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Suzon B, Goulabchand R, Louis-Sidney F, Maria A, Najjari R, Chauvet E, Le Quellec A, Bessis D, Guilpain P. Subcutaneous tissue involvement in idiopathic inflammatory myopathies: Systematic literature review including three new cases and hypothetical mechanisms. Autoimmun Rev 2023; 22:103284. [PMID: 36736986 DOI: 10.1016/j.autrev.2023.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Involvement of subcutaneous tissue in idiopathic inflammatory myopathies (IIM) is poorly known. METHODS We conducted a systematic review of the literature regarding panniculitis and lipodystrophy/lipoatrophy in juvenile and adult IIM via PubMed/Medline, Embase and Scopus databases. Three local observations are included in this review. Epidemiological, clinical, paraclinical and therapeutic data were collected. RESULTS Panniculitis appears to be more common in adults than in juveniles. It was mainly localised in the upper and lower limbs. Panniculitis improved in most cases with steroids and panniculitis and myositis had a similar course in 83.3% and 72.2% of cases in juveniles and adults, respectively. Lipodystrophy appeared to be more frequent in juveniles and was only observed in dermatomyositis in both juveniles and adults. Lipodystrophy was mainly partial in juveniles and adults. The median time from myositis to the diagnosis of lipodystrophy was 6 years [0-35] and 2.5 years [0-10] in juveniles and adults, respectively. Lipodystrophy was associated with anti-TIF1 gamma auto-antibody positivity, a polycyclic/chronic course of myositis and the occurrence of calcinosis and might be an indicator of poor disease control. CONCLUSION Adipose tissue involvement, particularly lipodystrophy, occurs almost exclusively in dermatomyositis. The insidious onset and lack of awareness of the diagnosis may underestimate its prevalence. Larger studies are needed to identify possible risk factors in these patients, to better potential underlying pathophysiological process, in order to discuss potential therapeutic targets.
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Affiliation(s)
- Benoit Suzon
- Department of Internal Medicine, Martinique University Hospital, Fort-de-France, Martinique, France; EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Nîmes University Hospital, France; Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France
| | - Fabienne Louis-Sidney
- EpiCliV Research Unit, University of French West Indies, Fort-de-France, Martinique, France; Department of Rheumatology, Martinique University Hospital, France
| | - Alexandre Maria
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Department of Internal Medicine and Immuno-Oncologie (MedI(2)O), Montpellier University Hospital, France; Montpellier-1 University, Faculty of Medicine, France
| | - Redwann Najjari
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Elodie Chauvet
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Alain Le Quellec
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Didier Bessis
- Department of Dermatology, Montpellier University Hospital, France
| | - Philippe Guilpain
- Institute for Regenerative Medicine and Biotherapy, INSERM U1183, Montpellier, France; Montpellier-1 University, Faculty of Medicine, France; Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France.
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Schiraldi L, Sapino G, Meuli J, Maruccia M, Cherubino M, Raffoul W, di Summa PG. Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal. J Clin Med 2022; 11:jcm11164708. [PMID: 36012947 PMCID: PMC9410081 DOI: 10.3390/jcm11164708] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Autologous fat is ideal soft tissue filler. It is easily accessible, biocompatible, cheap, and it provides both volume augmentation and skin quality improvement. Fat grafting has been used since 1893, but it has only gained widespread popularity since the development of modern liposuction by Colemann and Illouz in the 1980s. Every year more than half a million facial fat grafting procedures are carried out worldwide and the trend is rapidly increasing. Overall, general complications associated with facial fat grafting are assumed to be around 2%. Is that true? Material and Methods: Until July 2021, a systematic search of the literature was performed interrogating PubMed search engines. The following algorithm was used for the research: (fat graft OR lipofilling) AND face AND complications. Exclusion criteria applied hierarchically were review articles, not reporting recipient site complications; not in English and paediatric population. Abstracts were manually screened by LS, GS, JM and PDS separately and subsequently matched for accuracy. Pertinent full-text articles were retrieved and analysed and data were extracted from the database. The flow chart of article selection is described following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In total, 462 papers were identified by PubMed search. A total of 359 were excluded: 38 papers were not in English, 41 were review articles, 279 articles did not report recipient site complications and 1 was not on human subjects. Average complication rate ranged from 1.5% to 81.4%. A total of 298 adverse events were identified: 40 (13.4%) intravascular injections, 13 (4.3%) asymmetry, 57 (19.1%) irregularities, 22 (7.4%) graft hypertrophy, 21 (7%) fat necrosis, 73 (24.5%) prolonged oedema, 1 (0.3%) infection, 6 (2%) prolonged erythema, 15 (5%) telangiectasia and 50 (16.8%) cases of acne activation. Conclusions: FFG related side effects could be resumed in three categories: severe, moderate, and minor. Severe (13.4%) side effects such as intravascular injection or migration require neurological or neurosurgical management and often lead to permanent disability or death. Moderate (38.3%) side effects such as fat hypertrophy, necrosis, cyst formation, irregularities and asymmetries require a retouch operation. Minor (48.3%) side effects such as prolonged oedema or erythema require no surgical management. Despite the fact that the overall general complication rate of facial fat grafting is assumed to be around 2%, the real complication rate of facial fat grafting is unknown due to a lack of reporting and the absence of consensus on side effect definition and identification. More RCTs are necessary to further determine the real complication rate of this procedure.
