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Improvement of Skin Quality after Fat Grafting: Clinical Observation and an Animal Study
Abstract
Restoration of volume and contour defects is a challenge in plastic surgery. Autologous fat tissue transfer is gaining increasing popularity in this field. The aim of this study was to investigate the histologic modifications of the skin after fat tissue grafting on an animal model.
Thirty nude mice, divided into three groups, were used in the experiment. All 30 mice received human fat tissue on one side. On the opposite side, 10 mice received nothing (negative control group), 10 mice received cell proliferation medium, and the remaining 10 mice received only subcutaneous tunneling. Eight weeks later, biopsies of the skin and subcutaneous tissue were performed and specimens were analyzed by hematoxylin-phloxin-saffron staining. Dermis thickness was measured. To differentiate human from murine collagen fibers, human and murine collagen type I antibodies were used. The other types of collagen were investigated by immunohistochemistry (immunostaining) using collagen type III, V, and VI antibodies.
Fat tissue was found in all animals. Macroscopically, fat tissue presented normal aspects, with abundant peripheral neovascularization. Histologic examination showed abundant extracellular matrix around the injected human fat tissue. This was attributable to increased type I collagen fibers of murine origin as a result of the murine fibroblast stimulation by the grafted human fat tissue. Dermal thickness after fat grafting was significantly greater. This was not attributable to inflammatory reactions, because no modification was detected in our control groups.
This study shows that fat tissue grafting stimulates a neosynthesis of collagen fibers at the recipient site and makes the dermis thicker. However, the long-term effects remain undetermined and need further investigation.
... However, these methods fail to resolve the ulcers completely, and patients are often left with recurring DFUs, which greatly affect their quality of life [2]. The emergence of skin substitute technology has changed the paradigm of DFU treatment [5]. Accordingly, a variety of biological skin substitutes, derived from either natural or synthetic biomaterials, have been developed over the last 20 years to improve the prognosis of DFUs [5]. ...
... The emergence of skin substitute technology has changed the paradigm of DFU treatment [5]. Accordingly, a variety of biological skin substitutes, derived from either natural or synthetic biomaterials, have been developed over the last 20 years to improve the prognosis of DFUs [5]. ...
Adipose tissue is an abundant source of extracellular substances that support the tissue repair process. This pilot study was carried out to determine the efficacy of 3D-bioprinted autologous adipose tissue grafts on diabetic foot ulcers (DFUs), with fibrin gel used to stabilise the graft. This was a single-arm pilot study in a tertiary hospital that provides diabetic wound care services. A total of 10 patients with a DFU were enrolled, and the primary endpoint was complete healing within 12 weeks. The secondary endpoints were wound size reduction, time to healing, and adverse events. Seven out of ten patients showed complete healing of their DFU within 12 weeks (at 2, 4, 5, 10, and 12 weeks, respectively). The wound size reduction rate was significantly and progressively reduced over time. According to our data, autologous adipose tissue grafting using a 3D bioprinter, with the addition of fibrin gel that acts as a scaffold, promotes wound healing with high-quality skin reconstruction. Throughout this study period, no adverse events were observed.
... [29][30][31][32] Fat placed around the nerve could avoid the recurrence of scar contracture, and this condition could improve patients' pain. 33 Chin fat grafting is largely used in aesthetic surgery with low incidences of complication. 34 The possibility of speeding up wound healing by performing fat grafting before wound closure is described in the literature. ...
... Several authors demonstrated efficacy of AFG in tissue repair, analgesic effect, and reduction of functional limitations. 33 However, there are some authors who suggest that there is no effectiveness of AFG in scar treatment. Brown et al 38 demonstrated no statistical evidence between AFG and saline injection, but this result could be conditioned by the low number of patients in the study. ...
Due to the spread of the coronavirus disease 2019 pandemic, an increasing number of ill patients have been admitted to intensive care unit requiring mechanical ventilation. Although prone positioning is considered beneficial, long periods in this position may induce important complications, including pressure ulcers in high-risk and uncommon body areas. We report five cases of pressure ulcer necrosis of the chin in coronavirus disease 2019 patients as a consequence of mechanical ventilation in prone positioning using autologous fat grafting (AFG) as a secondary technique. A series of five patients with secondarily-healed chin necrosis treated by AFG between February and June 2020 were reviewed. All patients had been treated initially with surgical debridement followed by conservative treatment. Secondary AFG was performed to reduce patient’s pain, improve chin contour-projection, and minimize cosmetic sequelae and scarring. Patient satisfaction was assessed using a five-point Likert scale (0–4). Vancouver scale was used to evaluate the chin scars clinically. The average amount of fat injected into the chin area was 8.1 ± 2.0 ml. At 6-month follow-up, all patients were mostly satisfied (average Likert-scale 3.2 ± 0.4). Based on the Vancouver scale, improvement of the chin scar from 9.5 ± 0.8 to 4.7 ± 0.8 was found. We report a positive experience with secondary AFG for correction of painful and unaesthetic scarring and contour abnormality following surgical debridement and secondary-intention healing of chin pressure ulcers.
... However, adipose-derived stem cells (ASCs) were discovered by Zuk et al. in 2002 [3], promoting a plethora of research on the regenerative properties of adipose tissue. Thus, the scope of clinical application of adipose tissue graft is now being expanded beyond volumizing procedures to skin rejuvenation procedures [4][5][6] and treatment of wounds [7][8][9], among others. lial progenitor cells, and immune cells, (2) extracellular matrices (ECMs), and (3) cytokines, we hypothesized that MAT grafting may be a promising alternative for diabetic foot ulcer (DFU) treatment. ...
... Several key factors, including reduced cell proliferation and migration, slower growth factor production, and an abnormal ECM, contribute to impaired wound healing in patients with diabetes [16][17][18][19]. To overcome these obstacles, MAT niche treatment might be a promising therapeutic alternative in that it is composed of cellular components such as ASCs [3,[20][21][22][23][24][25][26][27][28], ECMs [29][30][31][32][33][34], and various cytokines [4,35], which are fundamental factors in wound healing. ...
Numerous studies have demonstrated the various properties of micronized adipose tissue (MAT), including angiogenic, anti-inflammatory, and regenerative activities, which can be helpful in wound healing. This exploratory clinical trial aimed to report the efficacy and safety of MAT niche for treating diabetic foot ulcers. Twenty subjects were randomly divided into MAT niche treatment (n = 10) and control groups (n = 10). All patients were followed up weekly for 16 weeks. We evaluated the efficacy of the MAT niche treatment by assessing the (1) reduction in wound area after 4 weeks and (2) percentage of patients who achieved complete wound closure after 16 weeks. All possible adverse events were recorded. The wound area was reduced by 4.3 ± 1.0 cm 2 in the treatment group and by 2.0 ± 1.1 cm 2 in the control group (p = 0.043). Complete wound healing was achieved after 16 weeks in eight out of 10 patients (80%) in the treatment group and three out of six (50%) in the control group (p = 0.299). No serious adverse events related to MAT niche treatment were observed. Although the present study's findings do not support the use of this therapy to treat foot ulcers of patients with diabetes owing to the small number of patients included and the absence of statistical significance, the results of this pilot preliminary study are promising in that MAT niche autografts may offer the possibility of a simple and effective treatment for diabetic ulcers. Further follow-up studies with a larger number of patients are required to validate our findings.
... 10 Others have also observed increased trophicity of radiation-damaged skin after fat grafting, yet these studies do not make any effort to quantify trophic or viscoelastic changes of the observed skin changes. 11,12 The current study expands on previous work and quantifies the observed skin trophic changes. ...
... We set out to design a study in which the real-world application of these previous findings could be tested. Similar to Razzouk et al 11 and Mojallal et al, 12 we made similar clinical observations regarding the improvement of skin trophicity after autologous fat graft. We developed a method to quantify the observed changes. ...
Introduction:
The impact of fat grafting on the viscoelasticity of irradiated tissues is poorly defined. We investigate the effect of subcutaneous fat grafting on postmastectomy tissue expansion in patients undergoing delayed breast reconstruction. We quantify observed viscoelastic and trophic changes of the skin envelope. We hypothesize that fat grafting changes the trophic and viscoelastic properties of the breast soft tissue envelope.
Methods:
Postmastectomy defects delayed more than 2 years and reconstructed with subpectoral tissue expanders were prospectively studied. Control (no irradiation, no fat grafting, n = 7), fat grafted (no irradiation, fat grafting n = 8), and irradiated plus fat grafting (irradiation, fat grafting, n = 9) groups were included. Hydrostatic pressures of the tissue expanders were measured before and immediately after expansion, and again postexpansion day 1. Pressure changes calculated as "postexpansion-relaxation interval": difference between maximal pressure at each expansion and the minimal pressure before the next expansion session. Differences were analyzed between groups.
Results:
Hydrostatic pressure plots reflect the soft tissue ability to accommodate sequential expansion. Fat grafted breasts demonstrated a statistically significant increased postexpansion-relaxation interval versus the nongrafted control group (P < 0.0001). Irradiated plus fat grafting breasts achieve similar postexpansion relaxation interval to the control group (P = 0.597). These changes are observed at postoperative week 6. Viscoelastic changes impact the overall expansion time: the fat grafted group achieved total expansion 2 weeks earlier than the nongrafted control group (P = 0.019). The fat grafted, radiated group completed expansion in similar time interval as nongrafted control group.
Conclusions:
Observed viscoelastic changes impact the overall expansion time. Fat grafting in nonradiated mastectomy defects allows for shorter expansion period. Fat grating in radiated postmastectomy defects allows expansion durations equivalent to nonradiated, nonfat grafted control defects. There is a delayed effect of fat grafting observed at postoperative week 6.
... Therefore, FG has become a basic tool in the armamentarium of head and neck, breast, trunk, and extremity reconstructive and aesthetic procedures as well as in burns sequelae and chronic wound treatment. [1][2][3][4][5][6] FG in the face has been utilized for over a century. 7 However, it did not become widely utilized until modern liposuction was invented and Coleman conducted his studies in the 1990s. ...
... However, its main disadvantage remains the unpredictable take rates that can compromise the final result. 1,8 If FG is not properly performed, the take rate can vary from total resorption to overfilling. In this sense, the following basis principles must be respected in performing facial FG: appropriate equipment and surgical tools (appropriate harvesting and injection cannulas, which are essential), harvesting technique, processing, and injection technique. ...
See the Original Article here.
Fat grafting (FG) is increasing in popularity in both reconstructive and aesthetic surgery. Therefore, FG has become a basic tool in the armamentarium of head and neck, breast, trunk, and extremity reconstructive and aesthetic procedures as well as in burns sequelae and chronic wound treatment.¹⁻⁶
FG in the face has been utilized for over a century.⁷ However, it did not become widely utilized until modern liposuction was invented and Coleman conducted his studies in the 1990s.8,9 The relative ease of harvesting, processing, and injecting the fat tissue renders the technique appealing in addition to its excellent filling and regenerative effect.
However, its main disadvantage remains the unpredictable take rates that can compromise the final result.1,8 If FG is not properly performed, the take rate can vary from total resorption to overfilling. In this sense, the following basis principles must be respected in performing facial FG: appropriate equipment and surgical tools (appropriate harvesting and injection cannulas, which are essential), harvesting technique, processing, and injection technique. The donor fat tissue also must match the recipient site in terms of type, size of the lobules, and favorable recipient extracellular matrix and microenvironment.
... No obstante, sí se demostró mejoría que no solo resultó de la expansión volumétrica, sino también del efecto de las ASC que aumentan la producción de grandes cantidades de colágeno tipo I y III, en menor cantidad V y VI, fibroblastos, y matriz extracelular, lo que garantiza una reparación estructural de la dermis.(30) En 2009, Mojallal(31) hace referencia a las inyecciones subcutáneas de tejido graso que hacen que la piel luzca más joven debido a la estimulación de la neosíntesis de fibras de colágeno en el sitio receptor. El mismo planteamiento es realizado por Zheng(32) en 2019, en su estudio cuyos resultados revelan que las arrugas en las áreas inyectadas con nanograsa centrifugada y convencional, reducen significativamente, atribuyéndole estas respuestas a los efectos desencadenados por las ASC. ...
Objetivo:
Evaluar el efecto de las células madre derivadas del tejido adiposo en el tratamiento de las arrugas periorbitarias.
