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We describe the case of a 45-year-old male patient who presented a retractile and painful scar in the nasolabial fold due to trauma which determined partial motor impairment of the mouth movements. We subsequently treated him with autologous fat grafting according to Coleman’s technique. Clinical assessments were performed at 5 and 14 days and 1, 3, and 6 months after surgical procedure and we observed a progressive release of scar retraction together with an important improvement of pain symptoms. A second procedure was performed 6 months after the previous one. We observed total restoration of mimic movements within one-year follow-up. The case described confirms autologous fat grafting regenerative effect on scar tissue enlightening a possible therapeutic effect on peripheral nerve activity, hypothesizing that its entrapment into scar tissue can determine a partial loss of function.

A rare case of isolated congenital bone agenesis in a young woman referred to the authors for aesthetic correction of the dorsum profile is described. There are no descriptions of surgical treatment for this isolated facial defect in the literature. After a complete and accurate diagnostic study, a rhinoplasty was performed with a good result and without complications during a 2-year follow-up period. To explain this congenital malformation, several hypotheses were examined, such as bony resorption and embryologic bony development syndromes. This report describes the possibility of intervention in the case of nasal bone absence and shows how risks of structural instability can be avoided with an accurate preoperative study and a careful surgical approach.

Autologous fat graft is becoming a widely used procedure in plastic surgery. Its indications are progressively increasing, ranging from functional to aesthetic surgery. The procedure has now entered in the field of regenerative medicine. Although many have commented on the long-term safety implications of fat grafting, especially to the breast, there is no body of information in the literature that analyzes near-term complications associated with this procedure. We performed a retrospective study of 1000 consecutive fat transplantation cases in our hospital since 2005. Complications were divided between donor-site complications and recipient-site complications. Of 1000 procedures, there were 2 donor-site hematomas and 83 local deformities caused by liposuction. In treated patients, the recipient site, there were 4 infections. One patient reported implant rupture at 1 month after fat graft. There was no skin necrosis in the grafted areas and no systemic complications such as pulmonary embolism, cardiac arrest, or deep venous thrombosis. The complications in fat transplantation are dominated by complications of the liposuction-the donor harvesting phase of the procedure. The relatively low complication rates in the recipient site suggest that fat transplantation, especially considering the recipient, is characterized by a high safety level and our device is simple to use.

To evaluate the technical feasibility of real-time elastography (RTE) to assess the stiffness of the skin of the peri-oral region in patients affected by systemic sclerosis (SSc).Six female patients affected by SSc (median age = 52 years) presenting with microstomia and six healthy controls matched for age and sex underwent RTE evaluation of the peri-oral region. Two operators with different experience evaluated the stiffness of the peri-oral region placing the probe in four different positions: parasagittal left (PL), parasagittal right (PR), upper axial (UA), lower axial (LA). Color map was converted into a semi-quantitative scale in which blue = 1, green = 2 and red = 3. Thus, each subject had a variable score ranging from 4 (four positions × value = 1) and 12 (four positions × value = 3). Mann-Whitney U and k statistics were used.RTE demonstrated that the skin of the peri-oral region of patients affected by SSc was stiffer than that of controls, both overall (6;4-6 [median; 25-75th percentile] vs. 11;9-11, p 0.001) and for each probe position (PL = 1;1-2 vs. 2;2-3, PR = 1;1-2 vs. 2;2-3, UA = 1;1-2 vs. 2;2-3; LA = 1;1-1 vs. 3;3-3, p ≤ 0.011 for all). Interobserver reproducibility was excellent both overall and for each probe position (k = 1).RTE is a feasible modality to assess peri-oral region skin stiffness with excellent interobserver reproducibility. Further studies on a larger cohort of patients including more clinical data and measures are warranted to confirm our initial results.Valutare la fattibilità dell’utilizzo dell’elastosonografia per studiare la rigidità della cute della regione periorale in pazienti affetti da sclerosi sistemica.Sei pazienti affette da sclerosi sistemica (età mediana = 52 anni) con microstomia e sei controlli sani appaiati per sesso ed età sono state sottoposte ad elastosonografia della regione periorale. Due operatori con differente esperienza hanno valutato l’elasticità della regione periorale con la sonda in quattro posizioni parasagittale sinistra (SX), parasagittale destra (DX), assiale superiore (AS), assiale inferiore (AI). La mappa colore è stata convertita in una scala semi-quantitativa in cui blu = 1, verde = 2 e rosso = 3. Pertanto, ogni soggetto ha avuto un punteggio totale variabile tra 4 (quattro posizioni × valore = 1) e 12 (quattro posizioni × valore = 3). Sono stati utilizzati i test U di Mann–Whitney e k di Cohen.L’elastosonografia ha dimostrato che la cute della regione periorale delle pazienti affette da sclerodermia è più rigida di quella dei controlli, sia globalmente (6;4–6 [mediana; 25–75th percentile] vs. 11;9–11,L’elastosonografia può essere eseguita nella regione periorale per valutare il grado di rigidità della cute, con eccellente riproducibilità interosservatore. Ulteriori studi che includano un campione maggiore di pazienti con dati clinici sono necessari per confermare i nostri risultati preliminari.

Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

Recent studies tried to identify new indicators of risk in the development of insulin resistance, cardiovascular disease, and metabolic syndrome; recently, breast size has been proposed as a new measure of risk for type 2 diabetes mellitus in women. To understand the role of breast adipose tissue and subcutaneous adipose tissue in lipidic and glucose metabolism, we decided to evaluate the variation on levels of adiponectin in plasma and other well-known metabolic markers before and after surgical fat reduction.We formed 2 groups: breast reduction group (M-) and abdominoplasty group (ADD). For all patients enrolled in the study, we recorded anthropometric measurements 1 hour before surgery (that we considered as time zero). At time zero, we always performed a blood sample to observe the assay of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, CRP, TNF-α, IL-1, IL-6, and adiponectin. The dosage of the above parameters was repeated 40 days after the surgical intervention with the aim of assessing whether they showed a statistically significant change after surgery.Adiponectin levels increased significantly in both groups of patients after surgery: in patients undergoing reduction mammaplasty and abdominoplasty, the mean increase was equal to 1.68 (P = 0.007) and 4.28 (P = 0.019), respectively. The variation in increase was not statistically different between the 2 groups (P = 0.254).Moreover, in the M- group, we observed that HDL levels increased and glycemia decreased significantly.Our study shows that reduction mammaplasty is a surgical procedure associated with a significant improvement in adiponectin level, HDL cholesterol level, and a significant decrease in glycemia level.The effective correlation between the role of breast adipose tissue and appearance of disease is still to be determined.

Breast cancer is the most common cancer in women worldwide, affecting one in eight women. Breast-conserving surgery (BCS) has become a well-established alternative to mastectomy in the treatment of breast cancer, providing a less invasive treatment. Just as life expectancy after breast cancer has improved, so has morbidity increased. One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome (PMPS). Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy and our experience in scar treatment with fat grafts were the theoretical bases for this prospective study. From April 2011 to April 2012 a total of 96 patients, who had undergone lumpectomy and radiation therapy, with the diagnosis of PMPS were considered for fat grafts. We performed autologous fat grafting in 59 patients (study group), whereas 37 patients did not receive any further surgical procedure (control group). Pain assessment was performed using the visual analog scale (VAS) before and after treatment in the treated group and in the control group at the first visit and the control visit, with a mean follow-up of 10 months. Results were analyzed using the Wilcoxon rank sum test. Four patients were lost to follow-up (two patients in the control group and two patients in the treated group). A significant VAS pain decrease was detected in patients treated with autologous fat grafting (3.1 point reduction, p ≤ 0.005). Because of the safety, efficacy, and optimal tolerability of the procedure, we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Regenerative medicine is an emerging and rapidly evolving field of research and therapy, thanks to new discoveries on stem cells. Adipose tissue is a connective tissue which contains a reserve of mesenchymal stem cells. Clinical improvements in trophic characteristics of teguments after autologous fat graft are well described in literature. In this paper, we present our observation after 6 years of autologous fat graft experience in scar remodeling.All patients recruited had retractile and painful scars compromising the normal daily activity/mobility of the joint involved. We performed surgical procedure with Coleman technique. In 20 patients, we performed a clinical assessment using Patient and Observer Scar Assessment Scale (POSAS) and Durometer measurements.In all treated scars, a qualitative improvement was shown both from an aesthetic and functional point of view. Most importantly, reduction or complete resolution of pain and increases in scar elasticity were objectively assessable in all cases. In patients studied using Durometer and POSAS score, areas treated with autologous fat graft showed statistically significant reduction in hardness measurements in comparison with areas infiltrated with saline solution. POSAS scores showed a statistically significant reduction of a great deal of POSAS parameters as a result of an improvement of both clinical evaluation and patient perception.Injection of processed autologous fat seems to be a promising and effective therapeutic approach for scars with different origin such as burns and other trauma scars, and post-surgery and radiotherapy outcomes. In general, we can affirm that treated areas regain characteristics similar to normal skin, which are clinically objectivable, leading not only to aesthetic but also functional results.

Background Mastectomy with axillary dissection is still one of the most common procedures in oncologic surgery. Unfortunately, a condition of neuropathic pain, termed postmastectomy pain syndrome, can appear after mastectomy. Although evidence regarding the epidemiology of postmastectomy pain syndrome is well researched, an effective therapy is still unknown. The aim of this study was to assess the clinical effectiveness of lipoaspirate graft in the treatment of postmastectomy pain syndrome. Methods From February of 2006 to August of 2008, a total of 113 patients affected by postmastectomy pain syndrome and severe scar retractions were enrolled for this clinical study. Seventy-two patients were treated with autologous fat grafted in painful scars, and 41 patients did not undergo any further surgical procedure. Pain assessment was performed using a visual analogue scale before and after treatment, with a mean follow-up of 13 months. In addition, antalgic drug intake was recorded in the 34 patients who received a surgical treatment. Results were analyzed using the Wilcoxon rank sum test. Results A significant decrease in pain according to the visual analogue scale was detected in patients treated with autologous fat graft (3.23-point reduction, p = 0.0005). Twenty-eight of 34 patients stopped their analgesic therapy with a significant follow-up (13 months). Conclusions Autologous fat grafting is a safe, relatively noninvasive, and rapid surgical procedure. The authors' results suggest its effectiveness for treatment of postmastectomy pain syndrome. Clinical question/level of evidence Therapeutic, II.

Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1 year.The results at 1 year showed high rates of improvement in tip definition (mean, 7.9±2.4) and nasal tip only evaluation (mean, 6.5±3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2±3.2), nostril symmetry (mean, 4.5±4.1), and tip projection (mean, 5.8±2.9).This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.

We report the case of a 55-year-old female patient who attended our clinic for the presence of a scar retraction in the upper pole of the left breast as a complication of breast augmentation. In the scar area, we observed an orifice that probing revealed to be a fistula. The patient was referred to surgical intervention under general anesthesia to obtain scar contracture release using autologous fat graft; one month after autologous fat injection, following healing of the fistula, the patient underwent a second surgical procedure to replace the left breast implant. Unexpectedly, two weeks after the surgical procedure, complete healing of the breast fistula within the scar area was observed; this observation was confirmed during the second surgical step for left breast implant repositioning, when we observed the absence of the fistula orifice in the breast implant cavity. Upon clinical examination at 1-year followup, tissue integrity was preserved. The patient's satisfaction was excellent. We have observed a possible additional effect of fat graft.

Parallel to its life-threatening nature, breast cancer can affect physical integrity, having a psychosocial impact on patients. Determining the optimal proportion of patients who should undergo breast reconstruction after cancer surgery represents a complex task. What seems to be unquestionable is that the ability to offer reconstruction and a wide range of surgical options plays an important role in current breast cancer management. The multidisciplinary approach is a paramount aspect not only for a successful oncologic treatment, but also for improving patient quality of life.

We present a rare case of squamous cell carcinoma that arose deeply in the abdominal wall, 10 years after abdominal dermolipectomy and wall repair by dermal-adipose graft was performed. The patient presented a 10-cm-diameter subcutaneous tumor that was ulcerated on its superficial aspect, adherent to deep tissues. After histologic examination, we tried to remove the neoplastic mass in a radical way. The surgical defect was repaired with a bilateral tensor fasciae latae flap. The extension, aggressiveness, and deep localization of the malignancy led to the patient's death. In this article, we also analyze a different hypothesis about the origin of squamous cell deep carcinomas and the related literature.

