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Optimizing Fat Graft Processing: A Prospective, Controlled Clinical Trial Comparing Telfa Rolling versus Centrifugation for Fat Grafting Craniofacial Deformities
Isaac B. James, MD, Debra Bourne, MD, Danielle Minteer, PhD, Sheri Wang, BS, Albert Donnenberg, PhD, Vera Donnenberg, PhD, Barton Branstetter, MD, Kacey Marra, PhD, Sydney Coleman, MD, J Peter Rubin, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND:
Fat grafting has become a powerful tool in the plastic surgeonís armamentarium. It is a safe and effective reconstructive method for craniofacial deformities. However, the usefulness of fat grafting remains tempered by variable retention which often necessitates multiple procedures to achieve desired results. The aim of this prospective, controlled clinical trial is to compare the efficacy of two commonly used fat graft processing techniques (telfa rolling and centrifugation) for the reconstruction of craniofacial deformities.
METHODS:
Twenty-nine patients underwent fat grafting procedures for the treatment of craniofacial deformities. Patients underwent fat graft processing by either telfa rolling (n=10) or centrifugation (n=19). Follow-up was nine months. Outcome measures included volume retention as measured by 3D CT scans, a facial volume appearance scale (FVAS) scored by a member of the surgical team, and cellular composition of stromal vascular fraction (SVF) measured by flow cytometry.
RESULTS:
Average age was 40. Average BMI was 27. BMI was stable throughout the course of the study. Sixty percent of participants were male. Average volume injected in the telfa and centrifuge groups was 22.2mL (SD 12.3) and 26.1mL (SD 12.2) respectively. Average volume retention in the telfa rolling group was significantly lower than in the centrifugation group (35% (SD 15.7) vs 63% (SD 16) respectively; p=0.001). Similarly, the telfa group had a significantly lower proportion of adipose stem cells (ASCs) in SVF isolates (56% (SD 35) vs 83% (SD 12); p=0.009). Results from visual assessment of facial volume were similar between the groups at nine months.
CONCLUSIONS:
Fat grafts processed both by telfa rolling and by centrifugation resulted in significant improvements in facial appearance. However, when compared to telfa rolling, fat grafts processed by centrifugation resulted in higher volume retention. This difference may be partly related to a smaller proportion of ASCs seen in fat grafts processed by telfa rolling.


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