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.