To evaluate the benefit of autologous fat grafting (AFG) in improving function and volume loss-related symmetry in facial-paralysis patients and to assess patient satisfaction.

A retrospective, noncomparative clinical audit of periorbital AFG performed on 15 patients with facial-paralysis (5M:10F). Standard photos taken pre-op were compared to post-op at 0-3 months, 3-6 months and >6 months and scored by 2 graders. Clinical parameters were noted: brow ptosis, lagophthalmos, lower lid retraction, temporal/periorbital hollowness, symmetry and MRD2. Adverse outcomes were recorded. Patient satisfaction was assessed by questionnaire-survey.

Mean age was 54.8 years (SD=15.1, range 26-76 years). A total of 16 procedures were carried out. One patient (6.3%) developed cheek cellulitis 5 days post-AFG; pre-operative lower eyelid oedema increased and persisted for 6 months in 3 (18.8%). An early significant improvement for infraorbital rim visibility (p=0.014) was obvious. AFG alone did not influence other clinical parameters. Twelve (80%) responded to the survey; Patient Satisfaction: “very satisfied” (n=4), “satisfied” (n=4), “neutral” (n=3) or “dissatisfied” (n=1); Regarding Symmetry: “very happy” (n=2), “happy” (n=6), “neutral” (n=2) or “unhappy” (n=2); Less ocular lubricants: “agree” (n=4), “neutral” (n=4), “disagree” (n=3), “strongly disagree” (n=1); Will you recommend it? “Yes” (n=11), “No” (n=1).

AFG may be a useful adjunct in improving symmetry in patients with facial-paralysis. Patient-satisfaction is high and would recommend it. Objective outcome measures are difficult to report and in isolation it is not expected to improve lagophthalmos or resolve asymmetry. Eyelid oedema may persist if present pre-operatively.