Joris van Dongen

156 Chapter 7 In ten studies of these publications, comprising of a total of 156 patients, complications were recorded: in nine of these ten studies, no complications were recorded whereas in one study with 12 patients there was a case of cellulitis reported as a complication. Hence, it seems that risks of lipofilling in scar areas is rather low. All fourteen case reports or clinical trials reported some degree of amelioration in scar appearance after lipofilling: in other words, scars became less different from normal skin and/or became lessvisible.However, overall result of these clinical studies is not unequivocal. Firstly, not all studies use the same outcome measurements to report scar appearance: most studies used patient satisfaction or patient and observer rated grading scales for scar severity to report the effect of lipofilling, whereas other studies used measuring devices for skin elasticity or dermal pigmentation. Secondly, whether or not there is improvement in scar appearance varies within these studies: some studies report improvement in most patients, contrasted by no effect in a few other patients. Lastly, also, within the same study, improvement after lipofilling in one outcome measure (e.g. less stiffness of the scar) is reported, but there is no improvement in other outcome measures (e.g. no improvement in discoloration). Thus, the overall trend is that lipofilling improves scar appearance in several different outcome measures, which is confirmed by two systematic reviews 39,40 . However, due to lack of uniformity in intervention and follow up, no definitive conclusions can be drawn. Only five well designed controlled studies had well-defined objectives and outcome parameters and had included both non-treated 27,34,37 or placebo 29,31 controls. Four of these studies focused on clinical outcomes 27,31,34,37 and are discussed below and one addresses histological changes 29 and is discussed in the next section. In two studies, performed under supervision of the same senior researcher 27,37 , the effect of lipofilling as adjuvant procedure to reduce formation of new scars after surgery is evaluated. During primary cleft lip repair surgery, efficacy of lipofilling is examined by comparison of pre- and post-operative pictures for residual cleft stigmata by a blinded reviewer panel. Compared to primary cleft lip repair without lipofilling, it resulted in significantly less residual cleft stigmata and thus in better scar appearance. Apparently lipofilling led to reduction of scar formation. Also already existing scars can be treated by means of lipofilling: in prosthetic breast reconstruction in the setting of post mastectomy radiotherapy, post-radiotherapy lipofilling can reduce the degree of capsular contracture as measured by the Baker classification 34 . Here, lipofilling apparently is able to prevent or even (partially) revert the fibrotic process of capsular contracture. Another example is the treatment of post-surgical scars in patients with achondroplasia that require surgical limb lengthening 31 . In this study, lipofilling was