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Periorbital Autologous Fat Grafting in Facial Nerve Palsy

Siah, We Fong M.R.C.P.I., F.R.C.S.I. (Ophth.), F.R.C.Ophth.*; Litwin, Andre S. F.R.C.Ophth.*; Nduka, Charles M.D., F.R.C.S., F.R.C.S. (Plas.); Malhotra, Raman F.R.C.Ophth.*

Ophthalmic Plastic and Reconstructive Surgery: May/June 2017 - Volume 33 - Issue 3 - p 202–208
doi: 10.1097/IOP.0000000000000710
Original Investigations

Purpose: To report outcomes and complications of periorbital autologous fat grafting (AFG) in improving volume loss-related symmetry and function in facial nerve palsy patients and to assess patient satisfaction.

Methods: A retrospective, noncomparative review of all facial nerve palsy patients who underwent periorbital AFG at single center over a 4-year period. Two independent graders objectively assessed standard photographs for any change in volume loss and symmetry: pre- and postoperative periods (early, 0–2 months; intermediate, 3–9 months; and late, >10 months). Any adverse outcomes were recorded. Patient satisfaction was assessed by questionnaire survey.

Results: A total of 18 facial nerve palsy patients (13 females) underwent periorbital AFG between February 2011 and 2015. Mean age was 51.9 ± 15.3 years (range, 26–76). Mean follow up was 6.8 ± 4.6 (range, 0.5–15) months. Photographs of 14 patients were eligible for evaluation. Tear trough visibility (p < 0.01), infraorbital rim visibility (p = 0.03), and lower eyelid-cheek junction symmetry (p < 0.01) improved in the early postoperative period with persistence of improvement in the latter parameter at intermediate postoperative period (p < 0.01). Lagophthalmos significantly improved (p = 0.03) in the early postoperative period. Two patients developed cheek cellulitis and 4 had persistent malar edema (3 had existing edema). Questionnaire survey showed a reduction in daytime ocular lubricants and an improvement in nocturnal-lagophthalmos symptoms.

Conclusion: Periorbital AFG is a useful adjunct in improving symmetry and lagophthalmos in facial nerve palsy patients where volume loss is a contributory factor but effects were not long lasting. Patient satisfaction is high. Those with preexisting malar bags are at higher risk of developing persistent malar edema following periorbital AFG.

Periorbital autologous fat grafting in patients with facial nerve palsy has the potential to improve symmetry and lagophthalmos in the short to intermediate postoperative period.

*Corneoplastic Unit, and Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United Kingdom

Accepted for publication March 11, 2016.

Preliminary results from this study were presented as a poster at the British Oculoplastic Surgery Society (BOPSS) Annual Meeting, June 2015.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Raman Malhotra, F.R.C.Ophth., Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, United Kingdom. E-mail:

© 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.