Métodos:
Ensayo comparativo aleatorizado doble ciego en el Servicio de Cirugía Plástica del Hospital Ameijeiras, en el período comprendido entre septiembre de 2019 y julio de 2021. La muestra quedó formada por 70 pacientes que cumplieron los criterios de selección que se distribuyeron en dos grupos de tratamiento.
Resultados:
Predominaron las mujeres (88,6 %) con promedio de edad de 47 años sin diferencias significativas entre los grupos de tratamiento. El 60,0 % del grupo estudio y el 62,9 % del control presentaron fototipo cutáneo II sin diferencias significativas entre los grupos (p= 0,855). El mayor porcentaje del grado de envejecimiento correspondió al III y el menor al IV (14,3 % contra 20,0 %), sin diferencias significativas entre los grupos (p= 0,487). Antes del tratamiento, hubo mayor frecuencia de arrugas moderadas (estudio: 42,9 %; control: 51,4 %) y severas (estudio: 42,9 %; control: 34,3 %). Posterior a la intervención, se constató una mejoría superior en el grupo estudio con cambios significativos en ambos conjuntos tratados (p< 0,001). Se presentó una complicación del grupo control (2,9 %); 100 % quedó satisfecho y los resultados fueron buenos en el grupo estudio (94,3 %) y regulares en igual proporción del control con diferencias significativas (p< 0,001).
Conclusiones:
La lipotransferencia asistida con células madre ofrece resultados superiores a la convencional en el rejuvenecimiento periorbitario.
... The recent debate regarding fat grafting concerns how the different processing methods of the lipoaspirate may influence the therapeutic effect, and if it is necessary to associate additional growth factors. This evidence, however, is currently based on clinical observations, in vitro or animal experiments [16,17] . ...
... Các nếp nhăn có thể được cải thiện tốt bằng kỹ thuật cấy mỡ nông dưới da, tuy nhiên cấy nông với số lượng quá nhiều dễ gây vón cục, sờ thấy nốt sần trên da và giảm khả năng sống của mỡ. 12 Sau khi cấy mỡ, lượng mỡ sẽ tiêu đi một phần, thông thường lượng mỡ được cấy sẽ tiêu đi khoảng 50 đến 90%, vì vậy lượng mỡ cấy vào cần nhiều hơn do với mục tiêu (khoảng 20%). 13 ...
Cấy mỡ tự thân là phẫu thuật sử dụng mô mỡ để cấy vào mô dưới da, mỡ được lấy trên chính bệnh nhân này. Phẫu thuật này thường được sử dụng cho mục đích thẩm mỹ, đặc biệt là tạo hình khuôn mặt. Mỡ tự thân được nhiều phẫu thuật viên xem là chất liệu độn lý tưởng vì nó không bị đào thải, kết quả mềm mại, tự nhiên và có thể tồn tại vĩnh viễn
... Studies have shown high levels of patient satisfaction and low complication rates with this technique [26][27][28] . Fat grafting can effectively improve the overall breast contour and achieve a more natural-looking shape [29,30] . Delayed grafting is often favored as the recipient tissue bed becomes more vascularized with time and yields increased graft retention. ...
Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures. Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability; it can be used independently to replace more invasive flap procedures or implants, or as an adjunct for smaller volume supplementation. The breadth of applications in the breast necessitates diversity in technique and approach, and while there is no universally agreed-upon protocol, basic principles have guided the evolution of some commonly adopted tenets. Broadly, fat grafting outcomes are highly favorable but dependent on patient and procedure factors, requiring learned patient selection and expertise in recipient site assessment. Common complications from fat grafting, such as fat necrosis and the development of nodules, are particularly troublesome for post-oncologic patients, requiring considerable pre-surgical consultation for patient education and managing expectations. In addition to volume and contour augmentation, fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or post-mastectomy pain syndrome, improved skin quality and reduced fibrosis following radiation, and possible anti-tumorigenic effects. New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma. Preclinically, research towards safe and effective regenerative medicine approaches is actively underway, with the ultimate goal of achieving predictable and increased graft retention, reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.
... Fat grafting has many advantages, including the absence of foreign body granuloma or biofilm formation [25]; the possibility of injection in all layers; the abundance of material, allowing larger volumes to be injected, with better distribution; and better tissue integration, with more natural and complete results. ...
This book is the result of a collective effort to present and develop knowledge in all scientific areas. We would like to thank all participants in this magnificent interdisciplinary work, firstly. We would also like to remind you that the idea of this connection and conversation between diverse areas, all correlated with the improvement of science, is done internationally, preferring to eliminate borders to reach the largest number of people and spread knowledge. In this sense, we quote Bobbio, who says that borders are a great obstacle to reaching all those who are different and that people are people no matter their nationality when he talks about the diffusion of human rights. In this way, this book, despite being indexed in a platform, can reach everyone and fulfill its role of developing and flourishing in different places without excluding people. Finally, we hope, dear reader, that you find this book pertinent, and if you feel instigated, you can contribute to our mission and spread the knowledge through future submissions.
... 3 In addition to the graft survival, fat grafting showed regenerative effect (improvements in terms of skin quality, scarring, and fine wrinkles) due to the ADSCs. [4][5][6][7] There has also been significant advances in the harvesting and processing of autologous fat, thus enhancing the applicability of facial fat grafting. ...
Background:
Age-related changes to the face pertinent anatomy and important aspects of autologous fat grafting have been widely applied in facial rejuvenation. Various types of autologous fat products (Macrofat, Microfat, SEFF, nanofat, and SVF-gel) with different properties and applicabilities have been introduced and available for surgeons.
Methods:
Key differences between common techniques for fat processing and infiltration. Develop a plan for patients based on site-specific facial anatomical zones, we suggested a pyramidal multiple-theory (multi-type, multi-method and multi-layer) for facial fat grafting. Based on the complicated mechanism of the face decrepitude in different layers of facial soft tissue, autologous fat products with various particle sizes and components into different layers.
Results:
Fifty-eight patients underwent this facial fat grafting strategy from June 2020 to Jan 2022. All achieved cosmetic improvements, with higher patients' satisfaction, and minor complications. Our facial fat grafting strategy takes advantage of different fat products and is able to address the physiological tissue changes during aging, more properly and targetedly, than the traditional facial fat grafting.
Conclusions:
Fat grafting to the face aids in volume restoration and rejuvenation, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. The technique described as "lipo-tumescence" has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.
... [7][8][9] Furthermore, anti-inflammatory cytokines, proangiogenic factors, and healing-related peptides present in autologous fat may positively affect wound healing. 10 In an animal study conducted by Mojallal et al, 11 autologous fat grafting resulted in the stimulation of collagen fiber neosynthesis and improved vascularization and thickness of the dermis and subcutaneous tissue in mice. And, in a recent randomized controlled trial, improved healing rates were noted for patients with diabetes who received local injection of autologous microfragmented adipose tissue following a minor foot amputation. ...
Diabetic foot complications are increasingly burdensome for patients, clinicians, and society. Development of innovative therapies to support good quality basic care is a priority among those with an interest in this area. One of these involves scanning and printing tissues to match and conform to a defect (so-called 3D printing).
Methods:
A single-arm pilot study of ten consecutive patients with a history of a chronic diabetic foot ulcer (DFU), treated with autologous minimally manipulated homologous adipose tissue (AMHAT), dispensed by a specialized 3D bioprinter, Dr. INVIVO, was performed. Patients with nonhealing DFUs present for more than 4 weeks and refractory to standard-of-care therapies were included. Wounds were treated with a single application of AMHAT, and then followed up weekly for up to 12 weeks, or until the wounds healed. The primary outcome measure was complete epithelialization of the wound up to 12 weeks after the treatment. Secondary outcome measures included wound size and/or volume reduction, assessment of ulcer grade, and time to closure.
Results:
Five wounds were healed by 5 weeks and one at 8 weeks. The mean percent area reduction at 12 weeks was 78.3% (SD: 33.23). Complete closure was achieved in 60% of wounds. The mean time to closure in these wounds was 49.1 days (95% CI, 29.9-68.3). No adverse events were reported.
Conclusions:
Single treatment of bioprinted AMHAT appears to be a safe and potentially effective treatment modality for patients with chronic DFUs. Further studies are warranted to explore the full potential of 3D bioprinting for tissue repair in this high-risk population.
... Autologous fat grafts consist primarily of adipose-derived stromal cells and stromal vascular fraction gel, which can minimize scar size and increase the quality and pliability of scars. [35][36][37][38][39][40][41][42] Adipose stromal cells have been found to enhance skin neovascularization, 43 allowing easy graft insertion and improving graft growth environments. Subcutaneous fat transplantation can also promote the regeneration of hair follicles in scarred areas, as good results were obtained when autologous fat grafts were used to treat atrophic scarring alopecia in eyebrows. ...
Background:
Scarring that results in eyebrow loss is a serious psychological and cosmetic problem. Although hair transplantation is increasingly utilized for eyebrow restoration, graft loss may occur, preventing achievement of desired results. Single-hair follicle transplantation, however, may be effective. The present study describes outcomes of a standardized method of eyebrow reconstruction, involving single-hair follicle transplantation combined with follicular unit extraction (FUE), in patients with absent eyebrows due to scarring.
Methods:
This study was approved by the institutional ethics committee of Nanfang Hospital and all patients provided written informed consent before surgery. The medical records of patients who underwent eyebrow reconstruction from 2012-2019 for eyebrow loss caused by scar formation were retrospectively reviewed. Outcomes evaluated included satisfaction, graft survival rate and long-term complications. A nine-step standardized operating procedure was established for eyebrow reconstruction in patients with eyebrow absence due to scarring.
Results:
During the study period, 167 patients (205 eyebrows) underwent eyebrow reconstruction. Following the first stage of reconstruction, 95% of patients were highly satisfied with the density and natural appearance of their eyebrows. The average graft survival rate was 85% (range, 70-90%), significantly higher than the 75% survival rate previously reported. Fewer than 5% of patients underwent the take second stage of reconstruction, with these patients expressing satisfaction with their outcomes. No obvious complications were observed.
Conclusion:
This standardized method may optimize outcomes in patients with eyebrow absence due to scarring.
... Mojallal et al. [32] grafted human fat tissue into mice scar model and assessed the histological changes. They demonstrated that fat tissue grafting stimulated a neosynthesis of collagen fibers at the recipient site and makes the dermis thicker. ...
Introduction:
The morphology and tissue response to macro- and micro-fat grafting have been widely studied in both clinical and experimental settings; the histological effects of the nanofat graft, however, remain largely unexplored.
Aims:
This study was carried out to evaluate the histological changes leading to scar rejuvenation in a fine scar following nanofat grafting.
Materials and methods:
This was an experimental study carried out on guinea-pig fine-line scar models. Nanofat prepared from abdominal fat of the animal was injected into scar on right legs (NFG) at 1 month whereas left acted as controls (CG). Punch biopsies from all scars were analyzed at 2, 4, and 6 months by Hematoxylin&Eosin, Masson's trichrome, and Picrosirius red stains to evaluate dermal/epidermal regeneration, collagen fiber orientation, pattern of distribution, and amount of mature and immature collagen.
Results:
Nine animals were included in the final analysis of the study. On histological analysis, the amount of inflammatory infiltrate, collagen fiber orientation, pattern and total histological score at 2, 4, and 6 months were similar between the groups. There was an increased trend for earlier appearance of organized and mature forms of collagen in the NFG group. The distribution of collagen was similar at 2 months; however, there was a significant increase in collagen distribution in NFG at 4 months (NFG: 46.11±11.6, CG: 31.16±9.9; P = 0.010) and at 6 months (NFG: 63.48± 6.6, CG: 49.9 ±8.8; P = 0.002).
Conclusion:
Nanofat grafting is associated with an accelerated and increased production of mature collagen with proper alignment in fine-line scars.
... However, almost the majority of these therapeutical methods have remained inconclusive and unsatisfactory and in fact no gold standard treatment has been provided for these lesions. Meanwhile, autologous fat grafting has been used as a comprehensive method for tissue repair in the recent decade, and in some studies [8][9][10], the effectiveness of this method in repairing the structure and formation of the skin and rejuvenation has been confirmed [11][12][13][14]. Fat tissue consists of two main components which are as follows: mature adipocyte cells and stromal vascular fraction (SVF) [15][16][17]. ...
Background
Acne is the most common skin disorder which is known as a chronic inflammatory disease with psychological burden and reduced quality of life. Adipose tissue-derived stromal vascular fraction (SVF) is recognized as a source of regenerative cells and improves the quality of skin by increasing collagen content. To date, a few studies have been performed on the therapeutic role of SVF in the treatment of acne scars.
Methods
This randomized, single-blinded clinical trial was performed on 7 patients with acne scars. In all patients, the initial grade of acne (volume, area and depth) was evaluated and ultrasound of the relevant scar was performed to evaluate neocollagenesis. As a spilt face study, for treating the scars, we used nanofat subcutaneously on one side of the face (control group) and combination of nanofat subcutaneously and SVF intradermally on the opposite side (intervention group). The patients were evaluated for severity of acne by visioface after one month, also for thickness of epidermis and dermis by ultrasound after one month and three months.
Results
All of the apparent findings of scars improved in two groups after one month, but these changes were significant just for the group treated with SVF ( p value < 0.05). Epidermal, dermal and complete thicknesses during the first month in both control and intervention groups were significantly increased ( p value < 0.05) but between the first and third months, there was no significant difference in the variables ( p value > 0.05). The findings showed that dermal and complete thicknesses of the skin in the first month were different between two groups significantly ( p value: 0.042 and 0.040, respectively).
Conclusion
The use of SVF in the treatment of patients with acne scars accelerates the improvement of volume, area and depth of the scar by increasing collagen content and the dermal thickness, so it can be used as a potentially effective treatment for these patients.
... In contrast, the skin texture and pigmentation changes may come from the regenerative effects of fat grafting (28). The regenerative effect of fat graft allows improvement of skin texture, including skin thickness and skin elasticity (29). Skin color modification can also be caused by diminishing local inflammation or by augmenting melanin (30). ...
Background
Microcirculation plays a vital role in scleroderma physiopathology and the mechanism of fat survival.Objective
This study aims to assess the blood perfusion change after fat grafting and evaluate the relationship between blood perfusion and fat graft retention in patients with localized scleroderma (LS).MethodsA pilot study was conducted in patients with LS receiving autologous fat grafting (AFG). Fat graft retention measured by magnetic resonance imaging (MRI) analysis and blood flow perfusion measured by laser speckle contrast imaging 6 months postoperatively were noted. PUMC Localized Scleroderma Facial Aesthetic Index was used to assess the improvement of facial aesthetic impairment.ResultsThe fat retention at the 6-month follow-up was 34.56 ± 11.89 percent. At the 6th month of follow-up, the relative blood perfusion at the lesion area was 115.08 ± 14.39 PU, significantly higher than 100.42 ± 10.62 PU at the pre-operation (p = 0.010). The blood perfusion at follow-up increased by an average of 1.15 ± 0.14 times before the operation. No association between the increase in the blood flow perfusions and fat graft retention was found (r = −0.082, p = 0.811).Conclusion
Local blood perfusion in the lesion area relatively increased after AFG, but no direct relationship was found between fat retention and increased blood supply.
... Adipose tissue transplantation could improve skin quality at the recipient site in addition to increasing skin volume. 89 Further experiments demonstrate that adipose derived stem cells contribute to the regeneration of skin during aging. 90 In recent clinical tests, autologous fat grafting rejuvenates aging skin and enhances the volume of periocular and perioral skin in recipients with an average age of 50 years. ...
Skin aging is a biological complex process influenced by a combination of intrinsic and extrinsic factors. The fact is that the skin health and beauty is considered as major principal factor representing “Health” and “Well-being” in humans. Several skin aging treatments have been developed in recent years. The main objective of this article is to review about the most important anti-aging strategies that a dermatologists have in their hands now-a-days, such as preventive measures, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures. Still research needed in this area to fully elucidate the molecular basis of the deteriorative changes during skin aging.
... Fat grafting, also termed as lipofilling or autologous fat transfer, was initially described in 1983 by Neuber as a therapeutic for scar tissue which is a method of adipose tissue grafting [12,13]. As a result of autologous fat transfer (AFT's) volume-increasing impact, new collagen fibers are generated, resulting in an increased dermal thickness and improved skin quality [14][15][16]. Furthermore, adipose tissue is a connective tissue that contains a variety of cell types, particularly mesenchymal stem cells, which play a critical part in AFT's regeneration [17]. ...
Background and Aim
Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions.
Methods
PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model.
Results
9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78–3.041), stiffness 2.9 points (95% CI 2.33–3.45), irregularity 2.2 points (95% CI 1.093–3.297) and thickness 1.8 points (95% CI 0.804–2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958–1.674) and 0.6 points (95% CI 0.169–1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098–0.96), pigmentation 0.8 points (95% CI 0.391–1.276) and surface area 0.8 points (95% CI 0.34–1.25). Thickness improved by 1.4 points (95% CI 0.582–2.3), relief 1.0 points (95% CI 0.461–1.545) and pliability 1.5 points (95% CI 1.039–2.036).
Conclusion
Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required.
... A large number of studies have shown that fat transplantation can not only fill the depression caused by scar, but also stimulate collagen regeneration, thereby increasing dermal thickness, improving skin texture and relieving pain caused by scar [37,38] . Other studies have shown that the scarred dermis after fat transplantation has the same properties as the normal dermis [36,39] . The mechanism of fat transplantation alleviating pain caused by scar may be related to the improvement of local microenvironment by fat stem cells and secretion of some substances that prolong pain loss [40,41] . ...
p class="a0">Autologous fat has become an ideal filler material due to its easy acquisition, good compatibility and no foreign body sensation after transplantation. In recent years, autologous fat has been widely used in facial rejuvenation or repair and reconstruction, and achieved satisfactory results, which is also in line with the currently advocated minimally invasive treatment direction. Autologous fat transplantation mainly includes fat extraction, separation, transplantation and postoperative treatment, each of which can affect the activity of fat particles and/or fat retention rate after transplantation. In this paper, the application of autologous fat in facial rejuvenation or reconstruction is described in detail.</p
... These findings were corroborated after treatment of 2 nd to 5 th recurrent carpal tunnel syndrome by extensive neurolysis followed by perineural lipografting, with a longer follow-up time (mean of 30 months) (Gostelie et al., 2020). Moreover, it may stimulate the regeneration and elasticity of the skin and adjacent tissues, and significantly reduce recurrent symptoms of carpal tunnel syndrome (Coleman, 2006;Mojallal et al., 2009;Khouri et al., 2013;Krześniak and Noszczyk, 2015). Thus, depositing adipose tissue directly around the nerve is hypothesized to stimulate nerve fiber regeneration (Krześniak and Noszczyk, 2015). ...
The application of autologous fat grafting in reconstructive surgery is commonly used to improve functional form. This review aims to provide an overview of the scientific evidence on the biology of adipose tissue, the role of adipose-derived stem cells, and the indications of adipose tissue grafting in peripheral nerve surgery. Adipose tissue is easily accessible through the lower abdomen and inner thighs. Non-vascularized adipose tissue grafting does not support oxidative and ischemic stress, resulting in variable survival of adipocytes within the first 24 hours. Enrichment of adipose tissue with a stromal vascular fraction is purported to increase the number of adipose-derived stem cells and is postulated to augment the long-term stability of adipose tissue grafts. Basic science nerve research suggests an increase in nerve regeneration and nerve revascularization, and a decrease in nerve fibrosis after the addition of adipose-derived stem cells or adipose tissue. In clinical studies, the use of autologous lipofilling is mostly applied to secondary carpal tunnel release revisions with promising results. Since the use of adipose-derived stem cells in peripheral nerve reconstruction is relatively new, more studies are needed to explore safety and long-term effects on peripheral nerve regeneration. The Food and Drug Administration stipulates that adipose-derived stem cell transplantation should be minimally manipulated, enzyme-free, and used in the same surgical procedure, e.g. adipose tissue grafts that contain native adipose-derived stem cells or stromal vascular fraction. Future research may be shifted towards the use of tissue-engineered adipose tissue to create a supportive microenvironment for autologous graft survival. Shelf-ready alternatives could be enhanced with adipose-derived stem cells or growth factors and eliminate the need for adipose tissue harvest.
... A lipoenxertia possui muitas vantagens e, dentre elas a: ausência de formação de granuloma de corpo estranho ou de biofilme [25] ; a possibilidade de injeção em todas as camadas; a abundância de material, podendo ser injetados volumes maiores, com melhor distribuição; e melhor integração tecidual, com resultados mais naturais e completos. Recentemente, pesquisas vêm sendo realizadas visando avaliar a capacidade de a lipoenxertia regenerar ou rejuvenescer a pele [26] . ...
A obra intitulada “Abordagens ligadas às ciências exatas vol.01”, publicada pela Brazilian Journals, apresentam um conjunto de dezenove capítulos que visam abordar assuntos relacionados com a área das ciências exatas. A seguir são apresentados os trabalhos que compõem os capítulos desta obra. Logo, os artigos apresentados neste volume abordam: uma metodologia simplificada para auxiliar o planejamento do alinhamento horizontal de rodovias rurais utilizando sistema de informações geográficas (SIG) e análise multicritério; desenvolvimento de um modelo de programação linear (PL) visando minimização do custo anual da rede hidráulica de um sistema de irrigação por microaspersão e operacionais, em uma área de 8,16 há; análise da literatura existente e as técnicas empregadas na reabilitação de estruturas de concreto armado com fibra de carbono; avaliação de efeitos do polimorfismo causal R441Q sobre as propriedades funcionais e estruturais da enzima ligase WWP1 da proteína ubiquitina de galinha Gallus gallus por estudos comparativos de predição in silico; revisão e literatura permeando uma temática que vem sido discutida, amplamente, pelos diversos setores da construção civil. A gestão ambiental, no que tange o reuso de resíduos deste setor, tem se mostrado promissora e agrega valor os subprodutos gerados nesta nova cadeia produtiva, entre outros. Dessa forma, agradecemos a todos os autores por todo esforço e dedicação que contribuíram para a construção dessa obra, e esperamos que este livro possa colaborar para a discussão e entendimento de temas relevantes para a área das ciências exatas, orientando docentes, estudantes e pesquisadores à reflexão sobre os assuntos aqui apresentados.
... In recent years, there has been an increased interest in the rejuvenating properties of ASCs and autologous fat grafting, in particular in aged skin of face and hands (Coleman 2006;Mojallal et al. 2009). Several animal studies described an improvement in skin texture, elasticity and aesthetic aspect, including scar tissue, radiationinduced fibrosis, sequelae of burns and scleroderma after treatment with ASCs and fat grafting . ...
Diabetes mellitus (DM) is a chronic, multifactorial metabolic disorder affecting
2–5% of the population and is a major challenge in health. DM type I (T1DM) or
juvenile-onset Diabetes is characterized by autoimmune selective destruction of
insulin-producing pancreatic β cells, which result in an absolute deficiency of insulin
required for glucose metabolism ultimately resulting in the loss of insulin production
and secretion that leads to increase in blood glucose level. So, patients are
dependent on exogenous insulin for their blood glucose control. Usually 60–80% of
the β-cell mass have been destroyed at the time of diagnosis. Insulin replacement
therapy by either insulin pump or multiple daily injections is intensive and often
associated with severe hypoglycemic episodes. Pathogenesis of DM type 2 (T2DM)
is related to genetic, environmental, and lifestyle factors resulting from insulin
resistance in target tissues such as liver, skeletal muscles, and adipose tissues. So, β
cells are unable to sustain the increased demand for insulin, which therefore leads
to chronic hyperglycemia and the onset of T2DM. Both types of diabetes have the
serious long-term complications in different organs such as liver, kidneys, eyes,
heart, nerves, and blood vessels (Diagnosis and classification of diabetes mellitus
2014). Edmonton protocol is the most reliable approach to the treatment of T1DM
by transplantation of whole pancreas or isolated islets. However, the scarcity ofhuman donors and the need for lifelong immunosuppressant to prevent immune
rejection are considered major obstacles to transplantation of islets (Gruessner et al.
2012; Jamiolkowski et al. 2012). Therefore, new therapeutic strategies are needed to
preserve or even promote regeneration of the β-cell mass. Due to the limitation of
using embryonic stem cells (ES) and induced puleripotent stem cells (IPS) in the
clinic, recently cell-based therapy has been focused on mesenchymal stem cells
(MSCs). MSCs have remarkable immunomodulatory properties, and they can be
isolated from adipose tissue and can be differentiated into insulin-producing cells
(IPC). Therefore, they have possible applications in the treatment of type 1 diabetes
(Liu and Han 2008; Wei et al. 2013). In addition, in the past 15 years, a family of
endogenous small noncoding RNAs known as microRNAs (miRNAs) has been discovered
as new players in regulation of protein coding genes. They are a novel class
of endogenous small nc-RNAs, of ~20–30 nucleotides in length that were first discovered
in 1993 in Caenorhabitis elegans and Drosophila and later identified in
many species (Ambros 2004).These nc-RNAs are encoded by up to 3% of all genes,
and approximately 30% of the genes are supposed to be regulated by small RNA
species that regulate gene expression posttranscriptionally (Zhang and Farwell
2008). In mammalians, miRNAs are transcriptional repressor and have inhibitory
effects on RNA stability by base pairing between 3′ untranslated regions (UTRs) of
target mRNAs and miRNA “seed region.” Each miRNA may have multiple targets
and therefor have multiple effects on physiological and pathological processes (van
Rooij 2011). Recently, several miRNAs have been identified that have potential
roles in pancreas development, islet function, insulin secretion, and diabetic complications (Zhang and Farwell 2008; Kantharidis et al. 2011).We also discussed important role of this miRNAs in diabetes and its complications.
... However, since the isolated SVF cells need to use collagenase in the extraction process, which increases the risk, which limits its application in clinical. Adipocytes in adipose tissue were removed by pure physical methods to prepare adipose stem cell gel (SVF-gel) [3,4], an injectable gel-like fat concentrate extract rich in SVF cells and extracellular matrix. It has been proved that the long-term survival rate after transplantation is much higher than that of ordinary fat transplantation [5]. ...
... This comes in agreement with our pathological results.[21][22][23][24] Mojallal et al25 demonstrated neosynthesis of collagen fibers and subsequent dermal thickening in a nude murine model after subdermal injection of human fat tissue. Contrary to our results, Brown et al 20 compared the effects of fat versus saline in treatment of scars. ...
... Fat grafting restores youthful appearance and possesses regenerative properties by the stimulation of collagen neosynthesis. 9 Skin rejuvenation can be the result of the trans-differentiation of pre-adipocytes cells present in the adipose tissue to epithelial stem cells. 10 Thus lipofilling is a potential filler of reference for rhinoplasty. ...
Background
Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining popularity. Given the characteristic of lipofilling to rejuvenate and improve skin texture, fat grafting can be used to reshape the nose in secondary rhinoplasty.
Methods
Fat was injected in 27 patients with a mean age of 42 years. Volume of fat ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months, and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evaluation questionnaire and plastic surgeons’ evaluation.
Results
After 1 year follow up, 20 patients were satisfied with the results at 1 year. The aesthetic outcome was noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of the patients had an improvement in skin texture with trophic effect on the skin .No complications were seen in our series
Conclusion
According to this study, nasal lipofilling is a safe and efficacious filler in secondary rhinoplasty. However, more studies are needed to assess the indications and limitations of nose lipofilling.
This article is protected by copyright. All rights reserved.
... In cancer research, water and fat have been shown to be crucial biomarkers for monitoring tumors [1][2][3], allowing groups to differentiate tissue types [4,5] and locate resection margins [6,7]. Tissue composition has also been the subject of interest in areas such as sports medicine to track fitness and weight loss [8][9][10][11], emergency medicine to regulate patient hydration [12][13][14], and cosmetic dermatological treatments [15][16][17]. ...
We report a narrow wavelength band diffuse reflectance spectroscopy (nb-DRS) method to determine water and fat ratios of scattering media in the 900-1000 nm range. This method was shown to be linearly correlated with absolute water and fat concentrations as tested on a set of turbid emulsion phantoms with a range of water and lipid compositions. Robustness to scattering assumptions was demonstrated and compared against measured scattering by a frequency-domain photon migration system. nb-DRS was also tested on ex-vivo porcine samples and compared against direct tissue water extraction by analytical chemistry methods. We speculate nb-DRS has potential applications in portable devices such as clinical and digital health wearables.
... Mojallal et al noted increased type 1 collagen production and associated increases in dermal thickness following fat grafting in a nude mouse model. 48 Additional murine studies suggest that this is likely driven by stem cells within the graft because similar findings have been reported after injection of isolated adipose stem cells without fat. 49,50 Similarly, Hu et al found that adipose stem cell exosomes alone effectively stimulated fibroblasts to upregulate collagen and elastin. ...
Background
The shock-absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Heel fat pad atrophy (FPA) is common and can be painful and debilitating. In our previous work, autologous fat grafting (AFG) was effective for treating pain from forefoot FPA.
Objectives
We hypothesized that AFG to the heel would relieve pain and improve function in patients with heel FPA.
Methods
Patients with heel FPA and associated pain were recruited and randomized into two groups. Group 1 received AFG upon enrollment and was followed for 2yrs. Group 2 received offloading and activity modification for 1yr, then crossed over, underwent AFG, and was followed for 1yr afterward. Outcome measures included ultrasound-measured fat pad and dermal thickness, pedobarograph-measured foot pressures and forces, and patient-reported outcomes as measured by the Manchester Foot Pain and Disability Index (MFPDI).
Results
Thirteen subjects met inclusion criteria and completed the study. Seven (12 affected feet) were randomized into Group 1, and six (9 affected feet) were randomized into Group 2. Average age was 55yrs and BMI was 30.5kg/m 2. Demographics were not significantly different between groups. Heel fat pad thickness increased after AFG but returned to baseline at 6mo. However, AFG increased dermal thickness significantly and increased fat pad thickness under compressive load compared to controls at 6-12mo. Foot pain, function, and appearance were also significantly improved compared to controls at 6-12mo.
Conclusions
AFG improved patient-reported foot pain, function, and appearance and may rejuvenate local soft tissues in patients with heel FPA.
Background:
The volume and position of the buccal fat pad (BFP) were reported to change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing.
Objectives:
We aimed to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness thereof.
Methods:
Two cadavers were used for the dissection of the BFP and the demonstration of our surgical procedures. Forty-eight patients were treated for midfacial hollowing with our modified grafting strategy. Through a percutaneous zygomatic incision, we filled the BFP and observed an immediate amelioration in the hollow area. Improvements were evaluated by Ogee line and its Ogee angle, Face-Q questionnaires, and three-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed.
Results:
The Ogee angle was 6.6 ± 1.9° pre-operatively and 3.9 ± 1.4° post-operatively (average reduction, 2.7°). Patients' Ogee lines were smoother post-operatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and post-operative outcomes and felt 6.61 ± 2.21 years younger. Overall, 88%, 76%, and 83% of the cases were graded as good and excellent in improvement by surgeon, patient, and the third party, respectively.
Conclusions:
For age-dependent midfacial hollowing in female patients, our modified percutaneous grafting technique was safe and efficacious in restoring BFP volume. With this technique, a smoother Ogee line and a natural, younger midfacial contour could be achieved.
Cleft lip is a common craniofacial anomaly and aesthetic obstacle. Different procedures, techniques, and steps are required for repair. These procedures may result in secondary abnormalities or volume deficiencies that can be managed by different methods such as autologous fat grafting. We aim through this study to identify the technique of autologous fat graft in cleft lip deformity and the patient characteristics for selecting this particular technique. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time- limitation. A total of 14 articles published in the period between 2004 and 2022 were included, then patients in each study who did not meet the inclusion criteria were excluded. A total of 519 patients who underwent autologous adipose tissue augmentation of cleft lip deformity were included and analyzed. Autologous fat graft is found to be safe, effective in improving lip appearance as well as contour, and associated with high satisfaction rate among cleft lip patients. A selected patients with vermilion deficiency, whistle deformity, or overall lip volume deficiency is found to have a higher satisfaction rate. The most frequently reported complications were excess fullness, nodule formation, graft resorption, and nostril deformity.
Over the past 30 years, there has been a dramatic increase in the use of autologous fat grafting for soft-tissue augmentation and to improve facial skin quality. Several studies have highlighted the impact of aging on adipose tissue, leading to a decrease of adipose tissue volume and preadipocyte proliferation and increase of fibrosis. Recently, there has been a rising interest in adipose tissue components, including adipose-derived stem/stromal cells (ASCs) because of their regenerative potential, including inflammation, fibrosis, and vascularization modulation. Because of their differentiation potential and paracrine function, ASCs have been largely used for fat grafting procedures, as they are described to be a key component in fat graft survival. However, many parameters as surgical procedures or adipose tissue biology could change clinical outcomes. Variation on fat grafting methods have led to numerous inconsistent clinical outcomes. Donor-to-donor variation could also be imputed to ASCs, tissue inflammatory state, or tissue origin. In this review, the authors aim to analyze (1) the parameters involved in graft survival, and (2) the effect of aging on adipose tissue components, especially ASCs, that could lead to a decrease of skin regeneration and fat graft retention.
Clinical relevance statement:
This review aims to enlighten surgeons about known parameters that could play a role in fat graft survival. ASCs and their potential mechanism of action in regenerative medicine are more specifically described.
Background: Irregularity of the dorsum is one of the common complications in rhinoplasty. Today, various methods are used to correct the irregularity of dorsum. This study was conducted to determine the effects of using Buccal Fat pad on dorsum changes. Methods: In a randomized clinical trial, 20 patients undergoing primary rhinoplasty with open technique were randomly assigned to the intervention and control groups. In intervention groups, after the end of the osteotomy and before the skin is sutured, A layer of buccal fat was placed on the dorsum and fixed. In the control group dorsum region without the use of buccal fat was sutured. Both groups followed for six months and were assessed regarding, dorsum changes and satisfaction of dorsum aesthetic. Results: In the intervention and control groups, the mean age of patients was 26.60 ±3.92 and 25.90 ±4.38 years, respectively (P = 0.711). In terms of gender, 70% of patients in the intervention group and 80% in the control group were women. The frequency of nasal asymmetry, nasal depression, dorsum narrowing, step and nasal width in the intervention and control groups were 20% and 50% (P = 0.350). The mean score of patient satisfaction and surgeon satisfaction with the beauty of the bridge of the nose in the intervention group was significantly higher than the control group (P <0.05). Conclusion: Using Buccal Fat pad on dorsum during primary rhinoplasty, in addition to reducing changes in dorsum, increases the satisfaction of dorsum beauty.
The skin is the first defense of the body from infections, autoimmunity, and other exogenous factors, including UVA. These factors stimulate the skin to continuous repair. The skin is the most staminal tissue of the body after the digestive mucosa. Fat grafting in the context of skin aging treatment has proven to be useful for regenerative purpose and skin rejuvenation. Recently, the subcutaneous fat was distinguished in deep subcutaneous white adipose tissue (SWAT) and in superficial dermal white adipose tissue (dWAT), which penetrates the dermis through fat bridges or dermal cones around hair follicles. Therefore, dWAT is by definition the best choice to improve the skin. Additionally, ADSCs in the superficial fat show faster proliferative capacity. A special microcannula―the Trivisonno Micro Harvester™ (Tulip Medical Products, San Diego, CA)―was projected to harvest selectively dWAT microfat, which was intradermally injected with a 23 gauge needle or injected close to the deep dermis by a 1.2 mm microcannula, which resulted in improved skin photoaging.KeywordsSkin regenerationSkin rejuvenationCollagen inductionWrinklesPhotoagingWound healingAcne scarsAdipose tissueStromal vascular fraction cellsRegenerative medicine
The contemporary era is hallmarked by development of techniques of harvesting and transplantation of autologous fat tissue aimed at reconstruction of soft tissue defects, but at the same time this also raised the need for further research of its regenerative potentials. As one of the biggest endocrine systems in the human body, fat tissue regulates numerous metabolic processes, not only of fats but also of other endocrine processes. Providing a certain survival of autologous fat tissue remained a great challenge for a contemporary researcher. The very process of adipocytes survival or differentiation of progenitor adipocyte cells into other cell lines is still a controversial issue nevertheless the advantages of using a fat tissue are numerous because of its accessibility, potentially easy implementation in various body parts, biological compatibility, low antigen potential, and minimal donor’s morbidity. Providing and defining the appropriate technique and ways of fat transfer from donor’s to recipient’s region of the lower leg is definitely the least invasive method of lower leg sculpturing. This technique could be the definite first choice, with minimal potential complications for patients with neuromuscular dystrophies or those with lower legs damaged by trauma.KeywordsLower leg augmentationFat transplantationFat tissue survivalFat reabsorptionLipo-filling
Forefoot fat pad atrophy is a common disorder often attributed to advancing age, obesity, prior surgery, or overuse from athletic activity. This thinning of the foot pad often results in debilitating pain that prevents patients from accomplishing usual activities of daily living and diminishes quality of life. Previous treatment options for this progressive disorder are limited, only provide temporary non-sustained relief, and are not measured by objective outcomes. We review the anatomy of the foot relative to patients that often develop fat pad atrophy and describe our current technique. This chapter summarizes data from three randomized, controlled clinical trials using autologous fat grafting as a therapy for pedal pad atrophy with the goal of providing a durable, long-term treatment option.KeywordsFat pad atrophyForefootFoot painFat graftingBall of foot
Objectives
Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if there is any evidence to support ADSC use in VLU patients, a systematic review was conducted.
