Dermis-fat grafts are useful in supplying subcutaneous bulk to scarred areas in the lower lid/cheek and in the upper lid sulcus. The fat cells inhibit further scarring and provide a more natural antifibrotic effect than antimetabolites.
Dermis-fat grafts can be obtained from the periumbilical and groin regions of the abdomen or from the buttock. The graft is marked and xylocaine/adrenaline injected to obtain a peau d'orange effect. The epidermis is raised and excised using a blade in a manner similar to raising a split-skin graft, then discarded. The dermis-fat graft is excised and placed in sterile, saline-soaked gauze while the donor site is closed. The dermal element can be sutured into the scarred tissues such that it supports the fat element which comes to lie subcutaneously.
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