Nanofat for Injection Laryngoplasty: Office and Operative Results.

OBJECTIVE

Nanofat is fat emulsified into micron-sized particles. Unlike microfat, nanofat increases the release of adipose-derived stem cells by destroying lipocytes. This study evaluated whether nanofat injection laryngoplasty alone leads to lasting bulking and sustained long-term voice improvement.

METHODS

We retrospectively reviewed patients with glottal insufficiency due to atrophy, paresis, or scarring who underwent operative (n = 13) or office-based (n = 18) nanofat injection laryngoplasty. The average injected fat volume was 0.5 mL per side. Median follow-up was 12 ± 4 months. Stroboscopy was used to assess vocal fold closure and vibration. Pre- and post-Voice Handicap Index-10 (VHI-10) and Cepstral Spectral Index of Dysphonia scores were compared.

RESULTS

VHI-10 scores improved significantly from pre- to post-treatment (p < 0.05). Improved glottic closure after nanofat injection correlated with improved voice. Unwanted stiffness was noted in only one case. Unwanted absorption occurred in the first year in nine patients (29%), whereas the remaining patients maintained good long-term function.

CONCLUSION

Nanofat-only lipoinjection is a potential alternative to microfat injection for the treatment of glottal insufficiency. Office-based nanofat injection using a small-gauge needle cannula is a practical alternative to operative microfat injection. Early absorption remains a challenge, and targeted overinjection and improved fat processing should be considered to optimize outcomes.

LEVEL OF EVIDENCE: Level 4. Retrospective case series.