Long-Term Outcome of Fat Grafting to Treat Facial Systemic Sclerosis: A Prospective Cohort Study

Abstract

Background: – Systemic sclerosis (SSc) is characterized by subcutaneous tissue loss and dermal fibrosis, with limited facial movement and mouth opening. Fat grafting is a minimally invasive technique used to restore facial volume and improve skin fibrosis. Methods: – A cohort of 93 patients were assessed using 3-dimensional imaging before and after fat grafting. Secondary outcomes included physician-based assessment; mouth function (using the Mouth Handicap in Systemic Sclerosis Scale), psychological status, quality of life (using the Derriford Appearance Scale, Hospital Anxiety and Depression Scale, visual analog scale, and Brief Fear of Negative Evaluation Scale); and patient satisfaction. Results: – After an average of 2.96 ± 2.2 sessions of fat grafting, with an injection volume of 11.9 ± 6 cc in each session, the overall retention rate was 53.1% ± 0.17% at an average follow-up of 3.11 ± 1.73 years. Patients undergoing 5 or more interventions presented a higher retention rate (73.1% ± 0.08%) than those receiving 1 or 2 treatments (45.2% ± 0.09% and 50.5% ± 0.15%, respectively) (P < 0.05). Significant improvements were found in mouth function (P < 0.0001) and quality of life (P < 0.0001). Conclusions: – Facial fat grafting is an effective technique for restoring facial volume and improving oral function and quality of life in patients with scleroderma. This study presents the largest number of patients published to date with the longest follow-up period. CLINICAL QUESTION/LEVEL OF EVIDENCE: – Therapeutic, IV.