Efficacy and Safety of Autologous Fat Transfer in Facial Reconstructive Surgery: A Systematic Review and Meta-analysis

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.

Figure 1.. Examples of Indications That Could Potentially Benefit From Autologous Fat Transfer

This is an original illustration by Todor K. Krastev, MD, depicting patients with acquired soft-tissue defects who could benefit from the autologous fat transfer technique.

Figure 2.. Study Selection Process

Flow diagram depicting the number of articles identified, retrieved, screened, and included in the final systematic review and meta-analysis.

Figure 3.. Patient and Surgeon Satisfaction

This model is based on categorical data. AFT indicates autologous fat transfer; NR, data not reported.

Figure 4.. Meta-analysis of Patient and Surgeon Satisfaction

This model is based on continuous data. AFT indicates autologous fat transfer; NR, data not reported.

Figure 5.. Meta-analysis of Graft Retention Over Time for Patients Who Underwent Facial Reconstruction

A, Volume retention in patients with congenital deformities (circles). B, Volume retention in patients with HIV-associated lipodystrophy. Studies were categorized based on whether patients experienced a normal (expected) rate of resorption (yellow circles) or extreme hypertrophy (blue circles). The size of the circles corresponds to sample size, thick lines represent meta-regression effect estimates and their respective 95% CI (gray dotted lines). The total number of patients with volume measurements at each time point in the follow-up is shown below. HIV indicates human immunodeficiency virus.