We treated 22 patients affected by Romberg syndrome,1 hemifacial atrophy, and volumetric deficit with platelet gel mixed with centrifuged fat tissue at the Department of Plastic and Reconstructive Surgery, “Tor Vergata” University of Rome. Patients, ranging in age from 25 to 50 years old, were treated using the Coleman technique.2
The preoperative study included a complete clinical examination, a photographic examination in four projections (frontal, lateral, three-fourths, and axial), and RM of the facial tissue. In addition, in the more complex cases, a high-resolution computed tomography scan was performed, with three-dimensional imaging for a better view of the anatomical structures.3–5 Postoperative follow-up examinations were performed at 2 and 5 weeks, 3, 6, and 12 months, and then annually.
Platelet-rich plasma was prepared from a small volume of blood (9 cc) taken from a peripheral vein using sodium citrate as an anticoagulant. The current systems for preparing platelet concentrations use various centrifuges (we used a centrifuge kit by Cascade at 1100 g for 10 minutes).
The secretion of growth factor begins with platelet activation. The platelet-rich plasma protocol uses Ca2+ to induce platelet activation and exocytosis of the alpha granules.
Platelet gel is a mixture of autologous proteins, containing more than 300,000 to 350,000 platelets/μl4, whose action consists of stimulating skin fibroblasts when injected at a mixed depth (we used 0.5 ml of platelet gel mixed with 1 ml of centrifuged fat tissue), favoring tissue growth by new synthesis of collagen.
We harvested 120 to 180 cc of fat in the abdominal region using specific cannulas of 1.5 mm in diameter. Maintaining asepsis, we took the plungers from the syringes and closed them with their cap, and then positioned them, flat, in the sterile centrifuge.
The syringes were processed for 3 minutes at 3000 rpm. This procedure obtains highly purified fat tissue, preserving the integrity of the adipocyte walls while separating the fluid fat portion from the serous, bloody part. This purified body fat is put in 1-cc syringes and aseptically reinjected using the specific microcannulas for implanting.
After 4 to 8 months, the patients underwent another lipostructure treatment (Coleman)2 to guarantee an optimal three-dimensional reconstruction of the different planes. The implant locations on the face were selected by an accurate study of the necessary corrections (temporal, zygomatic, orbital, buccal, and mandibular regions).
Fat tissue was implanted at different levels in small tunnels that were created by forcing the cannula with precise, controlled movements. Small quantities of fat cells were injected, one or two at a time, in the exiting movement of the cannula in order to create a large grid to favor correct vascular development around each fat cell.
We planned sequential treatments of platelet gel mixed with centrifuged fat tissue followed by the Coleman technique for reconstructing three-dimensional projection of facial contour to restore the superficial density of facial tissues. The results we obtained prove the efficacy of combining these two treatments, and the patients' satisfaction confirms the quality of our results (Figs. 1 and 2).
Valerio Cervelli, M.D.
Pietro Gentile, M.D.
Department of Plastic and Reconstructive Surgery
University “Tor Vergata”
1. Moko SB, Mistry Y, Blandin TM. Parry-Romberg syndrome: Intracranial MRI appearances. J Craniomaxillofac Surg.
2. Coleman SR. The technique of periorbital lipoinfiltration. Oper Tech Plast Reconstr Surg.
3. Moore MH, Wong KS, Proudman TW, David DJ. Progressive hemifacial atrophy (Romberg's disease): Skeletal involvement and treatment. Br J Plast Surg.
4. Azzena B, Mazzoleni F, Abatangelo G, Zavan B, Vindigni V. Autologous platelet- rich-plasma as an adipocyte in vivo delivery system: Case report. Aesthetic Plast Surg.
5. Chbicheb M, Gelot A, Rivier F, et al. Parry-Romberg's syndrome and epilepsy [in French]. Rev Neurol.
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