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01 February 2022, Volume 18 Issue 1 Previous Issue    Next Issue

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Surgical treatment of lymphedema　 WANG Xin 2022, 18 (1):  1.  Abstract ( 116 )   PDF (307KB) ( 74 )   【Key words】　Lymphedema;　Surgical treatment;　Vascularized lymph node transplantation Related Articles | Metrics

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Transplantation of flap with lymph nodes in the treatment of lower extremity lymphedema　 CHEN Chuan, PAN Jiadong, HUANG Yaopeng, et al 2022, 18 (1):  4.  Abstract ( 136 )   PDF (538KB) ( 106 )   Transplantation of flap with lymph nodes in the treatment of lower extremity lymphedema　CHEN Chuan, PAN Jiadong, HUANG Yaopeng, YIN Shanqing, ZHOU Xianting, WANG Xin. Ningbo No.6 Hospital, Ningbo 315100, China. Corresponding author: WANG Xin (E-mail: dr.wangxin@hotmail.com). 【Abstract】　Objective　To explore the efficacy of flap transplantation with lymph nodes in the treatment of lower extremity lymphedema. Methods　From June 2019 to June 2021, 5 cases with stage II-III lower extremity lymphedema were treated with flap transplantation with lymph nodes. The size of the flap was (10-30) cm×(4-9) cm. The recipient area was selected in the lower leg area. The vessels in the recipient area were anterior tibial artery and accompanying vein. Follow up was carried out after operation. Results　One patient had partial necrosis of flap after operation. After dressing change, the wound healed with scar, and the flap of the other 4 cases survived well. After follow-up for 0.5-2 years, the peripheral diameter of the affected limb was decreased by 0.84 cm and 2.29 cm on average at 1 month and 6 months after operation. No lymphangitis was observed, and there was no lymphatic leakage and lymphedema in the donor area. Conclusion　The short-term effect of lymph node flap transplantation in the treatment of limb lymphedema is good with no complications in the donor area. It is one of the optional treatment methods for early and mid-term limb lymphedema. Related Articles | Metrics

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Application of thin vascularized lymph node transfer combined with reverse mapping in the treatment of secondary upper extremity lymphedema LIAO Xiaoming, JIANG Yi, TANG Wei, et al 2022, 18 (1):  8.  Abstract ( 152 )   PDF (1676KB) ( 117 )   Objective　To explore the effect of thin vascularized lymph node transfer (VLNT) combined with reverse mapping in the treatment of secondary upper extremity lymphedema. Methods　From July 2019 to September 2020, the free vascularized inguinal lymph node thin-layered flap was prepared by the reverse mapping guided by indocyanine green and methylene blue double staining, which was excised and transplant to the upper limb of the affected side to treat 5 patients with secondary lymphedema after the operation of breast cancer. The flap was about 10 cm×5 cm in size and 0.7 cm in thickness. About 2 to 3 lymph nodes in the donor area were excised. The patients were followed up for 7 to 15 months. Results　All the flaps survived well and all lymph nodes survived. In postoperative follow-up, the circumference of the affected limb was significantly reduced 1.5 months later, and the donor area had no complications. Conclusion　Thin VLNT combined with reverse mapping in the treatment of secondary upper extremity lymphedema has good efficacy and aesthetic effect. Related Articles | Metrics

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Simultaneous application of vascularized lymph nodes transfer and liposuction for treatment of secondary lymphedema of the lower extremities WEI Miaomiao, WU Xiangkui, WU Bihua, et al 2022, 18 (1):  14.  Abstract ( 106 )   PDF (743KB) ( 59 )   Objective　To investigate the clinical efficacy of liposuction combined with vascularized lymph nodes transfer in the treatment of secondary lymphedema of the lower extremities. Methods　A retrospective analysis was performed on the clinical data of 12 patients with secondary lymphedema of the lower extremity after gynecological malignant tumor surgery from November 2018 to November 2021. The volume of the affected thigh was reduced by liposuction, and the supraclavicular vascularized lymph nodes were removed and transplanted to the lower leg. Paired T test was used to compare the circumference of the affected extremities before and after treatment. Meanwhile, the incidence of erysipelas and the change of quality of life before and after treatment were recorded. Results　About 500-1 200 mL adipose tissue was extracted from the thigh of the affected limb, with an average of (917±196) mL. The diameter of the affected extremities was significantly reduced after operation(P<0.05). No erysipelas occurred during follow-up, and the subjective symptoms were significantly improved while compared with those before operation. Conclusion　Liposuction combined with vascularized lymph nodes transfer is an effective method for the treatment of lower extremity lymphedema, and is worthy of clinical application. Related Articles | Metrics