Nasogastric intubation has become a frequently used method for alleviating gastrointestinal symptoms. Necrosis from alar pressure during prolonged nasogastric and nasotracheal intubation is common, and can result in considerable deformity if it is unrecognized. The reconstruction of full-thickness alar wounds often requires multiple challenging surgical procedures. Difficult full-thickness alar defects often require nasal mucosal replacement for lining, cartilage batten graft support for the preservation of nasal function, and skin coverage for the restoration of an aesthetically correct appearance. Free composite conchal grafting can offer a single-staged, one-step repair of difficult full-thickness alar wounds that are no larger than 1.5 cm in size. A thorough explanation of the graft design and execution is presented, as well as a case report and literature review. Free composite con-chal grafting can produce aesthetic and functional results that rival the most sophisticated flap reconstructions of the lateral ala.

Over the past few years, treatment of burn scars with lipofilling has shown encouraging clinical results in terms of texture, color, softness, and quality of skin patterns. This clinical application has been widened to include treatment for scars resulting from surgical correction of cicatricial ectropion. In fact, although standard surgery with flaps and skin grafts can grant significant functional and cosmetic improvements, these often are not complete because of secondary surgical scars. The case of a 43-year-old man with cicatricial outcomes from chemical burns and subsequent surgical repair of medial ectropion in the lower eyelid is reported. The scar area was treated with injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman’s technique. At the 1-year follow-up assessment after lipostructure, the patient no longer reported xeroftalmia and epiphora. He had experienced complete functional recovery with excellent cosmetic results. Lipostructure of cicatricial ectropion seems to complete and improve the results of the standard surgical approach, and its long-lasting benefits are in keeping with the theoretical basis of this procedure.

A cell encapsulation technology in alginate has been developed with the aim of obtaining cell controlled release or three-dimensional cultures. The aim of this work is to verify the predictability of alginate capsules for large-scale production by Good Manufacturing Practice (GMP) standardized procedures in a cell factory. A cell-free capsule model was performed following the GMP guidelines: an opaque agent suspension in a bivalent cation solution (Ca2+, Ba2+, Sr2+) was dropped in a sodium alginate solution, obtaining capsules presenting a liquid core surrounded by a gel alginate membrane. The concentration of the ion, and the treatment with protamine, can considerably vary the characteristics of the capsules (weight, whole diameter, core diameter, gel capsule thickness, capsule strength). It is therefore possible to optimize the performance of the capsules, relating the molecular structure and size of the polymeric membrane to the desired functional properties. Technological resources are available for large-scale cell encapsulation intended for advanced therapies (gene therapy, somatic cell therapy and tissue engineering) in a cell factory, following GMP guidelines.

Background Autologous fat tissue grafting (AFTG) has been successfully used in the treatment of different sclerotic conditions, including scleroderma. Objectives We evaluated in patients with SSc who complained of a reduced mouth opening, the long-term efficacy of AFTG of the lips in improving mouth opening in comparison with hyaluronic acid (HA) filler. We also investigated whether these procedures may induce some changes in the microvascular architecture and dermal structure of the treated skin area. Methods We studied 30 patients with dcSSc, (median age 37±12 yrs, disease duration 11±8yrs): 15 were treated by topical perioral AFTG according to Coleman technique and 15 by HA filler. The filler was repeated after 3 months. Baseline and after treatment (at months 3, 6, and 12) mouth opening changes were assessed by measuring inter-incisal distance and oral perimeter. Pre- and post-treatment modifications of microvascular architecture were assessed by counting capillaries in the inferior lip videocapillaroscopy (VC) images. Similarly, histological sections of perioral skin biopsy were examined at baseline and 3 months to evaluate dermo-epidermic junction (DEJ), the collagen content (by Masson9s Trichrome staining) and microvessel density (MVD) (by anti-CD34/CD31staining). Results 3 months after treatment both the inter-incisal distance and oral perimeter significantly increased (p Conclusions The present study shows that, in patients with SSc, AFTG can improve mouth opening, induce a neovascularization, and partially restore the skin structure. All these effects were confirmed in the long-term observation. The lack of functional and biological effects in the control group treated by HA filler, suggests that the observed therapeutic effect of lipostructure may be specifically ascribed to the on site transplantation of fat tissue. Our study may open new perspectives for the local and general therapeutic approach to SSc. Disclosure of Interest None declared

TASK FORCE STATEMENT: In 2007, the American Society of Plastic Surgeons formed a task force to conduct an assessment regarding the safety and efficacy of autologous fat grafting, specifically to the breast, and to make recommendations for future research. The task force formulated specific issues regarding fat grafting and then compiled them to focus on five broad-based questions: 1. What are the current and potential applications of fat grafting (specifically breast indications, and if data are available, other cosmetic and reconstructive applications)? 2. What risks and complications are associated with fat grafting? 3. How does technique affect outcomes, including safety and efficacy, of fat grafting? 4. What risk factors need to be considered for patient selection at this level of invasiveness? 5. What advancements in bench research/molecular biology potentially impact current or future methods of fat grafting? To answer these questions, the task force reviewed the scientific literature, critically appraised the information available, and developed evidence-based practice recommendations. Although the primary issue of interest was fat grafting to the breast, other aspects of fat grafting were evaluated.

We read with great interest the article published by Cannistra et al. [1] about gynecomastia with severe ptosis and its treatment. We would like to point out that some forms of gynecomastia do not match properly the existing classifications [2–4]. Tuberous breast deformity can be associated with gynecomastia, with the same features as the corresponding condition in females. We suggest considering this a separate entity in male patients and we propose a specific surgical procedure. From January 2005 to January 2008 we treated six patients with gynecomastia and tuberous breasts using our technique. We combined traditional liposuction by the tumescent technique, standard maneuvers to reduce skin and gland excess, and gland redraping. About 50 ml of saline solution and 10 ml mepivacaine 2% with epinephrine 1:100,000 was injected via a 2-mm incision in the inferoexternal quadrant. Liposuction using a 2-mm blunt cannula was performed beneath the entire mammary region. A concentric circle entirely around the areola was deepithelized. A semicircular, infra-areolar incision of the dermis was made, leaving a superior dermal pedicle to the nipple-areola complex. A cone-shaped mass of breast tissue beneath the areola was resected. As with female tuberous breasts, the constricted base was released with electrocautery and radial incisions of the residual breast fibrous tissue beneath the areola were made. After hemostasis, a suction drain was placed laterally. An intradermal purse-string peripheral suture allowed areolar repositioning. Compressive elastic dressing was used to prevent seroma or hematoma. Elastic garments were kept on for 2 weeks postoperatively. At 1-year follow-up the cosmetic appearance was excellent in all patients (Fig. 1). Appropriate diagnosis is essential for treatment. Our studies on tuberous breasts in female patients suggest that

