Facial weakness and eyelid ptosis: Expanding the clinical heterogeneity of Bethlem myopathy from a novel gene mutation

tion of foreign substances are disadvantages of these techniques. Fat grafting is a common technique used in plastic surgery, and it has shown low complication rates and good results. Improved scar appearance and benefits in microcirculation have been described. Unpredictable resorption rates remain a major concern, ranging from 30% to 80%, with stable results after 3 months. Graft survival depends on local oxygen diffusion, pressure, and shear stress. Different attempts to improve nerve regeneration using fat tissue are described in basic research; however, knowledge about its application in humans is limited. In this case, discharge of overgrafted fat through interrupted sutures may have prevented excessive pressure in the fresh wound bed after neurolysis and scar release, resulting in an excellent outcome with stable graft volume after 6 months. In summary, this case shows that lipografting after open revision neurolysis of the tibial nerve in the tarsal tunnel can improve the postoperative outcome and lead to stable, satisfying results. Prospective observational studies are needed to elucidate the technique’s reliability and reproducibility.