PURPOSE: Rejuvenation of midface have been treated with various methods including autologous fat injection. However, liponecrotic pseudocyst may occur after roughly performed fat injection.1 The patients complain of subcutaneous nodules with abnormal symptoms such as tenderness, persistent swelling.2 The current study describes the authors’ experience to treat liponecrotic pseudocyst following fat transfer in the midface.
METHODS AND MATERIALS: We performed a retrospective review of management of 20 patients who presented with complications from injection of autologous fat for midface rejuvenation from October 2016 to November 2017. The procedure was performed under local anesthesia with intravenous sedation. About 3 cc of tumescent solution is injected subcutaneously around the cystic mass. Using 18 gauge blunt cannula, we tried to break the cystic wall mechanically and aspirate necrotic material while palpation and squeezing. The remnant chronic inflammation and fibrosis were reduced by intralesional injection of mixture of triamcinolone and verapamil. One 43 cm long U-shaped and three 9 cm long 1-0 absorbable face-lift sutures which are composed of polydioxanone (QTL, S.THEPHARM Inc., Seoul, Korea) were inserted each side through the subcutaneous plane to achieve superolateral and vertical elevation of the malar fat pad, respectively. The treatment outcomes were evaluated both objectively and subjectively. For objective assessment, two physicians who were not involved in the surgeries assessed surgical outcomes using serial photography. For subjective assessment, the results were evaluated by the patients based on post-operative satisfaction ratings on a five-point scale (excellent (5), very good (4), good (3), neutral (2) or poor (1)) 6 months after the operation by comparing the preoperative and postoperative clinical photos.
RESULTS: Of the 20 patients evaluated, all were women with a mean age of 35.9 (range, 24–46). The mean follow-up was 6 months (range, 3–12 months). Consensus ratings by the two independent physicians revealed that objective outcomes were divided between ‘very much improved’, ‘significantly improved’, and ‘no change’. All plastic surgeons reconized that postoperative appearance was improved after treatment; twelve were considered very much improved (60 %) and eight were considered significantly improved (40 %). The overall patient satisfaction with aesthetic outcome was reported as follows: excellent, 12 patients (60 %); very good, 4 patients (20 %); and good, 4 patients (20 %). No patients had neutral or poor aesthetic outcome. Additional revisional surgery was needed in 2 cases. Two patients were corrected simply by liposuction for small remnant pseudocyst. No other severe complications were reported.
CONCLUSIONS: Undesirable complications of autologous fat injection such as liponecrotic pseudocyst and midface ptosis can be successfully treated by our minimally invasive combination therapy in mid-term follow-up. However, longer follow-up is mandatory to determine the benefits of the current technique in properly selected patients.
1. Mineda K, Kuno S, Kato H, et al. Chronic inflammation and progressive calcification as a result of fat necrosis: The worst outcome in fat grafting. Plast Reconstr Surg. 2014; 133: 1064–72.
2. Yoshimura K, Coleman SR. Complications of fat grafting: How they occur and how to find, avoid, and treat them. Clin Plast Surg. 2015;42:383–8.