Skip to main content Accessibility help

Free fat grafting in superficial parotid surgery to prevent Frey's syndrome and improve aesthetic outcome

  • L S Chan (a1), M S Barakate (a1) and T E Havas (a1)



Frey's syndrome and cosmesis are important considerations in parotid surgery. Placement of an interpositional barrier can prevent these complications; however, surgical technique and efficacy remain controversial.


A prospective case series was collected comprising all patients undergoing primary superficial parotidectomy for benign pathology with abdominal free fat grafting between June 2007 and December 2010, performed by a single surgeon. A survey was also distributed to otorhinolaryngology consultants across Australia to assess current practice.


Twenty-eight patients were included. No patient had clinical symptoms of Frey's syndrome. Seventy-five per cent of patients were completely satisfied with their aesthetic outcome, 18 per cent scored 4/5 and the remaining 7 per cent (2 patients) scored 3/5. The survey revealed that 79 per cent of respondents did not use interpositional grafts.


Abdominal free fat is ideal for grafting as it is an effective, safe, simple, accessible, fast and inexpensive method of providing an interpositional graft.


Corresponding author

Address for correspondence: Dr Lyndon Chan, 20 Ducane St, Forrest, ACT, Australia2603 Fax: +61 2 4922 3344 E-mail:


Hide All

Presented as a poster at the Australian Society of Otolaryngology Head and Neck Surgery 2012 Annual Scientific Meeting, 1 April 2012, Adelaide, South Australia, Australia