Methods
A systematic review was conducted following the PRISMA guidelines. PubMed and Embase databases were searched for relevant papers. References from retrieved papers were reviewed to identify any extra eligible studies.
Results
After duplicate removal, 950 papers were screened for eligibility of which 932 were excluded based on title and abstract. Four papers were included in the final analysis (one randomised study and three non-randomised studies). 66 patients in total received ADSCs for VLU treatment. The only randomised paper reported 6-month healing rates of 75% with ADSCs compared to 50% in controls. 100% healing was achieved in one study. The remaining 2 studies reported 25% and 58% healing; however, they included patients with relatively large VLUs. Pain scores decreased after ADSCs application where reported. No serious procedure related complications were reported.
Conclusion
ADSCs may enhance ulcer healing in patients with chronic VLU and appears safe based on initial reports. Large, randomised trials are needed to definitively establish the technique’s role in VLU patients.
Background and aim:
Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions.
Methods:
PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model.
Results:
9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036).
Conclusion:
Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required.
Level of evidence iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Background:
Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration.
Methods:
In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography.
Results:
Cell yield for application and cell viability were 55.9 ± 28.5 × 106 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density.
Conclusions:
It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal-dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated.
Level of evidence iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Background:
The first-line treatment for vulvar lichen sclerosus (VLS) is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet-rich plasma as a second-line treatment for patients who do not respond to first-line treatment.
Methods:
This prospective single-center randomized pilot trial included 20 patients with a clinical and histological diagnosis of moderate to severe VLS. The patients in the treatment group (TG) received two infiltrations (at 3-month intervals) of nanofat mixed with platelet-rich plasma (PRP) into the vulvar area, while the control group (CG) received standard topical corticosteroid therapy. Fat was aspirated from the medial thigh or lower abdomen regions. Microfat was obtained after centrifugation and was emulsified to obtain a nanofat suspension. Treatment efficacy was determined by measuring changes in the vulvar skin elasticity, histopathology, and clinical signs, symptoms, and patient quality of life at after 1 year.
Results:
A total of 19 patients were finally assessed (9 TG and 10 CG). At the end of the study (1 year), there had been no significant improvement in vulvar skin elasticity. However, patients in the TG showed a significant improvement in their symptoms (itching, pain, burning, and dyspareunia) and clinical signs (cervical erosions, fissures, stenosis, and leukoderma). Analysis of skin biopsies revealed a significant decrease in all inflammatory cell types in the TG. No adverse events related to the autologous treatment were recorded.
Conclusions:
Compared with topical corticosteroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with VLS. Nonetheless, no improvement in vulvar skin elasticity was derived from the autologous treatment.
Level of evidence i:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Background
Severe atrophic acne scars (AAS) remain the “Achilles’s heel” of AAS treatment. The combination of microfat and subcision treatment is a potential solution for severe AAS.
Aims
This study aimed to evaluate the efficacy and safety of combined microfat and subcision treatment for severe (grade 4) AAS.
Methods
Data of patients with grade 4 AAS who underwent combined microfat and subcision treatment between September 2016 and December 2020 were reviewed. Post-treatment evaluation was performed at least 3 months postoperatively. The severity of AAS was graded based on Goodman’s qualitative classification. The volume of concavities was measured using an Antera 3D camera. Complications were documented.
Results
A total of 42 patients received a single treatment session. Excellent response was observed in 5 (11.9%) patients, very good in 13 (31.0%), good in 22 (52.4%), and poor response in 2 (4.7%). The average reduction of the total volume of concavities was 28.0%. The most common minor side effects were mild swelling and bruising. No major complications were observed.
Conclusions
Combined microfat and subcision treatment is a safe and effective treatment for severe AAS. The approach will be a significant treatment for severe AAS.
Targeted facial volume restoration and recontouring form an essential part of modern aesthetic rejuvenation procedures. This chapter provides a comprehensive overview of each stage of the patient consultation from evaluation of baseline anatomy, injection procedures, and techniques, with valuable tips and tricks to avoidance of adverse events. Three commonly used nonsurgical treatments for facial aging are discussed: dermal fillers, botulinum neurotoxins, and fat transfer. These procedures all have roles in facial rejuvenation and contour enhancement, whether alone, in combination, or to complement surgical options. Neurotoxins eliminate or reduce dynamic wrinkles, but by altering the balance of muscular action, a variety of other conditions can also be treated, from poor brow shape to a gummy smile. Dermal fillers are available for a wide range of facial indications, tissues, and injection depths, from restructuring facial architecture to smoothing fine lines. Finally, fat transfer is a biocompatible option that can be particularly valuable in areas where volume loss is most pronounced, and which may also have regenerative properties. The use of these procedures to individualize treatments for patients will allow physicians to achieve optimal aesthetic outcomes.
Resumen
La palabra «cicatriz» proviene del latín cicatrix (apósito) y el término inglés scar proviene del griego eskhara (costra). La cicatriz se define como una marca desprovista de estrías y de anexos cutáneos. Toda efracción completa de la dermis tiene como consecuencia la formación de una cicatriz. Las cicatrices presentes en las partes expuestas del cuerpo (cara y manos) tienen una connotación social negativa cuya repercusión psicológica es difícil de predecir y de tratar. Esta marca es, en el mejor de los casos, no visible y está bien integrada sobre la piel, pero con frecuencia presenta un cierto grado de distrofia (engrosada o deprimida) o de discromía (demasiado blanca, pigmentada o con un eritema residual que señala una actividad inflamatoria residual). La cicatrización, bajo influencia local u metabólica, generará principalmente fenómenos inflamatorios. Depende de la profundidad de la herida, de los tejidos expuestos, de la calidad de la piel adyacente y del volumen global de la pérdida de sustancia. Una cicatriz puede ser patológica por hiperplasia tisular (hipertrófica o queloidea) o considerarse como defectuosa por mala realización o debido a un defecto de maduración del tejido cicatricial. Este artículo trata sobre la cicatrización fisiológica y sus anomalías en sentido amplio, detallando las modalidades actuales de tratamiento.
Background
: Soft tissue expansion is a common technique for the regeneration of extra skin to repair skin defects. However some warning signs like skin thinning and telangiectasia are often found during the expansion process, which indicates the skin flaps cannot be further expanded. These signs may result in the suspension of expansion or ultimately jeopardize the final outcome. Fat grafting is used to treat these potential complications and enable continuation of the expansion procedure in some cases. In this study, we aimed to investigate the efficiency and safety of fat grafting in this process.
Methods
: The study was conducted on patients from January 2012 to December 2017 with warning signs of expansion treated with fat grafting (treatment group) or pause expansion (control group). Follow-up data, such as expansion status, dermal thickness, telangiectasia, skin texture using volume assessment, B-mode ultrasound, and semiquantitative scoring were collected.
Results
: A total of 67 expanded skin regions with warning signs were enrolled. The expansion fold increased 2.14-fold at 12 weeks after treatment compared with 0.74-fold in control (P=0.02).The semiquantitative score was significant improved at 4 weeks (9.03 ± 0.73 vs. 7.45 ± 0.55; p=0.033). Meanwhile, the skin thickness in the experimental group did not show decreasing trend even in the continued expansion process.
Conclusions
: Autologous fat grafting represents an effective and safe method to rescue expanded skin from limited skin regeneration. This technique also represents a valuable tool to increase the chances for further expansion.
Key Words
: Autologous fat grafting;Skin expansion; Skin regeneration
Chronic foot ulcers are the leading cause of prolonged hospitalization and loss of social participation in people with diabetes. Conventional management of diabetic foot ulcers (DFU) is associated with slow healing, high cost, and recurrent visits to the hospital. Currently, the application of autologous lipotransfer is more popular, as the regenerative and reparative effects of fat are well established. Herein we report the efficacy of minimally manipulated extracellular matrix (MA-ECM) prepared from autologous homologous adipose tissue by using 3D bioprinting in DFU (test group) in comparison to the standard wound care (control group). A total of 40 subjects were screened and randomly divided into test and control groups. In the test group, the customized MA-ECM was printed as a scaffold from the patient autologous fat using a 3D bioprinter device and applied to the wound directly. The control group received standard wound care and weekly follow-up was done for all the patients. We evaluated the efficacy of this novel technology by assessing the reduction in wound size and attainment of epithelialization. The patients in the test group (n = 17) showed complete wound closure with re-epithelialization approximately within a period of 4 weeks. On the other hand, most of the patients in the control group (n = 16) who received standard wound dressings care showed a delay in wound healing in comparison to the test group. This technique can be employed as a personalized therapeutic method to accelerate diabetic wound healing and may provide a promising potential alternative approach to protect against lower foot amputation a most common complication in diabetes.
Background:
Exposure to ultraviolet radiation causes erythema, inflammation, and photoaging. Mechanical micronization of adipose tissue can concentrate functional cells and has great potential as an alternative for regenerative medicine. Stromal vascular fraction gel is produced by means of a series of mechanical processes of lipoaspirates and can be injected intradermally. This study aimed to assess the therapeutic effect of stromal vascular fraction gel on photoaging skin.
Methods:
A photoaging model was established in nude mice. Photoaging mice received treatments of stromal vascular fraction gel, fat, tretinoin, or phosphate-buffered saline. Photoaging skin was characterized by histologic and immunohistochemical analyses. Expression of collagen synthesis-related or photoaging-related genes was assessed.
Results:
Stromal vascular fraction gel, fat, and tretinoin reversed photoaging, whereas stromal vascular fraction gel demonstrated the greatest therapeutic effect. Treatment with stromal vascular fraction gel restored intradermal fat tissue content and increased dermal collagen density. Injection of stromal vascular fraction gel had the strongest effect on stimulating fibroblasts and increasing the expression of transforming growth factor β1 (TGF-β1), propeptide of type-I procollagen, and Smad 2, decreasing the expression of Smad 3, compared with fat and tretinoin. Expression of photoaging-related genes was significantly reduced, whereas expression of fibulin-5 was significantly increased after stromal vascular fraction gel treatment.
Conclusions:
Stromal vascular fraction gel demonstrated remarkable therapeutic effects in reversing photoaging skin. Stromal vascular fraction gel can be injected intradermally and survive within dermal layer after grafting. This product increased TGF-β1 expression and activated fibroblasts to produce propeptide of type I procollagen, thus increasing the amount of collagen I, leading to thickening of the dermis of photoaging skin.