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Affiliation(s)
- Luigi Schiraldi
- Department of Plastic, Reconstructive Surgery, University Hospital of Lausanne (CHUV), 46, 1011 Lausanne, Switzerland
- Correspondence: (L.S.); (P.G.d.S.)
| | - Gianluca Sapino
- Department of Plastic, Reconstructive Surgery, University Hospital of Lausanne (CHUV), 46, 1011 Lausanne, Switzerland
| | - Joachim Meuli
- Department of Plastic, Reconstructive Surgery, University Hospital of Lausanne (CHUV), 46, 1011 Lausanne, Switzerland
| | - Michele Maruccia
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Mario Cherubino
- Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Wassim Raffoul
- Department of Plastic, Reconstructive Surgery, University Hospital of Lausanne (CHUV), 46, 1011 Lausanne, Switzerland
| | - Pietro G. di Summa
- Department of Plastic, Reconstructive Surgery, University Hospital of Lausanne (CHUV), 46, 1011 Lausanne, Switzerland
- Correspondence: (L.S.); (P.G.d.S.)
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Krastev TK, Beugels J, Hommes J, Piatkowski A, Mathijssen I, van der Hulst R. Efficacy and Safety of Autologous Fat Transfer in Facial Reconstructive Surgery: A Systematic Review and Meta-analysis. JAMA FACIAL PLAST SU 2019; 20:351-360. [PMID: 29596574 DOI: 10.1001/jamafacial.2018.0102] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The use of autologous fat transfer (AFT) or lipofilling for correcting contour deformities is seen as one of the major breakthroughs in reconstructive plastic surgery. Its applications in facial reconstructive surgery have been of particular interest owing to the prospect of achieving autologous reconstruction by a minimally invasive approach. However, its unpredictability and variable degree of resorption have limited its utility and much skepticism still exists regarding its efficacy. Furthermore, more than 2 decades of clinical research have produced a highly fragmented body of evidence that has not been able to provide definite answers. Objective To investigate the safety and efficacy of AFT in facial reconstruction through a systematic review and meta-analysis. Data Sources A literature search was performed in PubMed, Embase, and the Cochrane Library from inception to October 11, 2017. Study Selection All published studies investigating the efficacy and safety of AFT in facial reconstructive surgery. Data Extraction and Synthesis Two independent reviewers performed data extraction systematically, adhering to the PRISMA guidelines. Summary measures were pooled in a random-effects model meta-analysis. Main Outcomes and Measures The patient and surgeon satisfaction, graft survival, number of AFT sessions, and the incidence of AFT-related complications were the main outcomes of interest in this meta-analysis. Results This systematic review resulted in the inclusion 52 relevant studies consisting of 1568 unique patients. These included 4 randomized clinical trials, 11 cohort studies, and 37 case series. The overall follow-up averaged 1.3 years after AFT. Meta-analysis revealed a very high overall patient satisfaction rate of 91.1% (95% CI, 85.1%-94.8%) and overall surgeon satisfaction rate of 88.6% (95% CI, 83.4%-92.4%). The number of AFT sessions required to achieve the desired result was 1.5 (95% CI, 1.3-1.7) and 50% to 60% of the injected volume was retained at 1 year. Only 4.8% (95% CI, 3.3%-6.9%) of procedures resulted in clinical complications. Conclusions and Relevance To our knowledge, this study provides the first overview of the current knowledge about AFT in facial reconstructive surgery. Our results confirm that AFT is an effective technique for treating soft-tissue deformities in the head and neck, with low rate of minor complications. Level of Evidence NA.
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Affiliation(s)
- Todor K Krastev
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Jip Beugels
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Juliette Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Irene Mathijssen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rene van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Cho KH, Uthaman S, Park IK, Cho CS. Injectable Biomaterials in Plastic and Reconstructive Surgery: A Review of the Current Status. Tissue Eng Regen Med 2018; 15:559-574. [PMID: 30603579 PMCID: PMC6171701 DOI: 10.1007/s13770-018-0158-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/03/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Injectable biomaterials have attracted increasing attention for volume restoration and tissue regeneration. The main aim of this review is to discuss the current status of the injectable biomaterials for correction of tissue defects in plastic and reconstructive surgery. METHODS Requirements of injectable biomaterials, mechanism of in situ gelation, characteristics, and the combinational usage of adipose-derived stem cells (ADSCs) and growth factors were reviewed. RESULTS The ideal injectable biomaterials should be biocompatible, non-toxic, easy to use, and cost-effective. Additionally, it should possess adequate mechanical properties and stability. In situ gelation method includes physical, chemical, enzymatic and photo-initiated methods. Natural and synthetic biomaterials carry their pros and cons due to their inherent properties. The combined use of ADSCs and growth factors provides enhanced potential for adipose tissue regeneration. CONCLUSIONS The usage of injectable biomaterials has been increasing for the tissue restoration and regeneration. The future of incorporating ADSCs and growth factors into the injectable biomaterials is promising.
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Affiliation(s)
- Ki-Hyun Cho
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195 USA
| | - Saji Uthaman
- Department of Polymer Science and Engineering, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, 34134 Republic of Korea
| | - In-Kyu Park
- Department of Biomedical Sciences, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju, 61469 Republic of Korea
| | - Chong-Su Cho
- Research Institute for Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Republic of Korea
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Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond) 2017; 24:65-73. [PMID: 29188051 PMCID: PMC5694962 DOI: 10.1016/j.amsu.2017.11.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Adipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation. MATERIAL AND METHODS The purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable. RESULTS A standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue.He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. CONCLUSION Adipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles.Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.
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Affiliation(s)
- Elisa Bellini
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele P. Grieco
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Zhao H, Yang F, Fu J, Gao Q, Liu A, Sun M, He Y. Printing@Clinic: From Medical Models to Organ Implants. ACS Biomater Sci Eng 2017; 3:3083-3097. [PMID: 33445353 DOI: 10.1021/acsbiomaterials.7b00542] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | | | | | | | - An Liu
- Department
of Vascular Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Miao Sun
- Department
of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital,
School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Yong He
- State
Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, 710054, Xi’an China
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Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 2017; 20:49-60. [PMID: 28702187 PMCID: PMC5491488 DOI: 10.1016/j.amsu.2017.06.059] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. PATIENTS AND METHODS Literature review of publications concerning autologous fat grafting. RESULTS Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. CONCLUSIONS Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.
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Affiliation(s)
- Francesco Simonacci
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele Pio Grieco
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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El-Sabbagh AH. Modern trends in lipomodeling. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2017; 6:Doc06. [PMID: 28401032 PMCID: PMC5378998 DOI: 10.3205/iprs000108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lipomodeling is the process of relocating autologous fat to change the shape, volume, consistency, and profile of tissues, with the aim of reconstructing, rejuvenating, and regenerating body features. There have been several important advancements in lipomodeling procedures during the last thirty years. Four clinical steps are important for the success of engraftment: fat harvesting, fat processing, fat reinjection, and preconditioning of the recipient site. With the discovery of adipose derived stem cells and dedifferentiated cells, fat cells become a major tool of regenerative medicine. This article reviews recent trends in lipomodeling trying to understand most of the issues in this field.
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Polivka L, Revol M, Battistella M, Bachelez H. Lipofilling: A New Therapeutic Option for the Treatment of Lupus Panniculitis-Induced Atrophy. Case Rep Dermatol 2016; 8:323-326. [PMID: 27920685 PMCID: PMC5126595 DOI: 10.1159/000452325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/09/2016] [Indexed: 11/27/2022] Open
Abstract
Lupus panniculitis is a rare manifestation of cutaneous lupus erythematosus, which may lead to major aesthetic sequelae with a severe impact on patients’ quality of life. We report 2 cases supporting the short- and long-term efficacy and safety of lipofilling in the treatment of lupus panniculitis-induced atrophy. These observations pave the way for prospective, larger-scale studies in patients with scarring lupus panniculitis, provided that the autoimmune pathogenic process is in complete, stable remission.
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Affiliation(s)
- Laura Polivka
- Paris Diderot-Sorbonne Paris Cité University, Paris, France; Department of Dermatology, Saint Louis Hospital (AP-HP), Paris, France; INSERM Unit U1163, Institut Imagine, Necker-Enfants Malades Hospital, Paris, France
| | - Marc Revol
- Paris Diderot-Sorbonne Paris Cité University, Paris, France; Department of Plastic Surgery, Saint Louis Hospital (AP-HP), Paris, France
| | - Maxime Battistella
- Paris Diderot-Sorbonne Paris Cité University, Paris, France; Department of Pathology, Saint Louis Hospital (AP-HP), Paris, France
| | - Hervé Bachelez
- Paris Diderot-Sorbonne Paris Cité University, Paris, France; Department of Dermatology, Saint Louis Hospital (AP-HP), Paris, France; INSERM Unit U1163, Institut Imagine, Necker-Enfants Malades Hospital, Paris, France
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Objective Assessment of Facial Rejuvenation After Massive Weight Loss. Aesthetic Plast Surg 2015; 39:847-55. [PMID: 26311559 DOI: 10.1007/s00266-015-0540-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND While the literature is replete with articles about body contouring after bariatric surgery, little information exists regarding the outcomes of facelift following massive weight loss (MWL). A case report and a technique article are the only sources available addressing this issue. This pilot study objectively examines the effects of MWL in the cervicofacial region and results after facelift. METHODS A retrospective review of seven patients who underwent facelift after MWL (>100 pounds) was performed. Patient's change in appearance was objectively evaluated using an apparent age model. Forty blinded reviewers assessed pre- and postoperative photographs of seven MWL and eleven non-MWL female patients. The reviewers estimated the apparent age for each subject. Reduction in apparent age was calculated by comparing patient's apparent age against actual age. RESULTS The preoperative apparent age of MWL patients was 5.1 years older than their actual age (p < 0.02) compared to the increased preoperative apparent age of 1.2 years in non-MWL subjects (p > 0.05); suggesting MWL patients appear older than their actual age. Post-operatively, the apparent age reduction in MWL patients was 6.0 years; and their apparent age after surgery was 0.9 year less than their actual age (p > 0.05). In contrast, the control group exhibited an apparent age reduction of 5.4 years and a postoperative apparent age 4.2 years younger than their actual age (p < 0.01). Apparent age reduction was not significantly different for the two groups (p > 0.05). Age, BMI, and follow-up were similar between groups (p > 0.05). CONCLUSIONS MWL may accelerate apparent cervicofacial aging. Facelift following MWL enhances cervicofacial appearance and significantly reduces apparent age. We hope this study stimulates further interest in the study of facial esthetics in this increasing population. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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11
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Jagdeo J, Ho D, Lo A, Carruthers A. A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA). J Am Acad Dermatol 2015; 73:1040-54.e14. [PMID: 26481056 DOI: 10.1016/j.jaad.2015.08.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 01/07/2023]
Abstract
HIV facial lipoatrophy (FLA) is characterized by facial volume loss. HIV FLA affects the facial contours of the cheeks, temples, and orbits, and is associated with social stigma. Although new highly active antiretroviral therapy medications are associated with less severe FLA, the prevalence of HIV FLA among treated individuals exceeds 50%. The goal of our systematic review is to examine published clinical studies involving the use of filler agents for aesthetic treatment of HIV FLA and to provide evidence-based recommendations based on published efficacy and safety data. A systematic review of the published literature was performed on July 1, 2015, on filler agents for aesthetic treatment of HIV FLA. Based on published studies, poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D. Poly-L-lactic acid may be best for treatment over temples and cheeks, whereas calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement. Additional long-term randomized controlled trials are necessary to elucidate the advantages and disadvantages of fillers that have different biophysical properties, in conjunction with cost-effectiveness analysis, for treatment of HIV FLA.
