Perforator-Based Anterolateral Thigh Adipofascial or Dermal Fat Flaps for Facial Contour Augmentation

ABSTRACT

We describe our experience with perforator-based anterolateral thigh (ALT) flaps for facial contour augmentations in a standardized two-step procedure. In a series of eight consecutive patients (two men, six women) suffering from contour deformities due to different reasons (scleroderma: three, Parry-Romberg syndrome: three, trauma: one, tumor: one), soft tissue augmentations were performed via a preauricular approach. Flaps were harvested from the ALT as perforator-based dermofat (two) or adipofascial flaps (six) with only a small sheet of fascia and a minimal cuff of muscle around the perforators. All flaps were anastomosed to the superficial temporal vessels. For refinement of the primary result, excess volume was removed and minor contour irregularities were smoothed out after 6 months. Despite the small-vessel caliber, anastomoses caused no problems, and all flaps healed well. Because defects were located close to the temporal vessels, the length of the perforator pedicle was always sufficient. Facial contour could further be improved after secondary reshaping of the healed flaps. This led to nearly perfect long-term facial symmetry in all cases. The ALT proved to be a reliable donor site, providing enough well-vascularized fatty tissue for facial contour augmentation in normal-weight patients. No submandibular incision is necessary if the perforators are anastomosed to the superficial temporal vessels. The preauricular incision gives an excellent view to the operating field.

ALT flap - soft tissue augmentation - adipofascial flaps

REFERENCES

• 1 Vaienti L, Soresina M, Menozzi A. Parascapular free flap and fat grafts: combined surgical methods in morphological restoration of hemifacial progressive atrophy.  Plast Reconstr Surg. 2005;  116 699-711
• 2 Moscona R, Ullman Y, Har-Shai Y, Hirshowitz B. Free-fat injections for the correction of hemifacial atrophy.  Plast Reconstr Surg. 1989;  84 501-507
• 3 de la Fuente A, Tavora T. Fat injections for the correction of facial lipodystropies: a preliminary report.  Aesthetic Plast Surg. 1988;  12 39-43
• 4 Drommer R B, Mende U. Free fat transplantation in the face.  J Craniomaxillofac Surg. 1995;  23 228-232
• 5 Schuller-Petrovic S. Improving the aesthetic aspect of soft tissue defects on the face using autologous fat transplantation.  Facial Plast Surg. 1997;  13 119-124
• 6 Bracaglia R, Loreti A, Tarallo E, Fortunato E. Aesthetic treatment of Romberg's disease with multiple implants of fragmented Gore-Tex soft tissue patch.  Br J Plast Surg. 1998;  51 144-145
• 7 Rees T D, Ashley F L, Delgado J P. Silicone fluid injections for facial atrophy: a ten-year study.  Plast Reconstr Surg. 1973;  52 118-127
• 8 Sabapathy S R, Venkatramani H, Bharath R. Romberg's disease: modified Washio flap for facial contour reconstruction.  Plast Reconstr Surg. 2001;  108 705-708
• 9 Avelar J M, Psillakis J M. The use of galea flaps in craniofacial deformities.  Ann Plast Surg. 1981;  6 464-469
• 10 Harashina T, Nakajima T, Yoshimura Y. A free groin flap reconstruction in progressive facial hemi-atrophy.  Br J Plast Surg. 1977;  30 14-16
• 11 Anderl H. Free vascularized groin fat flap in hypoplasia and hemiatrophy of the face (a 3 years observation).  J Maxillofac Surg. 1979;  7 327-332
• 12 Koshima I, Inagawa K, Urushibara K, Ohtsuki M, Moriguchi T. Deep inferior epigastric perforator dermal fat or adiposal flap for correction of craniofacial contour deformities.  Plast Reconstr Surg. 2000;  106 10-15
• 13 Koshima I. Short pedicle superficial inferior epigastric artery adiposal flap: new anatomical findings and the use of this flap for reconstruction of facial contour.  Plast Reconstr Surg. 2005;  116 1091-1097
• 14 Goossens S, Coessens B. Facial contour restoration in Barraquer-Simons syndrome using two free TRAM flaps: presentation of two case reports and long-term follow-up.  Microsurgery. 2002;  22 211-218
• 15 Upton J, Albin R E, Mulliken J B, Murray J E. The use of scapular and parascapular flaps for cheek reconstruction.  Plast Reconstr Surg. 1992;  90 959-971
• 16 Rigotti G, Cristofoli C, Marchi A, Bruti M, Pignatti M. Treatment of Romberg's disease with parascapular free flap and polyethylene porous implants.  Facial Plast Surg. 1999;  15 317-325
• 17 Guelinckx P J, Sinsel N K. Facial contour restoration in Barraquer-Simons syndrome using two free anterolateral thigh flaps.  Plast Reconstr Surg. 2000;  105 1730-1736
• 18 Hsieh C H, Yang C C, Kuo Y R, Tsai H H, Jeng S F. Free anterolateral thigh adipofascial perforator flap.  Plast Reconstr Surg. 2003;  112 976-982
• 19 Agostini V, Dini M, Mori A, Franchi A, Agostini T. Adipofascial anterolateral thigh free flap for tongue repair.  Br J Plast Surg. 2003;  56 614-618
• 20 Guerrerosantos J. Long-term outcome of autologous fat transplantation in aesthetic facial recontouring: sixteen years of experience with 1936 cases.  Clin Plast Surg. 2000;  27 515-543
• 21 Fujino T, Tanino R, Sugimoto C. Microvascular transfer of free deltopectoral dermal-fat flap.  Plast Reconstr Surg. 1975;  55 428-434
• 22 Shintomi Y, Ohura T, Honda K, Iida K. The reconstruction of progressive facial hemi-atrophy by free vascularized dermis- fat flaps.  Br J Plast Surg. 1981;  34 398-409
• 23 Williams H B, Crepeau R J. Free dermal fat flaps to the face.  Ann Plast Surg. 1979;  3 1-12
• 24 Dunkley M P, Stevenson J H. Experience with the free “inverted” groin flap in facial soft tissue contouring: a report on 6 flaps.  Br J Plast Surg. 1990;  43 154-158
• 25 Siebert J W, Anson G, Longaker M T. Microsurgical correction of facial asymmetry in 60 consecutive cases.  Plast Reconstr Surg. 1996;  97 354-363
• 26 Wells J H, Edgerton M T. Correction of severe hemifacial atrophy with a free dermis-fat flap from the lower abdomen.  Plast Reconstr Surg. 1977;  59 223-230
• 27 Jurkiewicz M J, Nahai F. The use of free revascularized grafts in the amelioration of hemifacial atrophy.  Plast Reconstr Surg. 1985;  76 44-55
• 28 Koshy C E, Evans J. Facial contour reconstruction in localized lipodystrophy using free radial forearm adipofascial flaps.  Br J Plast Surg. 1998;  51 499-502
• 29 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 149-159
• 30 Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects.  Plast Reconstr Surg. 1993;  92 421-428
• 31 Pribaz J J, Orgill D P, Epstein M D, Sampson C E, Hergrueter C A. Anterolateral thigh free flap.  Ann Plast Surg. 1995;  34 585-592