaneously in the pediatric population and is unrelated to changes in BMI. Care should be taken to minimize the degree of primary overcorrection when treating facial asymmetry in the pediatric population.
自体脂肪移植是矫正面部软组织不对称和容量不足的一种重要手段。青春期生长发育和体重波动给儿科人群自体脂肪移植后取得满意效果带来了独特挑战。描述儿科面部脂肪移植结果及并发症的研究较少。本研究的目的是确定儿科人群自体脂肪移植矫正面部不对称和容量不足后的并发症情况及结果。
进行回顾性病历审查，确定19例接受面部自体脂肪移植以矫正面部容量不足或不对称的患者。分析术中变量，包括失血量、肿胀液量、抽脂量、移植脂肪量、供体脂肪处理技术和供区。使用移植时和最近一次随访时的体重指数（BMI）评估患者生长参数。根据移植的充分性、修复或矫正次数以及并发症评估结果。
共确定19例患者。首次脂肪移植时的中位年龄为17岁。从术前到最新记录日期，BMI的平均变化为+0.60±1.90。从首次手术到最近一次随访的平均时间为1.7年。腹部是最常用的供区。平均进行1.4次移植后实现了充分矫正。并发症包括轮廓不规则（n = 1）和持续性过度矫正（n = 3）。1例患者因过度矫正需要抽脂治疗。非配对t检验显示，充分矫正和过度矫正患者之间术前BMI（P = 0.58）、术后BMI（P = 0.28）或移植后BMI变化（P = 0.56）无显著差异。
脂肪移植是矫正儿科人群面部不对称的一种安全可行的方法。可能需要重复进行脂肪移植手术以实现充分矫正；然而，儿科人群术后过度矫正不太可能自发缓解，且与BMI变化无关。在治疗儿科人群面部不对称时，应注意尽量减少初次过度矫正的程度。