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Efficacy and safety of far infrared radiation in the treatment of gynecological cancer-related lymphedema　 WANG Xiaodian, CUI Chunxiao, XIA Liang, et al 2022, 18 (1):  19.  Abstract ( 195 )   PDF (614KB) ( 90 )   Objective　To investigate the efficacy and safety of far infrared radiation (FIR) in treating gynecological cancer-related lymphedema. Methods　From January 2013 to January 2020, 74 patients with gynecological cancer-related lymphedema were randomly allocated into two treatment groups: group of bandage treatment (n=35) and group of FIR plus bandage treatment (n=39). Variations of fluid, circumference of lymphedematous limbs, serum tumor markers CA125, inguinal-pelvic lymph nodes, vagina, lungs, and adverse reactions were assessed 1 year after treatment. In vitro experiment was used to examine the effects on cell viability, proliferation, apoptosis, and cell cycle of fibroblasts, A2780, HeLa, Ishikawa and SKOV-3 cells. Results　The FIR+bandage group showed significantly decreased tissue fluid and reduced limb circumference (P<0.05) in comparison with the bandage group at 1 year of follow-up. There was no increase of serum CA125in both groups, and no recurrence of neoplasia or lymphadenopathy was detected. No adverse reactions were recorded. In addition, no changes were detected after FIR treatment for fibroblasts, A2780, HeLa, Ishikawa and SKOV-3 cells in cell viability, proliferation, apoptosis, and cell cycle. Conclusion　The combination of FIR and bandage therapy is more effective in the treatment of gynecological cancer-related lymphedema, and does not promote the recurrence or metastasis of gynecological cancer, and is well tolerated without adverse reactions or side effects. Related Articles | Metrics

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Long-term effect of prolonged use of low elastic bandages after CDT treatment in patients with chronic lymphedema in limbs　 WANG Li, LIU Ningfei, CHEN Jiajia, et al 2022, 18 (1):  25.  Abstract ( 104 )   PDF (589KB) ( 69 )   Objective　To investigate the long-term effect of prolonged use of low elastic bandages after CDT (complex decongestion therapy) treatment in patients with chronic lymphedema in limbs. Methods　Since 2016, 57 patients with lymphedema were divided into A (>1 year), B (0.5-1 year) and C (<0.5 year) group according to the duration of self-use of low elastic bandage after treatment. Multi-frequency bio-resistance human component analyzer was used to measure tissue moisture, and limb circumference was measured by tape measure. The changes of water content and circumference at the return visit and the end of treatment were compared among the three groups. Results　Group A was significantly better than group B and C in maintaining limb circumference and water content, while group B was better than group C (P<0.05). The incidence frequency of erysipelas in the three groups was improved after treatment, and group A had the greatest improvement (P<0.05). Conclusion　Patients with chronic lymphedema of limbs should continue to bandage the affected limb after CDT treatment, and the longer the patients insist on using the low elastic bandage, the better the long-term efficacy. Related Articles | Metrics

