Fat Grafting an Ideal Filler For Contour Deformities With Hyperpigmentation On Face
Condition: Hyperpigmentation
MeSH terms: Hyperpigmentation
Study type: Interventional

Summary: 
      Pigmentary changes are commonly associated with contour defects of facial region. These
      deformities cause cosmetic concerns. Traditionally used techniques indwelling limitations and
      therefore it invokes innovative techniques to treat contour abrasion and pigmentation
      simultaneously. The current study focuses on evaluation of the role of autologous fat in
      improving contour defects of face associated with hyperpigmentation. 100 subjects having
      contour defects related skin pigmentation were recruited from Feb 2022 till Feb 2023. Fat was
      harvested, processed under sterilized conditions and grafted into the affected regions of
      face. The patients were kept under follow up for one year after fat injection. Subjective as
      well as objective evaluation was done before treatment and one year after fat injection.
      Results showed significant improvement in pigmentation after fat injection. Most of the
      patients had high satisfaction regarding improvement in pigmentation and pliability of the
      grafted area after use of fat graft. A software Image J was applied to objectively showing
      changes in hyperpigmentation of face after fat graft. In conclusion, utility of autologous
      fat has effective and promising role as an ideal filler for treating contour defects of face
      with pigmentary changes
    

Detailed description: 
      Introduction Facial contour defects need augmentation have pigmentary issues related to them.
      Such defects are noticed after trauma, autoimmune disease or after infection. These combined
      contour and pigmentary defects cause social as well as aesthetic concerns. Discolored skin
      makes them more prominent. Conventionally, fillers are employed but these are short lived at
      one hand while do not treat pigmentation on the other hand. Body tissues in the form of flaps
      have also been tried but with the same outcome as with the fillers. Lasers and chemical
      depigmentation improve skin color but has to do nothing with filling of the contour. In short
      so far, no single satisfactory remedy is available for such issues. Therefore, some
      innovative strategy is needed which can fill contour defect and resolves pigmentation too.

      Adipose tissue, being autologous, is a pronounced source with regenerative potential as well
      as natural augmentation. Due to its abundance, easy harvesting and pliability at recipient
      site make it ideal. Filling effect is just one aspect rather grafted fat not only softens
      scars, rejuvenates skin but also improves pigmentation. Therefore, in our study we aimed at
      the evaluation of fat as an ideal filler.

      Materials and Methods This prospective study was conducted in Plastic & Reconstructive
      Surgery Department of KEMU Lahore from Feb 2022 to Feb 2023. Hundred patients of both genders
      and age between 10 to 50 years having contour defects on face were recruited.

      Patients having rejuvenation procedure like filler, laser, depigmentation or PRP done were
      excluded from the study. Biodata along with deformity details were noted. Advantages,
      limitations and likely complications related to the procedure were explained and informed
      consent was documented.

      Pre-procedure skin texture, color and defect was noted. Donor area was marked and local
      anesthesia with 0.5% Xylocain and 1:500,000 Adrenaline in normal saline was infiltrated with
      one milliliter of fluid for one milliliter of fat to be procured. Fat was procured with blunt
      2-mm multi-hole cannula using 10cc Luer-Lok syringe under manual suction applied not more
      than 2ml. Then fat was transferred to recipient area by using Icc syringe and infiltration
      canula till symmetry achieved with contralateral respective area of face. Grafted area
      photographed and integrated color density (ICD1) was found with ImageJ. All patients were
      observed for 24 hours to look for any complication. Oral analgesic and antibiotics were
      prescribed for 3 days. Patients were kept under monthly follow up and sessions were repeated
      if required (13). Subjective as well as objective measurement of outcomes was done. For
      objective evaluation, repeat photograph was taken after one year of deformity got resolved.
      Integrated color density (ICD2) was again measured and compared with ICD1. For subjective
      evaluation, patient's was noted.

      Findings were recorded and variables like age, gender, area involved, duration, ICD and
      satisfaction documented. SPSS 22 used for data analysis with p- Value <0.05 considered
      significant.
    

Intervention name(s): Autologous fat grafting
Intervention type(s): Procedure
Intervention description(s): Autologous fat grafted at contour defects with pigmentary changes
Intervention model: Single Group Assignment
Intervention model description: Cohort study
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Pigmentation; Contour defect; Fat grafting