Application of microautologous fat transplantation in the correction of sunken upper eyelid

Abstract

Background: Although fat grafting has been clinically applied by surgeons in esthetic and reconstructive surgery, it has widely evolved in processes such as harvesting, processing, and placement of fat, using the fat-grafting procedure, which dates back over 100 years. Surgeons frequently use fat grafting to recontour, augment, or fill soft-tissue defects, facial wrinkles, or skin problems such as depressions or scars. However, fat grafting has not been thoroughly understood and has not been conclusively standardized to ensure superior clinical results.

Methods: This study was intended to determine the role of microautologous fat transplantation (MAFT) under evidence-based medicine, particularly in accurate delivery of small fat parcels. The research method involved the conceptualization of MAFT and the development of an innovative surgical instrument for fat placement. Clinically, 168 patients with sunken upper eyelids with multiple folds underwent this procedure.

Results: The major findings suggested that MAFT exhibits promising clinical results and offers a superior guideline for fat placement. Details of the technique and theoretical implications are also discussed.

Conclusions: The therapeutic effects of MAFT and the long-term clinical results of patients with sunken upper eyelids with multiple folds indicated satisfactory outcomes. Based on the results, MAFT offers an alternative option to surgeons for performing fat grafting and provides a more favorable option for the benefit and welfare of patients by reducing the potential complications.

Conflict of interest statement

Disclosure: Dr. Tsai-Ming Lin owns the patent rights of MAFT-Gun, is the scientific advisor of DPB, and received partial financial support from DPB, which is the manufacturer of the MAFT-Gun device. None of the other authors has any financial disclosures. The Article Processing Charge was paid for by the authors.

Figures

Fig. 1.

A, The processed fat after centrifugation was transferred from a 10-mL syringe to a 1-mL Luer Slip syringe through a transducer. B, The fat-filled syringe was loaded into the MAFT-Gun, and the fat was ready for transplantation. C, The predetermined fat volume of each delivery by triggering could be adjusted by switching the dial (“240” stands for each delivered fat parcel by pulling the trigger, which equals 1/240 mL). D, Panoramic view of the MAFT-Gun.

Fig. 2.

A, Sagittal view of the upper eyelid. B, The lower (deep) layers were transplanted with 3 to 4 layers of fat parcels (preferable volume of each parcel, 1/240 mL); the fat parcel was red in color. C, The intermediate (middle) layers were transplanted with 2 to 3 layers of fat parcels, each with a volume of 1/240 mL; the fat parcel was blue in color. D, The upper (superficial) layers were transplanted with a layer of the fat parcel (recommended volume of each parcel, 1/240 mL); the fat parcel was brown in color.

Fig. 3.

A 42-year-old woman suffered from bilateral sunken upper eyelids with multiple folds. One-time MAFT was performed at 2.2 mL/2.4 mL (right/left side). A, preoperative frontal view (left) and left profile view 12 months after grafting (right). B, Preoperative left profile view (left) and 12 months after grafting (right).

Fig. 4.

A 47-year-old woman underwent MAFT for the hollowness of her upper eyelids with multiple folds. One-time MAFT was performed at 1.8 mL/2.0 mL (right/left). A, Preoperative frontal view (left) and at 6 months follow-up (right). B, Preoperative left profile view (left) and at the 6-month postoperative follow-up (right). C, Preoperative right lateral view (left) and at 6-month postoperative follow-up (right).

Fig. 5.

Unilateral sunken eyelid of a 28-year-old woman who received MAFT at 1.5 mL on her left upper eyelid. A, Preoperative frontal view. B, Frontal view at the 6-month follow-up. Inset, Blue marking on left upper eyelid was the grafted area.

Fig. 6.

A 58-year-old woman requested recontouring of her bilateral sunken upper eyelids with left-side entropion (A) because of 2 previous blepharoplasties. Fat grafting was performed using MAFT at 1.2 mL/2.5 mL (right/left). B, The results observed 3 months after MAFT were satisfactory. C, Long-term results indicated that the recontouring was well maintained 15 months after grafting.

Fig. 7.

A, Sagittal view indicated an irregular, depressed area. B, Traditional fat-grafting was performed through injection and overcorrection. Three large fat parcels, A, B, and C, appeared. At this time, the overcorrection resulted in bulging of the surface of the depressed areas. C, After vigorous manual massage, the 3 parcels, A, B, and C, came into contact with each other and fused as a larger fat entity. D, Although the skin surface of the bulged areas smoothened and flattened after massage, the central area of this conjoined parcel, A + B + C, was presumed to have necrotized. E, Several weeks after the event of central necrosis, some absorption areas resulted in irregular skin surfaces, as presented between the 2 arrows in this figure. The newly formed depression or irregularity was visible after grafting.

Video 1.

See video, Supplemental Digital Content 1, which displays the microautologous fat transplantation for sunken upper eyelids. This video is available in the “Related Videos” section of the full-text article at http://www.PRSGo.com and is available at http://links.lww.com/PRSGO/A55.