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An animal model for lymphaticovenular anastomosis training　 LU Hongrui, XIE Qingping 2022, 18 (1):  29.  Abstract ( 109 )   PDF (910KB) ( 85 )   Objective　To provide an animal model of staining agreement lymphaticovenular anastomosis (LVA) for training. Methods　The 2 mL methylene blue staining agent was injected into the brain tissue of experimental chicken. The experimental animals were killed in the state of hyperaemia of arteries and veins in the head and neck. After the head and body of the experimental animals were cleaned and wrapped with plastic bags, the neck region was shaved. A middle neck incision was made. After dissected to the carotid sheath position, lymphatic vessels were clearly exposed. The lymphatic vessels, lymph nodes and surrounding internal veins were dissected and separated under a microscope. End to end anastomosis, end to side anastomosis and lymph node vein anastomosis were performed under a 20-fold microscope. Each group was provided with 20 training animals. The training period lasted from 14 to 28 days, with an average of 21 days. Results　In all animal models after staining, clear stained lymphatic vessels can be found in the neck experimental area, and internal fat veins can be found in the surrounding fat, which could be used for trainees to carry out repeated anatomical separation and anastomosis training under the microscope. After the training, the trainees can achieve high patency rate of lymphatic venous anastomosis and lymph node venous anastomosis, and the immediate patency rate reached 80%. Conclusion　The training animal model made by this method is easy to obtain, the experimental cost is controllable, lymphatic staining is obvious in the experiment, and there is no stain contamination, so it is suitable for popularization and application of training animal model for LVA. Related Articles | Metrics

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Quantitative analysis of anastomosis stoma in prophylactic lymphaticovenous anastomosis immediately after axillary lymph node dissection of breast caner: A case report　 SONG Jingyong, TANG Peng, ZHONG Xiaojie, et al 2022, 18 (1):  34.  Abstract ( 101 )   PDF (1833KB) ( 96 )   　In order to prevent breast caner related lymphoedema, 3D microsurgery technique and indocyanine green angiography were used to complete prophylactic lymphovenous anastomosis immediately after axillary lymph node dissection of one case of breast cancer on September 28, 2020. And the patency of anastomosis stoma was quantified by Zeiss Kinevo 900 FLOW800 fluorescence angiography and color map analysis module. In this paper, this case was reported and the relevant literature was reviewed. Related Articles | Metrics

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Research progress in the treatment of lymphedema HUANG Cheng, HU Xueqing 2022, 18 (1):  38.  Abstract ( 239 )   PDF (484KB) ( 210 )   Lymphedema is a chronic disease of the lymphatic system. With the increase of the number and incidence of malignant tumors in China, lymphedema after cancer treatment has become the main cause of secondary lymphedema. Proper treatment is very important for the prognosis of lymphedema. Recent advances in the field of lymphedema treatment have brought new hope to patients. In this paper, the research progress in the treatment of lymphedema was reviewed. Related Articles | Metrics

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Research progress and clinical significance of lymphatic distribution in the foot　 MA Chuanxiang, PAN Weiren, LIU Zhian, et al 2022, 18 (1):  42.  Abstract ( 151 )   PDF (1125KB) ( 117 )   The human lymphatic system is a part of the circulatory system, which is found later than the arterial and venous systems. Lymphatic vessels are first observed in the mesentery of mammals. Later, with the introduction of mercury direct injection technique, lymphatic vessels in the human limbs are discovered. Subsequently, the application of indirect injection and clinical observation enrich the basic theory of the lymphatic system in the field of anatomy. The knowledge has been widely cited in consecutive scientific research and clinical practice. However, it sometimes is unable to explain some unexpected clinical findings. Although the knowledge of the superficial lymphatic distribution of the lower limb has been updated over the past decade, the deep lymphatic distribution of the foot has not been confirmed until recently. In this paper, details of the lymphatic anatomy in the foot were reviewed. Related Articles | Metrics

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Research progress of vascularized lymph node flap transplantation for lymphedema of lower extremity　 SHENG Hangchong, PAN Jiadong, WANG Xin 2022, 18 (1):  45.  Abstract ( 146 )   PDF (505KB) ( 85 )   　The treatment of lymphedema of lower extremity is the difficulty and emphasis in clinical research. Severe lymphedema of the lower extremities has a significant impact on the patients' quality of life. In recent years, as a new surgical method, vascularized lymph node flap transplantation has a good effect on the treatment of severe lymphedema of lower extremities. In this paper, the mechanism, surgical methods, auxiliary means and common complications of vascularized lymph node flap transplantation were reviewed and prospected. Related Articles | Metrics

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Application of liposuction in the treatment of patients with chronic late lymphedema　 XIAO Yiding, LONG Xiaol 2022, 18 (1):  49.  Abstract ( 106 )   PDF (525KB) ( 69 )   With the deepening of our understanding of the pathophysiological mechanism of lymphedema and the updating of treatment methods, there has been more and more evidence showing that liposuction can be used for patients with chronic advanced lymphedema in terms of objective measurement and subjective feelings of patients. In this paper, focused on the application of liposuction in the treatment of patients with lymphedema, the treatment principles, surgical indications, therapeutic effects and combined applications were all comprehensively reviewed. Related Articles | Metrics

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Research progress of animal models for vascularized lymph node transfer　 YANG Sanhong, DENG Chengliang 2022, 18 (1):  53.  Abstract ( 95 )   PDF (452KB) ( 87 )   Lymphedema is pathological protein accumulation in the interstitial space caused by the dysfunction of lymphatic conveyance and the obstruction of lymphatic drainage, which seriously affects the life quality of patients. Vascularized lymph node transfer (VLNT) can significantly alleviate lymphedema volume and decrease the incidence of cellulitis, and has the initial promising safety and effectiveness. VLNT has become the preferred treatment for lymphedema at present, but its functional mechanisms are not fully understood. In this paper, the research progress of VLNT animal models was reviewed, aiming to provide animal model references for in-depth study of VLNT functional mechanisms and surgical procedures update. Related Articles | Metrics

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Accuracy analysis of cranio-maxillofacial plastic surgery robot in genioplasty　 SUN Tiecheng, YANG Bin, WANG Yu, et al 2022, 18 (1):  57.  Abstract ( 131 )   PDF (873KB) ( 79 )   Objective　To explore the application effect and accuracy of craniomaxillofacial plastic surgery robot in genioplasty. Methods　The clinical data of 10 patients treated with traditional clinical genioplasty (clinical group) from January 2015 to December 2020 was retrospectively analyzed and compared with the data of their 1∶1 3D plaster model underwent genioplasty via cranio-maxillofacial plastic surgery robot (robot group). Based on the pre-experimental research data standards of our department, the ideal preoperative surgical scheme (control group) was designed using digital simulation software. The distance between pogonion and nasion, the distance between anterior nasal spine and menton, the distance between gnathion and mental foramen, and the distance between gonion and mental foramen, the distance from incision inferior, tip of lower canine and tip of the molar cheek groove to the line of osteotomy, the closest distance between screw and mental foramen were measured and compared among the three groups. Results　There were no statistical differences between the robotic group and control group in the postoperative measurement index (P>0.05), and there was a statistical difference between the clinical group and the control group in the postoperative measurement index (P<0.05). There was no statistical difference between robotic group and control group in line of osteotomy (P>0.05)，but there was a statistical difference between the clinical group and the control group in line of osteotomy (P<0.05). Compared with the robotic group, the closest distance between screw and mental foramen after operation was smaller in the clinical group. Conclusion　Compared with the actual operation of human hands, the cranio-maxillofacial plastic surgery robot can perform genioplasty more accurately. Related Articles | Metrics

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Clinical analysis of the treatment and severity classification in radiation ulcer patients　 YANG Fei, XIE Weiguo, ZHANG Wei, et al 2022, 18 (1):  62.  Abstract ( 153 )   PDF (791KB) ( 118 )   Objective　To analyze the clinical characteristics and treatment effects of different degrees radiation ulcers according to the self-defined classification standard. Methods　The main factors affecting the severity of radiation ulcers were scored according to different weighting, which were defined as mild, moderate, and severe. Based on this standard, the patients of radiation ulcer admitted to our hospital from April 2014 to September 2020 were analyzed retrospectively, in addition, the treatment and follow-up results of patients with different severity and different primary diseases were grouped and compared. Results　A total of 31 patients were enrolled in this study. There were 3 cases (10.7%) of mild type, 12 cases (38.7%) of moderate type and 16 cases (51.6%) of severe type. Among the patients, 9 cases (29.0%) were repaired with conservative treatment, 14 cases (45.2%) were repaired with local pedicle flaps, and 8 cases (25.8%) were repaired with free flaps. In these three types of patients, the more severe the classification, the longer the course of the ulcer, the more flaps were used to repair, the higher the cost of treatment, and the longer the wound healing time (P<0.05). The clinical cure rates were 87.5%, 100%, and 100% in the mild, moderate, and severe groups respectively, and the ulcer recurrence rates were 33.3%, 25.0%, and 21.4% respectively, with no significant difference (P>0.05). The primary causes of radiotherapy included breast cancer in 12 cases (38.7%), malignant tumors of the reproductive system in 5 cases (16.1%), cutaneous squamous cell carcinoma in 4 cases (12.9%), angiopathy in 4 cases (12.9%), dermatofibrosarcoma in 3 cases (9.7%), nasopharyngeal carcinoma in 2 cases (6.5%), and lymphoma in 1 case (3.2%). The severity of ulcers varied in patients with different primary causes (P<0.05), but there was no significant difference in the clinical recovery rate and ulcer recurrence rate (P>0.05). Conclusion　There are statistical differences in the ulcer course, treatment methods, wound healing time and treatment costs among patients with radiation ulcers of different severity. Moreover, this classification standard has a guiding effect on the disease judgment and clinical treatment. Related Articles | Metrics

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Clinical application of cotton pad concentration in breast augmentation with fat grafting　 CHEN Bing, LI Facheng 2022, 18 (1):  67.  Abstract ( 107 )   PDF (852KB) ( 55 )   　Objective　To evaluate the effect of breast augmenting with fat purification by cotton pad concentration. Methods　From 2012 to 2014, 20 patients who suffered from macromastia were randomly chosen to receive fat grafting for breast augmentation. After 6 months of follow-up, chest circumference changes were measured, breast volume changes were assessed by Axisthree 3D simulation imaging, and the presence of cysts and mass formation was examined by MRI. Patients' satisfaction was followed up by questionnaire. Results　The postoperative breasts had natural shapes and soft texture. The chest circumference and breast volume of the patient increased by (3.98±1.13) cm and (138.15±24.39) mL. The fat survival rate reached 44.4%±6.6%. MRI showed no obvious necrosis, and the patient's postoperative satisfaction was high. Conclusion　The autologous fat transplantation processed by cotton pad concentration for breast augmentation has good appearance, less complication and satisfactory clinical effect. Related Articles | Metrics

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Application of MAFT-GUN autologous fat transplantation in facial contouring　 WANG Shuhong, REN Yue’e 2022, 18 (1):  71.  Abstract ( 144 )   PDF (592KB) ( 77 )   精微脂肪移植注射枪；　脂肪移植；　面部轮廓整形 Related Articles | Metrics

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Clinical efficacy of red and blue light combined with Adapalene gel in the treatment of mild to moderate acne　 WU Yiwen, WANG Shanshan, ZHANG Lvya, et al 2022, 18 (1):  74.  Abstract ( 251 )   PDF (489KB) ( 106 )   Objective　To explore the effect of red and blue light combined with Adapalene gel in the treatment of mild and moderate acne. Methods　From May 2018 to may 2019, 150 patients with mild to moderate acne were randomly divided into two groups. The patients in the experimental group (n=75) were treated with alternating red and blue light combined with Adapalene gel, and the control group (n=75) was treated with Adapalene gel. The treatment period was 1 month. Results　There was no significant difference in sex, age, blood pressure, liver function and renal function between the experimental group and the control group (P>0.005), but there were significant differences in hemoglobin (P<0.05). There was no significant difference in Leeds score between the experimental group and the control group before treatment (P>0.05); After one month of treatment, Leeds score in the experimental group was significantly lower than that before treatment (P<0.05), while Leeds score in the control group had no significant difference(P>0.05). After 1 month of treatment, the number of healing in the experimental group was significantly higher than that in the control group, and the overall effective rate was also significantly higher than that in the control group (P<0.001). Conclusion　Red blue light irradiation combined with Adapalene gel can significantly improve the appearance of patients with mild and moderate acne, and the treatment effect is obvious and safe. Related Articles | Metrics