Riassunto
La parola “cicatrice” deriva dal latino cicatrix (medicazione) e il termine inglese scar deriva dal greco eskhara (crosta). La cicatrice è definita come un segno sulla cute privo di striature cutanee e annessi cutanei. Ogni lesione completa del derma provoca la formazione di una cicatrice. Le cicatrici presenti sulle parti esposte del corpo (viso e mani) hanno una connotazione sociale negativa, le cui ripercussioni psicologiche sono difficili da prevedere e da trattare. Questo segno è, nella migliore delle ipotesi, non visibile e ben integrato sulla cute, ma, il più delle volte, presenta un certo grado di distrofia (ispessita o depressa) o di discromia (troppo bianco, pigmentato o con eritema residuo che indica un’attività infiammatoria residua). La cicatrizzazione, sotto l’influenza locale e metabolica, genererà principalmente fenomeni infiammatori. Essa dipende dalla profondità della ferita, dai tessuti esposti, dalla qualità della cute adiacente e dal volume complessivo della perdita di sostanza. Una cicatrice può essere patologica per iperplasia tissutale (ipertrofica o cheloidea) o considerata difettosa per cattivo confezionamento o a causa di un difetto di maturazione del tessuto cicatriziale. Questo articolo tratta la cicatrizzazione fisiologica e le sue anomalie in senso lato, descrivendo in dettaglio le attuali modalità di trattamento.
Autologous fat grafting is an increasingly popular technique in plastic surgery for volume augmentation and rejuvenation. However, the unpredictability of long-term volume retention limits its clinical application. Various animal studies have documented the positive effects of adipose tissue-derived stem cells (ADSCs) on the acceleration of lipofilling. However, the results have been inconsistent, and there is an insufficient number of high-quality clinical studies to formulate evidence-based recommendations for ADSC-enriched fat grafts. Moreover, related technical standards, such as the final count of harvested ADSCs and the enrichment ratio, have not yet been established. This systematic review included all clinical trials on ADSC-enriched fat grafts in plastic surgery from PubMed in the past 10 years, as well as all registered clinical trials on ClinicalTrials.Gov. To examine the current landscape of ADSCs harvest, we summarize the current applications of ADSCs in the field of plastic surgery and discuss the current barriers to universal clinical use.
Adipose tissue is in many regards an ideal filler for clinical practice. It is often abundant, can be collected with minimal donor site morbidity, and is valued for both its aesthetic appeal and its biocompatibility. Fat, however, functions as far more than filler and is unique in its ability to improve tissue quality. The mesenchymal niche of adipose tissue, that of the adipose-derived stem cells (ASCs), is a potent immunomodulatory, proangiogenic, and regulatory population within the stroma of whole adipose. The potency of these cells is such that several techniques have been developed to both maximize ASC viability at time of harvest and further enrich adipose autograft with ASCs to potentiate the ability of the grafts to integrate and improve the function of surrounding structures. Here, we will discuss the current state of fat grafting and ASCs in the clinical sphere, with a focus on current technologies, indications, and new developments likely to reach our patients in the near future.
This is a descriptive retrospective study of 42 cases of patients who underwent the lipostructure procedure at the Department of Plastic Surgery of Mohammed VI Teaching Hospital of Marrakesh, over a period of 6 years, from January 2012 to December 2017. It aims to report our experience, and to review the procedure, applications, and outcomes of lipostructure. A total of 61 procedures were performed. The average age of our patients was 28.78 years. A female predominance was noted (86%). The main indications were: burn sequelae (33%), trauma sequelae (17%), infection sequelae (10%) and facial rejuvenation (10%). In terms of local conditions, most of our patients suffered from skin scars (61.9%), atrophy (14.28%), wrinkles (9.52%), facial asymmetries (7.14%), and nasal deformities (7.14%). The samples was mainly harvested from the abdomen (42%), followed by the trochanteric region (saddle bags) in 38% of cases. 67.21% of the samples were harvested from a single donor site. The average volume collected was 74.52 ml. All the samples were centrifuged by the Regenlab system. 52% of the lipostructure procedures were performed on the face, with an average injected volume of 23.25ml. 42.62% of the lipostructures were associated with an injection of PRP, and 6.55% with a facelift.
Background
Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections.
Objectives
This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections.
Methods
We searched PubMed/Medline, and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. The reference list of included studies were also hand searched for potential studies. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet and two authors supervised the accuracy.
Results
The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as: an insufficient volume or decreased volume by resorption, tip excess and supra-tip fillness, and mild displacement. More than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%.
Conclusions
Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Although clinical expertise is essential to have a safe injection and to minimize the potential complications. Preserving the excess fat for further fat injection (if needed) is recommended.
Rectovaginal fistulas in patients with Crohn's disease are difficult to resolve, and surgical failure is very frequent. Recent studies have shown that adult stem cells extracted from certain tissues, such as adipose tissue, can develop into different tissues, such as muscle.
We report here the case of a young patient with Crohn's disease who had a recurrent rectovaginal fistula that was treated by autologous stem-cell transplantation with a lipoaspirate as the source of stem cells.
Although Crohn's disease is the worst condition for a surgical approach in cases of rectovaginal fistula, we observed good closure. Since the surgical procedure 3 month ago the patient has not experienced vaginal flatus or fecal incontinence through her vagina. Thus our treatment seems to be effective.
Cell transplantation to overcome healing problems is a new surgical tool, and careful evaluation of this new modality may provide an opportunity to define a new era in the treatment of surgical challenges associated with healing disorders. Ethical and safety items do not seem to be critical problems using autologous stem cells.
The delivery of autologous progenitor cells into ischemic tissue of patients is emerging as a novel therapeutic option. Here, we report the potential impact of cultured adipose tissue-derived cells (ADSC) on angiogenic cell therapy.
ADSC were isolated from C57Bl/6 mouse inguinal adipose tissue and showed high expression of ScaI and CD44, but not c-kit, Lin, CD34, CD45, CD11b, and CD31, compatible with that of mesenchymal stem cells from bone marrow. In coculture conditions with ADSC and human aortic endothelial cells (ECs) under treatment with growth factors, ADSC significantly increased EC viability, migration and tube formation mainly through secretion of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF). At 4 weeks after transplantation of ADSC into the ischemic mouse hindlimb, the angiogenic scores were improved in the ADSC-treated group, which were evaluated with blood flow by laser Doppler imaging (LDI) and capillary density by immunostaining with anti-CD31 antibody. However, injected ADSC did not correspond to CD31, von Willebrand factor, and alpha-smooth muscle actin-positive cells in ischemic tissue.
These adipose tissue-derived cells demonstrated potential as angiogenic cell therapy for ischemic disease, which appears to be mainly achieved by their ability to secrete angiogenic growth factors.
Since the nineteenth century, physicians have experimented with injections of a wide variety of substances to alter the surface contours of human faces. The ideal substance still eludes us, but fat grafting through a blunt cannula seems to be the safest of all the fillers used, and in skilled hands, can give long lasting results. A technique of harvesting, refining, and infiltrating fat is presented, along with a discussion of the qualities of this transplanted fat that make it one of the most ideal fillers available.
This article presents a specific method of autologous fatty tissue transplantation, Lipostructure, which incorporates the technique of syringe liposuction with an intricate layering of autologous fatty tissue. The presented methods of infiltration of fatty tissue allow precise control over the contours of the face to replace atrophied or missing structures and enhance facial contours. Autologous fatty tissue harvested, refined, and placed in the specific fashion described is presented as an exemplary agent for augmentation in soft-tissue facial recontouring.
L'activite des cellules du tissu conjonctif est modulee par un grand nombre de facteurs presents dans leur environnement. En plus des facteurs solubles tels qu'hormones, cytokines et facteurs de croissance, les cellules recoivent aussi des signaux des macromolecules de la matrice extracellulaire (MEC) qui les environnent. De plus, elles peuvent degrader les proteines de la MEC et liberer des peptides qui, par eux-memes, vont constituer de nouveaux signaux pour les cellules environnantes. Ainsi, une veritable boucle de regulation existe dans les tissus conjonctifs, constituee par les peptides generes par degradation de la MEC et les cellules du tissu conjonctif. Le nom de « matrikines » a ete propose pour designer de tels peptides d'origine matricielle capables de reguler l'activite cellulaire. Dans cette revue, nous resumons les resultats obtenus dans notre laboratoire avec deux matrikines differentes : le tripeptide glycyl-histidyl-lysine (GHK) et l'heptapeptide cysteinyl-asparaginyl-tyrosyl-tyrosyl-seryl-asparaginyl-serine (CNYYSNS). GHK est un puissant activateur de la production et du remodelage de la MEC tandis que CNYYSNS est capable d'inhiber l'activation des polynucleaires neutrophiles et de diminuer les capacites invasives de cellules cancereuses.
Arguments for graft of adipocytes in the Coleman's procedure.The main criticism against fat reinjection procedures is related to whether it is possible to graft adipocytes or not. The ideal solution would be to perform biopsies a few months after the operation to check the evolution of the grafted tissue, but such an approach would be difficult to accept for our patients. To overcome this difficulty the authors have compiled all the arguments that plead in favor of adipocyte grafts when Coleman's technique is used. Peer demonstrated in animal studies that it is possible to graft fatty tissue and that more resorption occurs when the fragments are large in size. The histologic studies have shown that the different stages of Coleman's technique do not alter the viability of the adipocytes. A disorganization of the architecture of the lobules is observed, but this does not compromise the theory of adipocyte grafting. An MRI study, performed on ten patients, demonstrated that the reinjected fat cells persist several months after the procedure. These fat cells presented the same characteristics as the patient's native fat in the surrounding area. This impression was confirmed by histological analysis of the reinjected fatty tissue 18 months after the graft. Finally, the clinical results obtained on over 200 patients treated for various indications in plastic and cosmetic surgery lead us to believe that it is possible to perform grafts of fatty tissue.
Most authors supported the theory of adipocyte survival. The viability of these cells has been demonstrated by various experimental clinical, radiological and biochemical studies. After a review of the literature, the authors report the various factors, which influence the survival of the transplanted adipocytes. These factors are presented according to their chronology in the operative procedure. The techniques used are very diverse. The reference technique chosen is that described by Coleman (Lipostructure®). The following factors are studied: type of anaesthesia, infiltration, donor site of adipose tissue, method of harvesting, method of refining adipose tissue, anabolic complements, receiving site, reinjection technique, number of grafting sessions, freezing of adipose tissue and complementary postoperative treatments. It seems imperative that each phase of the operative procedure should be carried out without damage to the adipocytes, in particular their harvesting, refining and reinjection. All the other factors studied require comparative analysis in order to demonstrate their true importance. This opens up various directions of research aiming to improve the survival of the transplanted adipocytes.
Fat grafting is an old technique. Since its first description in 1893, fat was used in a lot of indications. After more then a century of evolution, there is still no commonly accepted standard method of fat transfer by all the authors. On the contrary, many different techniques have been described in the literature with the only aim of reducing resorption of the transferred fat. Today the main inconvenient of fat grafting remains the partial resorption the transferred tissue. After a review of the literature of the various technique of fat transfer presented according to their chronology in the operative procedure, we have observed that the techniques developed by certain authors are the opposite of the techniques developed by others. This shows the lack of rigorous work concerning the fat transfer. Whether they are experimental or clinical, in most of these studies, we can find at least one skew which could have influence the results and the conclusion of these studies. A critical revue of the literature offers the opportunity to reconsider the actual bases of fat transfer. The use of an objective way of quantifying the volumes in clinical practice could permit the comparison of different studies in the future.
Use of adipous tissue transfer in plastic and reconstructive surgery is not new, and has been the subject of numerous studies. Transfer of autologous adipose tissue was reported for the first time at the end of the 19th century. Ideas and techniques have greatly changed during the last century. Adipocyte transfer has attracted renewed interest in recent years, due in particular to the development of Lipostructure® by Coleman, who introduced a procedure based on strict methodology and the use of specific material. The history of adipous tissue transfer is retraced through the works of various authors and briefly recounted by highlighting the major landmarks of its advance. The evolution of ideas and techniques can be divided into three periods. The period before the introduction of lipoaspiration was termed “open surgery”, when adipose tissue was harvested by surgical excision. The next period is that following the discovery of lipoaspiration, called the “unrefined” period, during which adipose tissue was obtained by aspiration and reinjected without preparation. During the third period, following the works of Coleman, the adipose tissue now undergoes non-traumatic refinement before grafting; this period is called “non-traumatic refined”. Various studies have shown that this technique causes little damage to the cells and have demonstrated survival of the tissue transferred. Discovery of the developmental capacities of the various lineages from a mesodermal stem cell, and in vitro culture of these cells, opens up new research perspectives and clinical applications. From this precursor cell, adipocytes, osteoblasts, chondrocytes, myocytes and neurone-like cells can be developed. The future of autologous reconstruction appears promising.
