The fate of intramuscularly injected fat autografts: an experimental study in rabbits

The Optimal Layer for Breast Augmentation in an Autologous Fat Grafting Murine Model

BACKGROUND

Fat grafting is an effective procedure for breast augmentation, but the variations in this technique result in unpredictable fat retention. Therefore, animal models are needed to simulate the operation and the optimal layer for fat retention.

OBJECTIVES

An autologous fat grafting murine model for breast augmentation was built to detect a new layer for fat grafting in the chest.

METHODS

The left side of the female rat inguinal fat flap was harvested, dissected into small pieces, and autotransplanted into 3 different layers of the breast. Retention rate and hematoxylin and eosin (H&E) staining were measured at 1, 4, 8 12, and 16 weeks. Immunofluorescence staining was utilized to detect adipocytes and endothelial cells, and immunohistochemistry was conducted to evaluate the expression of integrins β1 and α6.

RESULTS

The volume of fat grafts slightly grew in the intramuscular and submuscular layers at Week 4. Retention rates in the subcutaneous layer and submuscular layer were significantly higher than the intramuscular layer at Week 16. H&E staining showed that oil cysts existed in the subcutaneous layer throughout the 16 weeks. At the terminal time point, well-vascularized mature adipose structures were observed in intramuscular and submuscular layers, with smaller adipocytes in intramuscular layers. Immunohistochemistry analysis showed that integrin β1 was identically expressed in every adipocyte in all the layers, whereas integrin α6 selectively expressed in bigger adipocytes in the intramuscular layer. The expression intensities of integrin β1 and α6 were significantly higher in the intramuscular layer than in the subcutaneous and submuscular layers.

CONCLUSIONS

The angiogenic and moderate mechanical environment makes the submuscular layer the optimal layer for fat retention.

The effect of host tissue and radiation on fat-graft survival: A comparative experimental study

Because lipofilling is often associated with various reconstructive procedures, especially breast reconstructions, improving fat-graft retention remains a major concern for plastic surgeons. We conducted an experimental protocol in a rat model simulating an autologous breast reconstruction method using the fat-augmented latissimus dorsi myocutaneous (LDM) flap. This study aimed to compare the survival rates of autologous adipocytes when injected subcutaneously and intramuscularly and to evaluate the role of recipient host tissue, volume of the injected fat, and postoperative radiation on fat-graft retention. Thirty rats were divided into five groups (A, B, C, D, and E), of six rats each. All animals underwent a pedicled LDM flap transfer to the anterior thoracic wall, and different volumes of autologous fat were injected into three recipient areas, namely, the pectoralis major and latissimus dorsi muscles and the subcutaneous tissue of the flap's skin island, as follows: 1 mL of fat was injected in total in group A, 2 mL in groups B and D, and 5 mL in group C. Group D animals received postoperative radiation (24 Gy), whereas group E animals (controls) did not undergo any fat grafting procedure. Eight weeks after surgery, adipocyte survival was assessed in all groups using histological and immunochemistry techniques. The results showed that the pectoralis major muscle was the substrate with the highest adipocyte survival rates, which were proportional to the amount of fat injected, followed by the latissimus dorsi muscle and the subcutaneous tissue. Increased volumes of transplanted fat into the subcutaneous tissue did not correspond to increased adipocyte survival. Irradiation of host tissues resulted in a statistically significant decrease in surviving adipocytes in all three recipient sites (p<0.001). Our study strongly suggests that muscle ensures optimal fat-graft retention, whereas postoperative radiation negatively affects adipocyte survival following fat transplantation.

Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT)

The gluteal region remains the preferred site for fat grafting. However, the transition from the gluteal region to the thighs has not been well studied. This study aimed to describe an echographic guidance hamstring volumization procedure (Hv-FAT) as a complement to body contouring surgery.

Identification of the Optimal Recipient Layer for Transplanted Fat: A Prospective Study on Breast Lipoaugmentation

BACKGROUND

Fat grafting has become a popular procedure in aesthetic and reconstructive surgeries due to its safety, minimal invasiveness, and favorable visual outcomes, although the volume retention rate is unpredictable.

OBJECTIVES

A prospective clinical study on lipoaugmentation of the breast was conducted to compare fat retention rates in the pectoralis muscle and the periglandular area.

METHODS

This prospective study included 20 breasts from 11 patients who underwent primary lipoaugmentation. Volume retention rate and percentage augmentation among different recipient layers, as well as complications and patient satisfaction, were evaluated. Magnetic resonance imaging was performed preoperatively and at 1 day and 3 months postoperatively. Complications were recorded, and patient satisfaction was appraised through the use of the Breast-Q questionnaire.