Hide All
1Albergotti, W, Nguyen, S, Zenk, J, Gillespie, MB. Extracapsular dissection for benign parotid tumours: a meta-analysis. Laryngoscope 2012;122:1954–60
2Curry, J, King, N, Reiter, D, Fisher, K, Heffelfinger, R, Pribitkin, E. Meta-analysis of surgical techniques for preventing parotidectomy sequelae. Arch Facial Plast Surg 2009;11:327–31
3Sanabria, A, Kowalski, L, Bradley, P, Hartl, D, Bradford, C, de Bree, R et al. Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: a systematic review. Head Neck 2012;34:589–98
4Bianchi, B, Ferri, A, Ferrari, S, Copelli, C, Sesenna, E. Improving esthetic results in benign parotid surgery: statistical evaluation of facelift approach, sternocleidomastoid flap, and superficial musculoaponeurotic system flap application. J Oral Maxillofac Surg 2011;69:1235–41
5Asal, K, Köybaşioğlu, A, Inal, E, Ural, A, Uslu, S, Ceylan, A et al. Sternocleidomastoid muscle flap reconstruction during parotidectomy to prevent Frey's syndrome and facial contour deformity. Ear Nose Throat J 2005;84:173–6
6Bonanno, P, Palaia, D, Rosenberg, M, Casson, P. Prophylaxis against Frey's syndrome in parotid surgery. Ann Plast Surg 2000;44:498501
7Taylor, S, Yoo, J. Prospective cohort study comparing subcutaneous and sub-superficial musculoaponeurotic system flaps in superficial parotidectomy. J Otolaryngol 2003;32:71–6
8Ahmed, O, Kolhe, P. Prevention of Frey's syndrome and volume deficit after parotidectomy using the superficial temporal artery fascial flap. Br J Plast Surg 1999;52:256–60
9Cesteleyn, L, Helman, J, King, S, Van de Vyvere, G. Temporoparietal fascia flaps and superficial musculoaponeurotic system plication in parotid surgery reduces Frey's syndrome. J Oral Maxillofac Surg 2002;60:1284–97
10Elliott, R, Weinstein, G, Low, D, Wu, L. Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification system and algorithm. Ann Plast Surg 2011;66:429–37
11Valentini, V, Cassoni, A, Marianetti, TM, Battisti, A, Terenzi, V, Iannetti, G. Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap? J Craniofac Surg 2008;19:1148–53
12Dulguerov, P, Quinodoz, D, Cosendai, G, Piletta, P, Marchal, F, Lehmann, W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg 1999;125:833–9
13Sachsman, S, Rice, D. Use of AlloDerm implant to improve cosmesis after parotidectomy. Ear Nose Throat J 2007;86:512–13
14Sinha, U, Saadat, D, Doherty, C, Rice, D. Use of AlloDerm implant to prevent Frey syndrome after parotidectomy. Arch Facial Plast Surg 2003;5:109–12
15Nosan, D, Ochi, J, Davidson, T. Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 1991;104:293–8
16Harada, T, Inoue, T, Harashina, T, Hatoko, M, Ueda, K. Dermis-fat graft after parotidectomy to prevent Frey's syndrome and the concave deformity. Ann Plast Surg 1993;31:450–2
17Curry, J, Fisher, K, Heffelfinger, R, Rosen, M, Keane, W, Pribitkin, E. Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy. Laryngoscope 2008;118:210–15
18Conger, B, Gourin, C. Free abdominal fat transfer for reconstruction of the total parotidectomy defect. Laryngoscope 2008;118:1186–90
19de Bree, R, van der Waal, I, Leemans, C. Management of Frey syndrome. Head Neck 2007;29:773–8
20Luna-Ortiz, K, Sansón-RíoFrío, J, Mosqueda-Taylor, A. Frey syndrome. A proposal for evaluating severity. Oral Oncol 2004;40:501–5
21Mohammed, F, Asaria, J, Payne, R, Freeman, J. Retrospective review of 242 consecutive patients treated surgically for parotid gland tumours. J Otolaryngol Head Neck Surg 2008;37:340–6
22Linder, T, Huber, A, Schmid, S. Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope 1997;107:1496–501
23Owen, E, Banerjee, A, Kissin, M, Kark, A. Complications of parotid surgery: the need for selectivity. Br J Surg 1989;76:1034–5
24Clayman, M, Clayman, S, Seagle, M. A review of the surgical and medical treatment of Frey syndrome. Ann Plast Surg 2006;57:581–4
25Bray, D, Hopkins, C, Roberts, D. A review of dermal fillers in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2010;18:295302
26Neuber, G. Fat transplantation [in German]. Chir Kongr Verhandl Dtsch Gesellsch Chir 1893;22:66
27Boyce, R, Nuss, D, Kluka, E. The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck. Otolaryngol Clin North Am 1994;27:3968
28Ersek, R. Transplantation of purified autologous fat: a 3-year follow-up is disappointing. Plast Reconstr Surg 1991;87:219–27
29Matsudo, P, Toledo, L. Experience of injected fat grafting. Aesthetic Plast Surg 1988;12:35–8
30Pinski, K, Roenigk, HJ. Autologous fat transplantation. Long-term follow-up. J Dermatol Surg Oncol 1992;18:179–84
31Fontdevila, J, Serra-Renom, J, Raigosa, M, Berenguer, J, Guisantes, E, Prades, E et al. Assessing the long-term viability of facial fat grafts: an objective measure using computed tomography. Aesthet Surg J 2008;28:380–6
32Witt, R. The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope 2002;112:2141–54
33Casler, J, Conley, J. Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system plication in the prevention of Frey's syndrome. Laryngoscope 1991;101:95100
34Bonanno, P, Casson, P. Frey's syndrome: a preventable phenomenon. Plast Reconstr Surg 1992;89:452–6
35Allison, G, Rappaport, I. Prevention of Frey's syndrome with superficial musculoaponeurotic system interposition. Am J Surg 1993;166:407–10
36Taylor, S, Yoo, J, Matthews, T, Lampe, H, Trites, J. Frey's syndrome and parotidectomy flaps: a retrospective cohort study. Otolaryngol Head Neck Surg 2000;122:201–3
37Wille-Bischofberger, A, Rajan, G, Linder, T, Schmid, S. Impact of the SMAS on Frey's syndrome after parotid surgery: a prospective, long-term study. Plast Reconstr Surg 2007;120:1519–23
38Teknos, T, Nussenbaum, B, Bradford, C, Prince, M, El-Kashlan, H, Chepeha, D. Reconstruction of complex parotidectomy defects using the lateral arm free tissue transfer. Otolaryngol Head Neck Surg 2003;129:183–91
39Rappaport, I, Allison, G. Superficial musculoaponeurotic system amelioration of parotidectomy defects. Ann Plast Surg 1985;14:315–23
40Arden, R, Miguel, G. Aesthetic parotid surgery: evolution of a technique. Laryngoscope 2011;121:2581–5
41Kornblut, A, Westphal, P, Miehlke, A. A reevaluation of the Frey syndrome following parotid surgery. Arch Otolaryngol 1977;103:258–61
42Athavale, S, Phillips, S, Mangus, B, Datta, J, Sinard, R, Netterville, J et al. Complications of alloderm and dermamatrix for parotidectomy reconstruction. Head Neck 2012;34:8893
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed