title: Periorbital Autologous Fat Grafting in Facial Nerve Palsy.
abstract: OBJECTIVE
  To report outcomes and complications of periorbital autologous fat grafting (AFG) in improving volume loss-related symmetry and function in facial nerve palsy patients and to assess patient satisfaction.
  
  
  METHODS
  A retrospective, noncomparative review of all facial nerve palsy patients who underwent periorbital AFG at single center over a 4-year period. Two independent graders objectively assessed standard photographs for any change in volume loss and symmetry: pre- and postoperative periods (early, 0-2 months; intermediate, 3-9 months; and late, >10 months). Any adverse outcomes were recorded. Patient satisfaction was assessed by questionnaire survey.
  
  
  RESULTS
  A total of 18 facial nerve palsy patients (13 females) underwent periorbital AFG between February 2011 and 2015. Mean age was 51.9 ± 15.3 years (range, 26-76). Mean follow up was 6.8 ± 4.6 (range, 0.5-15) months. Photographs of 14 patients were eligible for evaluation. Tear trough visibility (p < 0.01), infraorbital rim visibility (p = 0.03), and lower eyelid-cheek junction symmetry (p < 0.01) improved in the early postoperative period with persistence of improvement in the latter parameter at intermediate postoperative period (p < 0.01). Lagophthalmos significantly improved (p = 0.03) in the early postoperative period. Two patients developed cheek cellulitis and 4 had persistent malar edema (3 had existing edema). Questionnaire survey showed a reduction in daytime ocular lubricants and an improvement in nocturnal-lagophthalmos symptoms.
  
  
  CONCLUSIONS
  Periorbital AFG is a useful adjunct in improving symmetry and lagophthalmos in facial nerve palsy patients where volume loss is a contributory factor but effects were not long lasting. Patient satisfaction is high. Those with preexisting malar bags are at higher risk of developing persistent malar edema following periorbital AFG.
authors.affiliation: *Corneoplastic Unit, and †Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United Kingdom.
authors.forename: We Fong
authors.initials: WF
authors.lastname: Siah
authors.forename: Andre S
authors.initials: AS
authors.lastname: Litwin
authors.forename: Charles
authors.initials: C
authors.lastname: Nduka
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000209:etiology / Q000601:surgery; D005158:Facial Paralysis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit; D017060:Patient Satisfaction; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous