title: Necrotizing metachronous facial ulcerations after "stem cell face lift".
abstract: BACKGROUND
  A 63-year-old woman underwent face and neck lift with autologous fat transfer-called by her physician a "stem cell face lift."
  
  
  METHODS
  Fatty aspirate from her abdominal wall was enriched by hyaluronic acid, triiodothyronine, thyroxine, insulin, dimethylaminoethanol, estriol, dexamethasone, indomethacin, and fibroblast growth factor before injection into the face.
  
  
  RESULTS
  At approximately 4-weeks postoperative, the patient developed facial swellings, erythema, necrotizing ulcers, and an orocutaneous fistula. New lesions continued occurring up to 16 weeks after surgery. After multiple surgical debridements and an oral course of rifampin, a decisive reduction in inflammation and healing was observed. Differential diagnosis included (1) mistaken transfer of allogeneic fat (ruled out), (2) toxic impurities in transferred material, (3) microbial contaminant(s) from multiple use liposuction cannula or tissue markers, and (4) endogenous anaerobic orofacial infection (history of previous radiation for tonsillar cancer and dental implants).
  
  
  CONCLUSIONS
  The most probable etiology was mycobacterial infection. This is based on a single colony of mycobacterium isolated, histologic finding revealing granulomatous inflammation, and the favorable response to rifampin. The patient underwent subsequent autologous fat transfers, which successfully reduced some disfigurement and scarring.
authors.affiliation: From the *Division of Plastic Surgery, School of Medicine, University of California San Diego, San Diego, CA; and †Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Marek
authors.initials: M
authors.lastname: Dobke
authors.forename: Jason
authors.initials: J
authors.lastname: Bailey
authors.forename: Dhaval
authors.initials: D
authors.lastname: Bhavsar
authors.forename: Salim
authors.initials: S
authors.lastname: Saba
authors.forename: Brian
authors.initials: B
authors.lastname: Mailey
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D005148:Facial Dermatoses / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000209:etiology* / Q000473:pathology*; D009336:Necrosis; D015361:Rhytidoplasty / Q000009:adverse effects* / Q000379:methods*; D012883:Skin Ulcer / Q000209:etiology* / Q000473:pathology*