PDF herunterladen
Facial Plast Surg
DOI: 10.1055/s-0044-1786185
Original Research

Characterization of Fat Used for the Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty

Katharina Storck
1   Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
,
Siegfried Ussar
2   Research Unit Adipocytes and Metabolism (ADM), Institute for Diabetes and Obesity at Helmholtz Center Munich, Neuherberg, Germany
,
Sebastian Kotz
1   Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
,
Irem Altun
2   Research Unit Adipocytes and Metabolism (ADM), Institute for Diabetes and Obesity at Helmholtz Center Munich, Neuherberg, Germany
,
Fiona Hu
2   Research Unit Adipocytes and Metabolism (ADM), Institute for Diabetes and Obesity at Helmholtz Center Munich, Neuherberg, Germany
,
Amelie Birk
1   Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
,
Johannes Veit
3   Praxis für Nasenchirurgie München, Munich, Germany
,
Milos Kovacevic
4   HNO-Praxis Hanse-Viertel, Hamburg, Germany
› Institutsangaben Funding The authors wish to acknowledge financial support received from Legerlotz Foundation.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Septorhinoplasty (SRP) is one of the most common aesthetic procedures worldwide. A thin or scarred soft tissue envelope, especially in the context of secondary SRP, can lead to unpredictable scarring, shrinkage, and discoloration of the skin. Other than the careful preparation of the soft tissue mantle, no gold standard exists to minimize the above-mentioned risks. Our aim was to create a thin “separation layer” between the nasal bridge (osseous and cartilaginous) and the skin envelope by autologous fat transfer with the addition of platelet-rich fibrin (PRF) to conceal small irregularities, to improve the quality of the skin soft tissue mantle, and to optimize the mobility of the skin. We report 21 patients who underwent SRP on a voluntary basis. All patients had either thin skin and/or revision SRP with scarring. Macroscopic fat harvested from the periumbilical or rib region was minced and purified. PRF was obtained by centrifugation of autologous whole blood samples and mixed with the fat to form a graft, which was then transferred to the nasal dorsum. Postoperative monitoring of graft survival included sonography and magnetic resonance imaging (MRI) of the nose. The harvested adipose tissue was also analyzed in vitro. In the postoperative follow-up after 1 year, survival of the adipose tissue was demonstrated in all patients by both sonography and MRI. The in vitro analysis showed interindividual differences in the quantity, size, and quality of the transplanted adipocytes. Camouflage of the nasal bridge by using adipose tissue was beneficial for the quality of the skin soft tissue mantle and hence represents a good alternative to known methods. Future aims include the ability to assess the quality of adipose tissue to be transplanted based on clinical parameters. Level of evidence: N/A.

Keywords

rhinoplasty - revision rhinoplasty - nasal dorsum - platelet-rich fibrin - fat transfer