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#br# Construction of the core knowledge system of training courses for specialized nurses of Plastic and Reconstructive Surgery in different grade hospitals　 HUANG Yin, ZHAO Xiaofen, YANG Jiafei, et al 2022, 18 (1):  77.  Abstract ( 143 )   PDF (682KB) ( 73 )   　Objective　Combined with the specific national conditions of China, the core knowledge system of surgical nurse training courses was constructed based on the survey results of the needs of nurses in Plastic and Reconstructive Surgery in different levels of hospitals. Methods　On the basis of literature review, a questionnaire of knowledge needs of training courses for specialized plastic surgery nurses was developed, which was divided into 5 grades according to the importance and scored according to likert-5 grading method. The knowledge needs of 413 plastic surgery nurses in 8 hospitals nationwide were investigated, and the needs of nurses at different levels were evaluated according to the survey results. Results　The core knowledge system of the training course for specialized plastic surgery nurses was preliminatively developed, including wound management, aesthetic surgical nursing, perioperative patient management, cranio-maxillofacial nursing, origin and establishment of plastic surgery nursing, and microsurgical nursing, with a total of 77 knowledge points. According to the analysis of the survey results, the training knowledge needs of primary and secondary hospitals focused onaesthetic surgical nursing and wound management, while the training needs of nurses in tertiary hospitals focused on wound management, microsurgical nursing and cranio-maxillofacial nursing. Correlation analysis showed that age, professional title, educational background, working hospital grade of nurses were positively correlated with the origin and establishment of surgical nursing, wound management and cranio-maxillofacial nursing. Working hospital grade was positively correlated with microsurgical nursing. Conclusion　Nursing staff at different levels of hospitals all have a high degree of demand for the training knowledge of specialized nurses in Plastic and Reconstructive Surgery. However, due to the different knowledge needs and familiarity of nurses in different hospitals, it is of practical significance to construct a free combination and modular training content for nurses at different levels. Related Articles | Metrics

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Research progress on the hypertrophy mechanism of port-wine stain　 ZHAO Chenwei, MA Gang, LIN Xiaoxi 2022, 18 (1):  83.  Abstract ( 154 )   PDF (388KB) ( 147 )   Port-wine stain is a common congenital capillary malformation disease, which can gradually progress to the hypertrophic and nodular PWS in the middle and late stages. The treatment method for hypertrophic lesions is different from flat lesions. Thus, the exploration of the hypertrophy mechanism of PWS appears to be particularly significant and will help to propose targeted treatments for this type of patients. In this paper, the histological and cytological phenotypes, common molecular manifestations of endothelial cells in hypertrophic port-wine stain tissue, as well as the recent finding of mutated genes that may lead to the pathogenesis and development of PWS were all reviewed. Related Articles | Metrics

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Research progress of autologous fat grafting in rhinoplasty　 GUO Haoyue, LI Jie, MA Jiguang 2022, 18 (1):  86.  Abstract ( 96 )   PDF (407KB) ( 60 )   Autologous fat grafting can be harvested in sufficient quantity, with easy availability and high safety. It can be used alone/in combination with other nasal implants in primary/reparative rhinoplasty. In this paper, the progress of autologous fat grafting in rhinoplasty in the following aspects were reviewed, including nasal contour reshaping, skin texture improvement, edema and bruises reduction, scars and contractures treatment and facial balance enhancement.  Related Articles | Metrics