Autologous fat injection: The intraoperative endpoint.

We examined a 40-year-old marketing executive and avocational performer in musical theater. He had been active in choral performance as a youth and had taken several years of vocal training during that time, but none since. Approximately 1 year prior to our evaluation, he noticed hoarseness, decreased range, dryness, breathiness, and a general sense that "my cords aren't working right."

The patient's diagnostic evaluation included strobovideolaryngoscopy, laryngeal electromyography, blood tests, and imaging studies. He was found to have right vocal fold paresis, presumably as a consequence of Lyme disease. He could not compensate for his glottic incompetence by voice and singing therapy alone. He was taken to the operating room for an autologous fat injection, and had a 30 to 40% overcorrection following injection at one location laterally (figure).