Vocal fold augmentation by autologous fat injection with lipostructure procedure

BACKGROUND: Fat is theoretically the ideal implant for vocal fold augmentation because it is soft, easily available and biocompatible. However, reabsorption is a frequent cause of long-term failure. OBJECTIVE: We prospectively tested Coleman's "lipostructure" technique used for facial recontouring in the treatment of glottic incompetence. STUDY DESIGN AND SETTING: Fourteen patients (aged 18-74 years, mean 48) with breathy dysphonia secondary to laryngeal hemiplegia (7) or anatomical defects (7) underwent vocal fold lipoinjection. Fat harvested by liposuction was centrifuged, and the fat cell layer injected into the vocalis muscle. The patients underwent pre- and postoperative videolaryngostroboscopy, maximum phonation time (MPT) measurements, GRBAS perceptual evaluations, and Voice Handicap Index (VHI) self-assessments. RESULTS: Voice quality improved soon after surgery and remained stable over 3-26 months (mean 10.6), being confirmed by the GRBAS, MPT and VHI evaluations ( P < 0.005). The results were best in the seven patients with paralytic dysphonia. CONCLUSION: Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.