Facial Augmentation by Intra-Oral Delivery of Autologous Fat

Background As harvesting techniques have improved the viability of transposed adipose tissue, autologous fat transfer is increasingly utilized for facial augmentation. Conventional techniques involve placing harvested fat deep in subcutaneous tissue through skin punctures. Trans-oral fat injections at the buccal and labial sulci and through the mucosa of the oral commissures obviate external scars. We report experience with this technique for augmentation of the cheeks, zygomatic arch, nasolabial folds, upper and lower lips, and chin in 130 patients over a 14-year period. Methods We report an observational case series of 147 procedures performed in 130 patients (118 women and 12 men, 19-69 years of age) in which 10 to 60 mL autologous fat supernatant harvested from the hips, buttocks, or abdomen were injected through the oral mucosa for augmentation. Single preoperative doses of antibiotic and methylprednisolone were administered in all cases. Fat frozen and banked during initial treatments was used for additional augmentation 3 to 6 months after initial treatments in 46% of cases. Outcomes were assessed clinically with physical exams and photographs. Results Mucosal puncture wounds healed uneventfully. Most patients tolerated the procedures well and recovered rapidly compared to historical experience with conventional percutaneous techniques. One patient developed a sterile seroma 3 weeks after facial augmentation that responded to needle aspiration. Conclusions Transmucosal, intra-oral autologous fat grafting was associated with minimal visible scarring, swelling, or infection at the recipient site. This technique may be considered an alternative to percutaneous transfer for proximate peri-oral facial augmentation.