To document the amount and rate of re-absorption of fatty tissue transplanted using the author's technique, the author initiated controlled studies in 1987. A selected crease was infiltrated with autologous fatty tissue using a nearby crease as control. At specific time intervals the infiltrated crease was compared to the nearby control crease to evaluate percentage of recurrence. Photographs were taken in the first week, then at least yearly over six years. All views, all positions of the mouth, and all lighting situations demonstrated the continued absence of any crease in the area of infiltration. In contrast, the nearby control crease remained unchanged or deepened from its preoperative condition, giving every indication of a permanent correction. This experiment demonstrates the potential lasting nature of corrections performed with the transplantation of fatty tissue and is supported by over 400 infiltrations into the nasolabial folds in the author's practice.
Lipostructure is a natural, long-lasting method of filling and supporting the face using intricate layering of infiltrated autologous tissue. This method allows the tissues to be sculpted to enact three-dimensional augmentation of facial elements. Because the grafted fat becomes integrated into the host tissues, it is almost undetectable after transplantation, except by photography. To successfully use fatty tissue as such a graft, attention must be paid to the nature of fatty tissue; to the methods of harvesting, transfer, and placement; and to the preparation of the patient. Fatty tissue is a complex, delicate structure that is easily damaged by mechanical and chemical insults. Successful fat transplantation demands that every step be practiced with attention to this fragile nature of fatty tissue. Precision is an important consideration in the augmentation of millimeters of facial elements. The true volume of infiltration is difficult to judge if too much blood, lidocaine, or oil is present in the tissue being placed. Fat is living tissue that must be in close proximity to a nutritional and respiratory source to survive. Therefore, placement of small amounts of fatty tissue in multiple tunnels assumes the utmost importance in the quest for both survival of fatty tissue and an aesthetically appropriate correction. Successful, three-dimensional sculpting requires attention to patient preparation, meticulous planning, and fastidious photographic evaluation. The potential applications in aesthetic and reconstructive surgeries of this new tool are profound. Lipostructure represents an important advance in plastic surgery: a safe, long-lasting method of recontouring the face with autologous tissue.
The distribution of eight types of extracellular matrix (ECM) proteins (type I-VI) collagen, laminin and fibronectin) in the skeletal muscle of Japanese Black cattle was determined by indirect immunofluorescence using specific antibodies against each protein. ECM proteins were well organized in the intramuscular connective tissue: type I, II, III collagen and fibronectin were localized primarily in the perimysium, type V and VI collagen in both the perimysium and endomysium, and type IV collagen and laminin were virtually confined to the endomysium. In the loose connective tissue holding the adipocytes together to form a tissue mass between the muscular bundles, seven of the ECM proteins not type II collagen were relatively abundant in a disordered arrangement. Further analysis by in vitro immunocytochemical staining also demonstrated that a stromal-vascular preadipocyte cell line (BIP cell), derived from Japanese Black cattle, synthesized various ECMs in much the same way as fibroblasts. Exponentially growing BIP cells with a fibroblastic phenotype were found to produce type II, V, and VI collagens, in addition to the other previously identified connective tissue glycoproteins of mouse 3T3 preadipocytes. When confluent preadipocyte cultures were stimulated with adipogenic medium, a fibrillar network of ECM was observed to bridge the intercellular space and connect adjacent cell surfaces. During adipocyte differentiation, type III collagen and laminin were arranged in a non-fibrous structure, and type-II collagen was only barely detected. These results are supported by the staining of the adipose tissue, where all ECM proteins studied except type II collagen were stained intensely. These data indicate that in vivo under conditions permissive for adipose conversion, the production and organization of ECM, accompanied by hyperplasia and hypertrophy of precursor cells, gives rise to adipose tissue in skeletal muscle with its own ECM products. These data further suggest that each ECM protein might have some role for the adipocytes in forming tissue.
Key events leading to terminal differentiation of preadipocytes into adipocytes have been characterized in the recent years. However, master genes that commit progression from multipotent mesenchymal stem cell to the adipoblast stage of development have not yet been identified. The use of embryonic stem (ES) cells as a route to study early events in adipogenesis and to characterize factors involved in the decision of stem cells to follow the adipogenic pathway is described in this paper. The capacity of lif-/- and lifr-/- ES cells to undergo adipocyte differentiation is reported as an application of mutant ES cells to study gene function during the development of adipose cells.
The activity of connective tissue cells is modulated by a number of factors present in their environment. In addition to the soluble factors such as hormones, cytokines or growth factors, cells also receive signals from the surrounding extracellular matrix (ECM) macromolecules. Moreover, they may degrade the ECM proteins and liberate peptides which may by themselves constitute new signals for the surrounding cells. Therefore, an actual regulation loop exists in connective tissue, constituted by peptides generated by ECM degradation and connective tissue cells. The term of "matrikine" has been proposed to designate such ECM-derived peptides able to regulate cell activity. In this review, we summarize some data obtained in our laboratory with two different matrikines: the tripeptide glycyl-histidyl-lysine (GHK) and the heptapeptide cysteinyl-asparaginyl-tyrosyl-tyrosyl-seryl-asparaginyl-serine (CNYYSNS). GHK is a potent activator of ECM synthesis and remodeling, whereas CNYYSNS is able to inhibit polymorphonuclear leukocytes activation and decrease the invasive capacities of cancer cells.
Currently, there is no adequate implant material for the correction of soft tissue defects such as after extensive deep burns, after tumor resection and in hereditary and congenital defects (e.g. Romberg's disease, Poland syndrome). The autologous transplantation of mature adipose tissue has poor results. In this study human preadipocytes of young adults were isolated and cultured. 10(6) preadipocytes were seeded onto collagen sponges with uniform 40 microm pore size and regular lamellar structure and implanted into immunodeficient mice. Collagen sponges without preadipocytes were used in the controls. Macroscopical impression, weight, thickness, histology, immunohistochemistry (scaffold structure, cellularity, penetration depth of the seeded cells) and ultrastructure were assessed after 24 h in vitro and after explantation at 3 and 8 weeks. Preadipocytes penetrated the scaffolds 24 h after seeding at a depth of 299+/-55 microm before implantation. Macroscopically after 3 and 8 weeks in vivo layers of adipose tissue accompanied by new vessels were found on all preadipocyte/collagen grafts. The control grafts appeared unchanged without vessel ingrowth. There was a significant weight loss of all grafts between 24 h in vitro and 3 weeks in vivo (p < 0.05), whereas there was only a slight weight reduction from week 3 to 8. The thickness decreased in the first 3 weeks (p < 0.05) in all grafts. The preadipocyte/collagen grafts were thinner but had a higher weight than the controls at this point in time. The histology showed adipose tissue and a rich vascularisation adherent to the scaffolds under a capsule. The control sponges contained only few cells and a capsule but no adipose tissue. Human-vimentin positive cells were found in all preadipocyte/collagen grafts but not in the controls, penetrating 1188+/-498 microm (3 weeks) and 1433+/-685 microm (8 weeks). Ultrastructural analysis showed complete in vivo differentiation of viable adipocytes in the sponge seeded with preadipocytes. Formation of extracellular matrix was more pronounced in the preadipocyte/collagen grafts. The transplantation of isolated and cultured preadipocytes within a standardised collagen matrix resulted in well-vascularised adipose-like tissue. It is assumed that a pore size greater than 40 microm is required, as preadipocytes enlarge during differentiation due to incorporation of lipids.
The main criticism against fat reinjection procedures is related to whether it is possible to graft adipocytes or not. The ideal solution would be to perform biopsies a few months after the operation to check the evolution of the grafted tissue, but such an approach would be difficult to accept for our patients. To overcome this difficulty the authors have compiled all the arguments that plead in favor of adipocyte grafts when Coleman's technique is used. Peer demonstrated in animal studies that it is possible to graft fatty tissue and that more resorption occurs when the fragments are large in size. The histologic studies have shown that the different stages of Coleman's technique do not alter the viability of the adipocytes. A disorganization of the architecture of the lobules is observed, but this does not compromise the theory of adipocyte grafting. An MRI study, performed on ten patients, demonstrated that the reinjected fat cells persist several months after the procedure. These fat cells presented the same characteristics as the patient's native fat in the surrounding area. This impression was confirmed by histological analysis of the reinjected fatty tissue 18 months after the graft. Finally, the clinical results obtained on over 200 patients treated for various indications in plastic and cosmetic surgery lead us to believe that it is possible to perform grafts of fatty tissue.
In the search for injectable subcutaneous fillers, fat harvested, transferred, and placed in the manner previously described has most of the characteristics of an ideal filler. It is biocompatible, versatile, stable, long-lasting, and natural-appearing. The key to successful fat grafting lies in the technique. Harvesting, refinement, and transfer of subcutaneous tissue to provide pure, intact parcels of fat are essential for successful fat grafting. The surgeon also must infiltrate the refined fat parcels into the recipient site so that they survive predictably and uniformly, become integrated into the host tissues, and accomplish the desired structural alteration. The key to attaining these goals is the placement of minuscule amounts of fatty tissue with each withdrawal of the infiltrating cannula. This maneuver maximizes the surface area of contact between the newly transplanted tissues and the recipient tissues. Applying this technique to enact structural volume alteration of the face can result in subtle or striking improvements in the appearance of patients. The ideal substance for soft-tissue augmentation still eludes physicians, but fat grafting through a blunt cannula seems to be the safest of all of the fillers used; in the hands of an experienced surgeon, it can provide long-lasting, natural-appearing structural changes.
The evolution of the face-lift technique used by the author, and the major contribution toward this development from Sydney Coleman's description of lipostructure, are described. At present, the superficial adipocutaneous system (SACS) face lift is almost always associated with a lipostructure performed in the same operative session. In most anatomical locations the structural fat grafting is done before the subfat undermining, although some minor touch-up lipostructure may be done at the end of the face lift.
Adipose tissue development and remodeling are closely associated with the growth of vascular network. We hypothesized that adipose tissue may contain progenitor cells with angiogenic potential and that therapy based on adipose tissue-derived progenitor cells administration may constitute a promising cell therapy in patients with ischemic disease.
In mice, cultured stromal-vascular fraction (SVF) cells from adipose tissue have a great proangiogenic potential, comparable to that of bone marrow mononuclear cells in the mouse ischemic hindlimb model. Similarly, cultured human SVF cells differentiate into endothelial cells, incorporate into vessels, and promote both postischemic neovascularization in nude mice and vessel-like structure formation in Matrigel plug. In vitro, these cells represent a homogeneous population of CD34- and CD13-positive cells, which can spontaneously express the endothelial cell markers CD31 and von Willebrand factor when cultured in semisolid medium. Interestingly, dedifferentiated mature human adipocytes have the potential to rapidly acquire the endothelial phenotype in vitro and to promote neovascularization in ischemic tissue and vessel-like structure formation in Matrigel plug, suggesting that cells of endothelial and adipocyte phenotypes may have a common precursor.
This study demonstrates, for the first time, that adipocytes and endothelial cells have a common progenitor. Such adipose lineage cells participate in vascular-like structure formation in Matrigel plug and enhance the neovascularization reaction in ischemic tissue. These results also highlight the concept that adipose lineage cells represent a suitable new cell source for therapeutic angiogenesis in ischemic disease.
A review of adipose tissue angiogenesis includes the morphological and cytochemical development of adipose tissue vasculature and the concept of primitive fat organs. Spatial and temporal relationships between fetal vascular and fat cell development are discussed, including depot- and genetic-dependent arteriolar differentiation. The relationship between connective tissue deposition and elaboration of adipose tissue vasculature is discussed with respect to regulating adipocyte development in a depot-dependent manner. In vitro studies indicated that depot-dependent vascular traits may be attributable to intrinsic growth characteristics of adipose tissue endothelial cells. These studies indicate that adipogenesis may be regulated by factors that drive angiogenesis. Fundamental aspects of angiogenesis, including basement membrane breakdown, vasculogenesis, angiogenic remodeling, vessel stabilization, and vascular permeability were reviewed. Critical angiogenic factors include vascular endothelial growth factor (VEGF), VEGF receptors, angiopoietins (Ang), ephrins, matrix metalloproteinases, and the plasminogen enzymatic system. Vascular endothelial growth factor is the most critical factor because it initiates the formation of immature vessels and disruption of a single VEGF allele leads to embryonic lethality in mice. Expression of VEGF is influenced by hypoxia, insulin, growth factors, and several cytokines. Angiogenic factors secreted and/or produced by adipocytes or preadipocytes are discussed. Vascular endothelial growth factor expression and secretion by adipocytes is regulated by insulin and hypoxia, and is associated with adipose tissue accretion. Vascular endothelial growth factor accounts for most of the angiogenic activity of adipose tissue. The proposed role of leptin as an adipogenic factor is reviewed with respect to efficacy on various aspects of angiogenesis relative to other angiogenic factors. The VEGF and leptin genes are both hypoxia inducible, but potential links between VEGF and leptin gene expression have not been examined. Finally, several studies including a study of mice treated with antiangiogenic factors indicate that adipose tissue accretion can be controlled through the vasculature per se.
