Background: No perfect solution yet exists for dermal fillers. The authors hypothesized that autologous dermis can be processed in an operator-friendly manner and adopted in selected patients as a filler, following the principle of replacing “like with like.”
Methods: The authors designed a prototype “cutting chamber” to morsel dermis into an injectable form. Autologous injectable dermis grafting was performed in 16 patients who underwent lip or labionasal fold correction concomitant with abdominoplasty or cesarean scar correction; patient dermis was used for the donor graft. Furthermore, injectable dermis grafting was performed in the subcutaneous tissue of three patients undergoing multistage reconstructive procedures for obesity. The grafts were harvested and examined histologically at 3, 7, and 12 months.
Results: Dermis processing and injection proved feasible with limited effort. All 16 patients presented good volume maintenance by 12 months. Two reported transient palpable firmness for the first 6 months, which subsequently resolved. Histological examination of processed and injected dermis showed volume maintenance over time, effective revascularization of the mass, and structural reorganization with collagen bundles and nested fibroblasts reminiscent of reticular dermis. A transient inflammatory reaction was observed, consistent with the expected healing events.
Conclusions: Use of autologous dermis as a filler substance for both aesthetic and reconstructive procedures appears to be a feasible option. It could be advised for patients requiring filler correction who undergo concomitant procedures involving excision of potential donor dermis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Padova, Italy; and Boston, Mass.
From the Institute of Plastic Surgery, University of Padova; the Department of Pathology, University Hospital of Padova; the Division of Plastic Surgery, Brigham and Women's Hospital; and Back Bay Plastic Surgery and Massachusetts General Hospital, Harvard Medical School.
Received for publication May 2, 2012; accepted September 26, 2012.
Disclosure: None of the authors has any commercial or financial interest to disclose. This study did not receive any external financial support.
Daniel A. Del Vecchio, M.D.; Back Bay Plastic Surgery, 38 Newbury Street, Boston, Mass. 02116, firstname.lastname@example.org