Background Adult stem cells, expecially those of mesodermal origin (MSCs), have received attention as an ideal source of regenerative capable cells because of their multipotentially and ability to replicate. Regenerative cells from the bone marrow, peripheral blood, and umbilical cord blood have been used to treat a variety of diseases. Adipose tissue is an attractive source of adult stem cells due to its abundance and surgical accessibility. Recent studies have shown the efficacy of the autologous fat grafting in the treatment of different skin diseases including localized scleroderma and ischemic diseases. Objectives We characterized phenotypically and functionally adipose tissue-derived mesenchymal stem cells (ADMSCs) from patients with Systemic Sclerosis (SSc). Methods Human adipose tissue samples were obtained from 10 patients with the diffuse form of SSc (dcSSc) undergoing autologous lipostructure for the treatment of fibrotic perioral changes. As controls, adipose tissue samples were obtained from 10 healthy donors (HD) undergoing aesthetic surgery. Lipoaspirate tissue was collected from elective liposuction procedures and processed by both explant and enzymatic methods. Key parameters of ADMSCs function and phenotype were assessed including the ability to: express cell surface antigens defining the MSC population (CD105, CD73, CD29, CD90, CD44 marker profile was examined by FACS analysis), proliferate (growth kinetics assay), differentiate along the adipogenic and osteogenic lineages, suppress in vitro lymphocyte proliferation induced by the mixed lymphocyte reaction. Results Cultured ADMSCs obtained from the processing of adipose tissue showed no significant differences in morphology and in proliferation rate in the culture conditions used. Phenotypically, SSc ADMSCs highly expressed CD105, CD73, CD90, HLA-ABC and were mostly negative for HLA-DR expression. The absence of contaminating hematopoietic stem cells was confirmed by the negative expression of CD34, CD14 and CD45 antigens in all studied cases. No phenotypic differences were observed between ADMSCs from patients with SSc and controls. When cultured in standard induction medium, all SSc and HD ADMSCs differentiated toward the osteogenic and adipogenic lineages. In MLR assays, no significant differences in ADMSCs mediated inhibition of proliferation were observed between SSc patients and controls. Conclusions Autologous adipose graft could be a new therapeutic option for the treatment of skin diseases such as SSc. The mechanisms through which adipose tissue exerts its therapeutic potential in tissue repair is not yet fully defined, but it might be related to the well known ability of MSCs to modulate inflammatory and autoimmune process, secrete soluble factors capable to stimulate functional recovery of injured cells and differentiate into other cell types. The results of our study show that ADMSCs from patients with SSc exhibit the same phenotypic, proliferative, differentiation potential and immunosoppressive properties as HD. Further studies are need to clarify the ADMSCs specific contribution to the clinically relevant benefits in SSc soft-tissue reconstruction. Disclosure of Interest None Declared

Background Autologous fat grafts (AFG) for restoring soft tissue defects have been used for many decades and has many clinical applications. Recent studies have shown the efficacy of the AFG in the treatment of localized scleroderma. Besides mechanical lipofilling, AFG seems to produce trophic effects on both vascular and stromal cells. However, the exact mechanisms underlying the clinical results are far to be completely understood. Objectives A prospective pilot study has been carried out aimed at evaluating whether the perioral AFG in SSc patients may improve the mouth functional impairment related to the sclerotic changes. In addition, we tried to clarify whether the perioral fat filling might induce local trophic changes in the stromal and vascular structures. Methods Twenty-five patients with diffuse SSc (dcSSc) (mean age + SD 36.5+16 yrs, disease duration of 12±9 yrs) and perioral skin fibrotic changes with limited mouth opening were treated by topical perioral administration of AFG. Lipofilling was performed according to the Coleman tecnique. Follow-up was performed at 1 and 3 months postoperatively by evaluating measure of inter-incisal distance and mouth perimeter; skin hardness was measured by a digital durometer. A baseline and 3 months post-treatment evaluation of microcirculatory abnormalities was made using labial video capillaroscopy and skin biopsy. Results: Results. All patients made good postoperative recovery without complications showing an immediate subjective improvement of their skin stiffness. One and 3 months after lipofilling, the median measure of inter-incisal distance was significantly increased in comparison with the score before treatment (p=0.02); the same results, with overtime significant improvement from baseline to 1 and 3 months, were confirmed by measuring mouth perimeter (p=0.004 and 0.003). Durometer evaluations showed that skin hardness resulted significantly lower after treatment (p=0.014 and 0.019). Labial capillaroscopy of treated patients showed significant improvement in microvascular patterns after AFG in term of increase in capillary density (p=0.001) with more regular organization of microcirculation, increased length and reduced diameter shapes. Pathological studies confirmed the improvement in capillary density in the areas of treated skin with a significant upregulation of CD31 and CD34 expression (p Conclusions Our study suggest that AFG of SSc fibrotic perioral changes can provide immediate and long-lasting benefits in terms of both aesthetic and functional improvement. Itis a safe, relatively non-invasive, and rapid procedure. In addition we provide evidences that AFG has the potential to favour neovascularization in SSc and revert SSc fibrotic features. The overtime increase of treatment benefits suggests that other mechanisms different from the simple fat filling may be involved. The cellular and/or tissue mechanisms underlying these changes need further investigation. Disclosure of Interest None Declared