Abstract
BACKGROUND: Orofacial modifications occurring in systemic sclerosis are detrimental for patients, but the therapeutic options are limited. OBJECTIVES: This systematic review aimed to perform an up-to-date appraisal of the literature focusing on fat grafting and other adipose stem cell-based therapies for the treatment of facial systemic sclerosis, determining its efficacy and safety, and investigating the current practice for treatment optimization. METHODS: The review was prospectively registered in PROSPERO (CRD42021286268) and followed the PRISMA principles. Multiple databases were searched and only original studies were included. RESULTS: Over the 12 studies matching the inclusion criteria, 174 patients were treated. Of these, 87.3% (n = 152) were considered to have improved. The complications, graded with the Clavien-Dindo grading system, were Grade 1 (no treatment required) or Grade 2 (antibiotic required). Patients received a mean [standard deviation] of 2.5 [3.68] (median, 1.35; range, 1-14) lipotransfer procedures. Overall, an average volume of 14.60 [6.24] mL was injected in the facial area (median, 16 mL; range, 3-27 mL). The average interval between procedures was 5.30 [2.04] months (median, 6 months; range 3-6.91 months). At the time of inclusion, patients were diagnosed with scleroderma disease on average after 14.7 [7.35] years. CONCLUSIONS: Fat grafting for facial systemic sclerosis is effective and safe. The definitive durability of the effect is still unclear, and the optimal number of treatments must be determined to define a precise evidence-based protocol. The body of evidence is highly fragmented, with disagreements over surgical techniques and outcome assessments, making results from different studies often not comparable. The level of evidence is overall low or very low, and the risk of bias of published studies is overall medium to high. Randomized controlled trials are urgently needed.