Recently, extracellular matrix components have been shown to contain domains that can interact with and activate receptors with intrinsic tyrosine kinase activity. These receptor tyrosine kinases are strong mediators of the cell responses of proliferation, migration, differentiation, and dedifferentiation. However, an interesting question is raised as to why cells would present growth factor receptor ligands in such a manner, as the majority of growth factors are small, soluble, or only transiently tethered ligands. With the exception of the discoidin domain receptors that bind collagen, the other described domains interact with a receptor that binds ubiquitous soluble peptide growth factors, the epidermal growth factor receptor. Unlike traditional growth factors, these individual "matrikine" domains within tenascin-C, laminin, collagen, and decorin possess relatively low binding affinity (high nanomolar or micromolar) and are often presented in multiple valency. The presentation of ligands within the extracellular matrix in this fashion might allow for unique biochemical and physiological outcomes. This new class of "matrikine" ligand may be critical for wound healing, as the majority of known extracellular matrix components possessing matrikines play a strong role, or are presented uniquely, during skin repair. Tenascin-C expression, for instance, is uniquely regulated spatially and has been proposed to present pro-migratory tracks during skin repair through its epidermal growth factor-like repeats. The epidermal growth factor-like repeats of laminin-5 act as cryptic ligands revealed upon matrix metalloproteinase-2 degradation of the surrounding extracellular matrix. The deletion of the discoidin domain receptors 1 and 2 for collagen have negative consequences on the role of fibroblasts and epithelial cells for matrix metalloproteinase production, migration, proliferation, and extracellular matrix turnover. Finally, decorin can bind to, inhibit, and down-regulate epidermal growth factor receptor levels and signaling, suggesting a tonic role of the epidermal growth factor binding domain of decorin in the resolution of wound healing. We provide a model framework for further studies into this emerging class of signals.
Adipose tissue has been used for volume restoration for over a century. Coleman's Lipostructure is a recent procedure for adipocyte transfer, based on strict methodology and the use of specific material. Our aim in this work is to provide an answer to several questions: what is the place of this technique in the restoration of facial volumes? Do aesthetic subunits have an impact on the result?
This retrospective study concerned 100 patients who had undergone volumetric facial restoration with face-lift and Lipostructure. A five-member jury carried out subjective evaluation through a questionnaire sent to the patients, and objective evaluation by assessment of pre- and postoperative photographs.
Mean time since surgery was 15 months. Overall patient satisfaction was 82% with a mean score of 15/20 on subjective evaluation and of 13.3/20 on objective evaluation. The results differed significantly according to the facial aesthetic subunit involved, the best results being obtained in the malar region and the cheek, and the least satisfactory in the upper and lower lips. This technique has few drawbacks. Prolonged oedema is the only complication (8%).
We consider that at the present time Lipostructure is the best means of restoring facial volume. It is a simple, effective and reproducible technique. Its application in all fields of plastic surgery is an essential adjunct to our specialty.
Most authors supported the theory of adipocyte survival. The viability of these cells has been demonstrated by various experimental clinical, radiological and biochemical studies. After a review of the literature, the authors report the various factors, which influence the survival of the transplanted adipocytes. These factors are presented according to their chronology in the operative procedure. The techniques used are very diverse. The reference technique chosen is that described by Coleman (Lipostructure). The following factors are studied: type of anaesthesia, infiltration, donor site of adipose tissue, method of harvesting, method of refining adipose tissue, anabolic complements, receiving site, reinjection technique, number of grafting sessions, freezing of adipose tissue and complementary postoperative treatments. It seems imperative that each phase of the operative procedure should be carried out without damage to the adipocytes, in particular their harvesting, refining and reinjection. All the other factors studied require comparative analysis in order to demonstrate their true importance. This opens up various directions of research aiming to improve the survival of the transplanted adipocytes.
Use of adipose tissue transfer in plastic and reconstructive surgery is not new, and has been the subject of numerous studies. Transfer of autologous adipose tissue was reported for the first time at the end of the 19th century. Ideas and techniques have greatly changed during the last century. Adipocyte transfer has attracted renewed interest in recent years, due in particular to the development of Lipostructure by Coleman, who introduced a procedure based on strict methodology and the use of specific material. The history of adipose tissue transfer is retraced through the works of various authors and briefly recounted by highlighting the major landmarks of its advance. The evolution of ideas and techniques can be divided into three periods. The period before the introduction of lipoaspiration was termed "open surgery", when adipose tissue was harvested by surgical excision. The next period is that following the discovery of lipoaspiration, called the "unrefined" period, during which adipose tissue was obtained by aspiration and reinjected without preparation. During the third period, following the works of Coleman, the adipose tissue now undergoes non-traumatic refinement before grafting; this period is called "non-traumatic refined". Various studies have shown that this technique causes little damage to the cells and have demonstrated survival of the tissue transferred. Discovery of the developmental capacities of the various lineages from a mesodermal stem cell, and in vitro culture of these cells, opens up new research perspectives and clinical applications. From this precursor cell, adipocytes, osteoblasts, chondrocytes, myocytes and neurone-like cells can be developed. The future of autologous reconstruction appears promising.
The correction of soft-tissue defects by adipose tissue transplantation often produces poor and unpredictable results. The implantation of isolated and cultured preadipocytes offers a solution to this problem since these cells differentiate into adipocytes when implanted in vivo. A field of major interest is to maximize the yield of preadipocytes isolated from adipose tissue showing only low contamination with other cell types. Aspiration and excision are two concurrent clinical ways of harvesting adipose tissue for the isolation of preadipocytes. This tissue is usually discarded after surgery. In this study, the yield of preadipocytes obtained from liposuction material was compared to that of excised adipose tissue. Furthermore, we determined the loss of precursor cells if isolation of preadipocytes was delayed for 24 h. Preadipocytes were isolated from the stromal cell fraction of human subcutaneous adipose tissue samples. Harvesting of adipose tissue by suction was performed according to the Coleman procedure (manually applied negative pressure using a 10-ml syringe with a blunt tip cannula). Isolation was either carried out within 60 min after extraction or after storage for 24 h in culture medium at 4 degrees C. Isolated preadipocytes were cultured for 24 h, trypsinized and counted in a Neubauer chamber. Our results show clearly that the yield of preadipocytes isolated from liposuction material (within 60 min after extraction and after 24 h of storage) is higher than the cell yield from excised adipose tissue. Overnight storage for 24 h leads to a significant loss of preadipocytes in excised tissue but not in liposuction material. The high yield of cells isolated from liposuction material proves that extraction by suction does not damage the stromal cell fraction in the adipose tissue. If cell isolation is not performed immediately after the operation, liposuction material is clearly the better alternative for storage.
Like mesenchymal stem cells from bone marrow (BM-MSCs), adipose tissue-derived adult stem cells (ADAS cells) can differentiate into several lineages and present therapeutical potential for repairing damaged tissues. The use of allogenic stem cells can enlarge their therapeutical interest, provided that the grafted cells could be tolerated. We investigate here, for the first time, the immunosuppressive properties of ADAS cells compared with the well-characterized immunosuppressive properties of BM-MSCs. ADAS cells did not provoke in vitro alloreactivity of incompatible lymphocytes and, moreover, suppressed mixed lymphocyte reaction (MLR) and lymphocyte proliferative response to mitogens. The impairment of inhibition when ADAS cells and BM-MSCs were separated from lymphocytes by a permeable membrane suggests that cell contact is required for a full inhibitory effect. Hepatocyte growth factor is secreted by both stem cells but, similar to interleukin-10 and transforming growth factor-beta (TGF-beta), the levels of which were undetectable in supernatants of MLR inhibited by ADAS cells or BM-MSCs, it did not seem implicated in the stem cell suppressive effect. These findings support that ADAS cells share immunosuppressive properties with BM-MSCs. Therefore, ADAS cell-based reconstructive therapy could employ allogenic cells and because of their immunosuppressive properties, ADAS cells could be an alternative source to BM-MSCs to treat allogenic conflicts.
Fat grafting is an old technique. Since its first description in 1893, fat was used in a lot of indications. After more then a century of evolution, there is still no commonly accepted standard method of fat transfer by all the authors. On the contrary, many different techniques have been described in the literature with the only aim of reducing resorption of the transferred fat. Today the main inconvenient of fat grafting remains the partial resorption the transferred tissue. After a review of the literature of the various technique of fat transfer presented according to their chronology in the operative procedure, we have observed that the techniques developed by certain authors are the opposite of the techniques developed by others. This shows the lack of rigorous work concerning the fat transfer. Whether they are experimental or clinical, in most of these studies, we can find at least one skew which could have influence the results and the conclusion of these studies. A critical revue of the literature offers the opportunity to reconsider the actual bases of fat transfer. The use of an objective way of quantifying the volumes in clinical practice could permit the comparison of different studies in the future.
Grafted fat has many attributes of an ideal filler, but the results, like those of any procedure, are technique dependent. Fat grafting remains shrouded in the stigma of variable results experienced by most plastic surgeons when they first graft fat. However, many who originally reported failure eventually report success after altering their methods of harvesting, refinement, and placement. Many surgeons have refined their techniques to obtain long-term survival and volume replacement with grafted fat. They have observed that transplanted fat not only adjusts facial and body proportion but also improves surrounding tissues into which the fat is placed. They have noted not only the improvement in the quality of aging skin and scars but also a remarkable improvement in conditions such as radiation damage, chronic ulceration, breast capsular contracture, and damaged vocal cords. The mechanism of fat graft survival is not clear, and the role of adipose-derived stem cells and preadipocytes in fat survival remains to be determined. Early research has indicated the possible involvement of more undifferentiated cells in some of the observed effects of fat grafting on surrounding tissues. Of particular interest is the research that has pointed to the use of stem cells to repair and even to become bone, cartilage, muscle, blood vessels, nerves, and skin. Further studies are essential to understand grafted fat tissue.
There is evidence that stem cells contribute to the restoration of tissue vascularization and organ function. The objective of this study was to assess the presence of adipose-derived adult stem cells left in their natural scaffold in the purified lipoaspirate and to assess the clinical effectiveness of lipoaspirate transplantation in the treatment of radiation side effects.
This study was designed beginning with surgical procedures in 2002 and envisaging a continuous patient follow-up to 31 months. Twenty consecutive patients undergoing therapy for side effects of radiation treatment with severe symptoms or irreversible function damage (LENT-SOMA scale grade 3 and 4) were enrolled. Purified autologous lipoaspirates (60 to 120 cc) taken from a healthy donor site were administered by repeated low-invasive computer-assisted injection. Therapy outcomes were assessed by symptoms classification according to the LENT-SOMA scale, cytofluorimetric characterization, and ultrastructural evaluation of targeted tissue.
In the isolated stromal vascular fraction of 2 cc of human lipoaspirate, cells with mesenchymal stem cell physical properties and immunophenotype were in average 1.07 +/- 0.5 percent (n = 4), with a clonogenic fraction of 0.139 percent. At least 1.02 x 10(3) colony-forming units-fibroblast were present in each lipoaspirate. Ultrastructure of target tissue systematically exhibited progressive regeneration, including neovessel formation and improved hydration. Clinical outcomes led to a systematic improvement or remission of symptoms in all evaluated patients, including otherwise untreatable patients exhibiting initial irreversible functional damage.
This surgical procedure is a low-invasive therapeutic approach for resolving the late side effects of radiotherapy. According to the proposed hypothesis of the ischemic nature of radiolesions, treatment with lipoaspirate transplantation is potentially extended to other forms of microangiopathies.