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Affiliation(s)
- Jared Jagdeo
- Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California; Department of Dermatology, University of California Davis, Sacramento, California; Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York.
| | - Derek Ho
- Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California
| | - Alex Lo
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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A case of facial lipoatrophy secondary to lupus profundus managed with lipofilling technique. Case Rep Dermatol Med 2012; 2012:720518. [PMID: 23304570 PMCID: PMC3529427 DOI: 10.1155/2012/720518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/12/2012] [Indexed: 11/17/2022] Open
Abstract
Facial lipoatrophy is one of the most difficult complication in the patients with lupus profundus. In this paper, we present a case of a 55-year-old woman affected by lupus profundus, with a grade V lipoatrophy, treated with lipofilling technique. No complications were observed and results at 12 months were stable, natural, and symmetric.
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13
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Liposuction for highly active antiretroviral therapy (HAART)-associated lipohypertrophy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Human Immunodeficiency Virus–Related Lipoatrophy of the Face: Where Should We Have to Fill? Plast Reconstr Surg 2011; 127:143e-144e. [DOI: 10.1097/prs.0b013e3182131e38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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Faghahati S, Delaporte T, Toussoun G, Gleizal A, Morel F, Delay E. Traitement par transfert graisseux des séquelles postradiques de tumeur faciale maligne de l’enfance. ANN CHIR PLAST ESTH 2010; 55:169-78. [DOI: 10.1016/j.anplas.2009.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 05/16/2009] [Indexed: 11/25/2022]
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Claude O, Domergue Than Trong E, Blanc R, Ascher B, Bagot M, Meningaud JP, Lantieri L. [Treatment of HIV facial lipoatrophy with a submalar porous polyethylene implant (Medpor)]. ANN CHIR PLAST ESTH 2008; 54:21-8. [PMID: 19042066 DOI: 10.1016/j.anplas.2008.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 05/28/2008] [Indexed: 10/21/2022]
Abstract
Human immunodeficiency virus associated facial lipoatrophy is becoming epidemic and is a distressing sign for patients. Non permanent fillers provide only temporary results and cannot be the solution for severe cases. Lipodystrophy makes the lipofilling difficult to perform with a fibrous low quality fat difficult to harvest. We propose another solution using porous polyethylene implants (Medpor). Eight patients underwent submalar augmentation through an upper gingivobuccal sulcus incision that allows a subperiosteal dissection. The implants are carved to provide the desired augmentation. Overall, eight patients had good or very good aesthetic postoperative outcomes as determined by the patient and the surgeon. No complications occurred and results remain natural. Porous polyethylene implant (Medpor) is our treatment of choice for mild to severe facial lipoatrophy. Besides these implants could be removed easily later if needed.
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Affiliation(s)
- O Claude
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Henri-Mondor, université Paris-XII, 51 avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France.
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Abstract
Enophthalmos can be defined as a relative, posterior displacement of a normal-sized globe in relation to the bony orbital margin. Non-traumatic enophthalmos has a wide variety of clinical presentations and may be the first manifestation of a number of local or systemic conditions. It may present with cosmetic problems such as deep superior sulcus, pseudoptosis or eyelid retraction; or functional problems such as diplopia or exposure keratopathy. There are three main pathogenic mechanisms: structural alterations in the bony orbit; orbital fat atrophy; and retraction. Evaluation of enophthalmos patients includes orbital imaging and a thorough ophthalmic and systemic examination. In this review, we discuss the presenting features of non-traumatic enophthalmos and include a brief description of the more important causes. An approach to the clinical evaluation of these patients is also discussed together with a brief overview of the principles of management.
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Affiliation(s)
- Paul A Athanasiov
- Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
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Behrens GMN. Treatment options for lipodystrophy in HIV-positive patients. Expert Opin Pharmacother 2007; 9:39-52. [DOI: 10.1517/14656566.9.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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