Publikationsverlauf

Artikel online veröffentlicht:
30. April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kosins AM. Comprehensive diagnosis and planning for the difficult rhinoplasty patient: applications in ultrasonography and treatment of the soft-tissue envelope. Facial Plast Surg 2017; 33 (05) 509-518
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Kovacevic M, Kosins AM, Göksel A, Riedel F, Bran G, Veit JA. Optimization of the soft tissue envelope of the nose in rhinoplasty utilizing fat transfer combined with platelet-rich fibrin. Facial Plast Surg 2021; 37 (05) 590-598
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee Jr WF. Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 1996; 122 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 4 Kerolus JL, Nassif PS. Treatment protocol for compromised nasal skin. Facial Plast Surg Clin North Am 2019; 27 (04) 505-511
    CrossrefPubMedGoogle Scholar
  • 5 Rosenberger ES, Toriumi DM. Controversies in revision rhinoplasty. Facial Plast Surg Clin North Am 2016; 24 (03) 337-345
    CrossrefPubMedGoogle Scholar
  • 6 Çakır B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
    CrossrefPubMedGoogle Scholar
  • 7 Saban Y. Rhinoplasty: lessons from “errors” : from anatomy and experience to the concept of sequential primary rhinoplasty. HNO 2018; 66 (01) 15-25
    CrossrefPubMedGoogle Scholar
  • 8 Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg 1997; 24 (02) 347-367
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Hassan WU, Greiser U, Wang W. Role of adipose-derived stem cells in wound healing. Wound Repair Regen 2014; 22 (03) 313-325
    CrossrefPubMedGoogle Scholar
  • 11 Sinno S, Wilson S, Brownstone N, Levine SM. Current thoughts on fat grafting: using the evidence to determine fact or fiction. Plast Reconstr Surg 2016; 137 (03) 818-824
    CrossrefPubMedGoogle Scholar
  • 12 Sclafani AP, Saman M. Platelet-rich fibrin matrix for facial plastic surgery. Facial Plast Surg Clin North Am 2012; 20 (02) 177-186 , vi vi
    CrossrefPubMedGoogle Scholar
  • 13 Choukroun J, Adda F, Schoeffler CVA. An opportunity in periimplantology: the PRF. Implantodontie 2001; 42: 55-62
    PubMedGoogle Scholar
  • 14 Verboket RD, Anbar B, Söhling N. et al. Changes in platelet-rich fibrin composition after trauma and surgical intervention. Platelets 2020; 31 (08) 1069-1079
    CrossrefPubMedGoogle Scholar
  • 15 Storck K, Kotz S, Riedel F, Veit JA. Complications associated with alloplastic materials in rhinoplasty and their operative management. Facial Plast Surg 2023; (e-pub ahead of print) DOI: 10.1055/s-0043-1772846.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Cao Y. Adipose tissue angiogenesis as a therapeutic target for obesity and metabolic diseases. Nat Rev Drug Discov 2010; 9 (02) 107-115
    CrossrefPubMedGoogle Scholar
  • 17 Jansson PA. Endothelial dysfunction in insulin resistance and type 2 diabetes. J Intern Med 2007; 262 (02) 173-183
    CrossrefPubMedGoogle Scholar
  • 18 Strassburg S, Nienhueser H, Stark GB, Finkenzeller G, Torio-Padron N. Human adipose-derived stem cells enhance the angiogenic potential of endothelial progenitor cells, but not of human umbilical vein endothelial cells. Tissue Eng Part A 2013; 19 (1–2): 166-174
    CrossrefPubMedGoogle Scholar
  • 19 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 Surg 2018; 20 (05) 351-360
    CrossrefPubMedGoogle Scholar
  • 20 Erol OO. Microfat grafting in nasal surgery. Aesthet Surg J 2014; 34 (05) 671-686
    CrossrefPubMedGoogle Scholar
  • 21 Kao W-P, Lin Y-N, Lin T-Y. et al. Microautologous fat transplantation for primary augmentation rhinoplasty: long-term monitoring of 198 Asian patients. Aesthet Surg J 2016; 36 (06) 648-656
    CrossrefPubMedGoogle Scholar
  • 22 Storck K, Fischer R, Buchberger M, Haller B, Regn S. Delivered adipose-derived stromal cells improve host-derived adipose tissue formation in composite constructs in vivo. Laryngoscope 2017; 127 (12) E428-E436
    CrossrefPubMedGoogle Scholar
  • 23 Ell J, Regn S, Buchberger AM. et al. Donor-dependent variances of human adipose-derived stem cells in respect to the in-vitro endothelial cell differentiation capability. Adipocyte 2017; 6 (01) 20-32
    CrossrefPubMedGoogle Scholar
  • 24 Gabrick K, Walker M, Timberlake A, Chouairi F, Saberski E, Steinbacher D. The effect of autologous fat grafting on edema and ecchymoses in primary open rhinoplasty. Aesthet Surg J 2020; 40 (04) 359-366
    CrossrefPubMedGoogle Scholar
  • 25 Nguyen PS, Baptista C, Casanova D, Bardot J, Magalon G. Rhinoplastie et injection de tissu adipeux autologue. Ann Chir Plast Esthet 2014; 59 (06) 548-554
    CrossrefPubMedGoogle Scholar
  • 26 Kovacevic M, Riedel F, Wurm J, Bran GM. Cartilage scaled embedded in fibrin gel. Facial Plast Surg 2017; 33 (02) 225-232
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 27 Crowley JS, Kream E, Fabi S, Cohen SR. Facial rejuvenation with fat grafting and fillers. Aesthet Surg J 2021; 41 (Suppl. 01) S31-S38
    CrossrefPubMedGoogle Scholar
  • 28 Lin T-M, Huang S-H, Lin Y-N. et al. Fat grafting for facial contouring (nose and chin). Clin Plast Surg 2020; 47 (01) 91-98
    CrossrefPubMedGoogle Scholar
  • 29 Daniel R, Palhazi P. Rhinoplasty: An Anatomical and Clinical Atlas. 1st ed.. Heidelberg: Springer; 2018
    CrossrefGoogle Scholar
  • 30 Zuk PA, Zhu M, Mizuno H. et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 2001; 7 (02) 211-228
    CrossrefPubMedGoogle Scholar
  • 31 Kilroy GE, Foster SJ, Wu X. et al. Cytokine profile of human adipose-derived stem cells: expression of angiogenic, hematopoietic, and pro-inflammatory factors. J Cell Physiol 2007; 212 (03) 702-709
    CrossrefPubMedGoogle Scholar
  • 32 Salgado AJ, Reis RL, Sousa NJ, Gimble JM. Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine. Curr Stem Cell Res Ther 2010; 5 (02) 103-110
    CrossrefPubMedGoogle Scholar