RESULTS

Breasts were injected with 207 ± 29 mL of fat, achieving overall volume retention rates of 56.63% ± 16.40%. The overall augmentation was 21.53% ± 10.27%. Volume retention rate was significantly higher (59.00% ± 13.84%) in the periglandular area than in the pectoralis muscle (47.21% ± 22.41%) (P = 0.04). Augmentation was significantly higher (32.13% ± 12.96%) in the periglandular area than in the pectoralis muscle (4.95% ± 4.23%) (P = 0.00). Pain and numbness were the only reported complications. The Breast-Q score increased significantly for the measures "satisfaction with breasts," "psychosocial well-being," and "sexual well-being."

CONCLUSIONS

Fat transfer is a safe and acceptable method for aesthetic and reconstructive breast surgery. The periglandular area was a better recipient site than muscle for transferred fat.

LEVEL OF EVIDENCE: 4

Insulin Promotes Adipose-Derived Stem Cell Differentiation after Fat Grafting

BACKGROUND

Adipose-derived stem cells are used to enhance fat graft survival. However, their mechanism of action when grafted is controversial. The grafted cells can be replaced by connective tissue or survive at the recipient site and differentiate. Insulin is a powerful agent used to induce their differentiation to adipocytes. The purpose of this study was to elucidate the fate of grafted adipose-derived stem cells in nonvascularized fat grafts with or without insulin.

METHODS

Fat was harvested from a female human donor who had undergone reduction mammaplasty. The authors also isolated and cultured adipose-derived stem cells expressing green fluorescent protein from transgenic Sprague-Dawley rats. Injection of free fat graft, the adipose-derived stem cells, phosphate-buffered saline, and insulin was performed on the four paravertebral points of the back of each mouse (n = 30) as follows: group A (control group) received adipose tissue and phosphate-buffered saline; group B received adipose tissue and adipose-derived stem cells; group C received adipose tissue, adipose-derived stem cells, and phosphate-buffered saline; and group D received adipose tissue, adipose-derived stem cells, and insulin. Green fluorescent protein expression was evaluated using an in vivo imaging system. The volume of transplanted fat was evaluated at 8 weeks after graft with six histologic parameters. The fat graft was immunostained with green fluorescent protein, 4',6-diamidino-2-phenylindole, and perilipin. Statistical analysis was performed using a one-way analysis of variance test.

RESULTS

The fat graft volume was significantly higher in group D (p < 0.05). Histologic examination revealed reduced fibrosis and increased cysts, vacuoles, integrity, and vascularity in group D. The green fluorescent protein and perilipin co-positive area was more apparent in group D compared with groups B and C.

CONCLUSION

Insulin could enhance the survival and differentiation of adipose-derived stem cells in nonvascularized fat grafts.

Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap

BACKGROUND

The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we report our experience of using the immediately lipofilled extended latissimus dorsi (ELD) flap and show it as a valid option for autologous breast reconstruction.

METHODS

Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.

RESULTS

A total of 71 ELD flaps with immediate lipofilling were performed. Forty-five reconstructions were immediate and the remaining 26 delayed. Median (range) volume of autologous fat injected immediately was 171 ml (40-630 ml). Contralateral reductions were performed in 25 patients with the median reduction volume 185 g (89-683 g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection requiring intravenous antibiotics occurred in five patients (7%). In 5 patients wound dehiscence occurred, and only two of these required resuturing (3%). In total, 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with no needing reoperation (4%).

CONCLUSIONS

Our experience represents the largest series to date and shows that in carefully selected patients the technique is safe, can avoid the requirement for implants, and has the potential to streamline the reconstructive journey.

Bone marrow mesenchymal stem cell‑derived extracellular vesicles improve the survival of transplanted fat grafts

Autologous fat grafting is a promising surgical technique for soft tissue augmentation, reconstruction and rejuvenation. However, it is limited by the low survival rate of the transplanted fat, due to the slow revascularization of such grafts. Previous studies have demonstrated that bone marrow mesenchymal stem cell-derived extracellular vesicles (BMSC-EVs) are proangiogenic. The present study aimed to investigate whether BMSC-EVs could improve the survival of transplanted fat grafts. Extracellular vesicles were isolated from the supernatant of cultured rat bone marrow mesenchymal stem cells, and characterized by flow cytometry and scanning electron microscopy. Their proangiogenic potential was measured in vitro using tube formation and cell migration assays. Subsequently, human fat tissue grafts, alongside various concentrations of BMSC-EVs, were subcutaneously injected into nude mice. A total of 12 weeks following transplantation, the mice were sacrificed and the grafts were harvested. The grafts from the experimental group had a higher survival rate and an increased number of vessels compared with grafts from the control group, as demonstrated by tissue volume, weight and histological analyses. Reverse transcription-quantitative polymerase chain reaction analysis indicated that the expression levels of proangiogenic factors were increased in the experimental group compared with in the control group, thus suggesting that BMSC-EVs may promote neovascularization by stimulating the secretion of proangiogenic factors. The present study is the first, to the best of our knowledge, to demonstrate that supplementation of fat grafts with BMSC-EVs improves the long-term retention and quality of transplanted fat.

Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers

INTRODUCTION

Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned.

METHODS

A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels.

RESULTS

We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve.

CONCLUSIONS

The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.

Is the Resorption of Grafted Fat Reduced in Cell-Assisted Lipotransfer for Breast Augmentation?

Cell-assisted lipotransfer (CAL) is a cotransplantation of adipose tissue and stromal vascular fraction (SVF) including adipose-derived stem cells. But although CAL can get satisfactory outcomes in breast augmentation, the resorption of the grafted fat is still unclear. A total of 12 patients received breast augmentation using CAL. All of them completed 6 months of follow-up. In 1 mini-CAL case, 500-mL liposuction fluid was used to harvest the SVF cells. In 11 full-CAL cases, 250-mL aspirated fat was needed apart from 500-mL liposuction fluid. The percentage of adipose-derived stem cells in SVF cells was detected using flow cytometry and their multilineage potential ability was assessed with in vitro induction. The volumes of breasts and pectoral muscle were measured, and radiological image change was analyzed using magnetic resonance imaging before the operation and 3 and 6 months after the operation. Additionally, the subjective evaluation on the cosmetic outcomes was determined by surgeons and patients. Adipose-derived stem cells in SVF cells accounted for 40.27% and 3.34% in full-CAL cases and mini-CAL cases, respectively. Postoperative atrophy occurred within the first 3 months. At the 6 months postoperatively, breast volume is augmented, ranging from 60.71 to 197 mL, with a mean value of 125.35 (45.49) mL. The ultimate resorption of grafted fat at the 6 months postoperatively is 51.84% (16.74%). Newly formed cysts and nodules were detected in 2 cases. No calcification was found in all magnetic resonance images. Only 1 patient was unsatisfied with the cosmetic outcome. Our preliminary study displayed a satisfactory augmented volume with little complications using CAL for breast augmentation. But the resorption at the 6 months postoperatively [51.84% (16.74%)] showed no significant advantage over non-CAL technique (40%-60% reported), which suggested that SVF cells harvested from 250-mL aspirated fat and 500-mL liposuction fluid were insufficient to average 250-mL grafted fat for each breast in this study. More SVF cells are needed to achieve lower resorption.

The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival

BACKGROUND

Free fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate.

OBJECTIVE

Our aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts.

METHODS

Inbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp.In vitro growth factor (vascular endothelial growth factor, transforming growth factor-β, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated.

RESULTS

The mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group.

CONCLUSION

Adipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.

The discordant histology of grafted fat: a systematic review of the literature

BACKGROUND

All combinations of harvesting, processing, and injection have been attempted to maximize fat graft take following transplantation. Two theories behind fat transplantation have been proposed: cell survival and host replacement. Although the cell survival theory states that fat cells survive and undergo neovascularization following transfer, host replacement theory predicts adipocyte necrosis and replacement of cells by host tissues. Whether or not transferred fat survives, proliferates, or is replaced by fibrous tissue is relevant for the investment of future resources into this thriving field of research.

METHODS

A literature search of the MEDLINE and Cochrane databases was performed for studies focusing on the histology of grafted fat after transplantation up to December of 2013. Histologic examinations of grafted fat were reviewed and compared in humans and animals.

RESULTS

Sixty-six articles met inclusion criteria, and eight of them were human studies. There was widespread diversity in the method of fat harvest and transfer among the studies, and the date of examination after transfer. Many studies reported the presence of viable adipocytes, although an extensive amount of fibrosis and inflammatory infiltration was also seen, depending on the period of examination.

CONCLUSIONS

Free fat grafts show a variable response following transplantation, with significant disagreement in the reported evidence. Although neovascularization and preservation of adipocyte architecture appear possible, other fat grafts are completely replaced by necrotic ghost cells and fibrotic ingrowth. Adipocyte survival likely contributes to volume maintenance, but fibrosis may also play a role.

Autologous fat injection into the pectoralis major as an adjunct to surgical correction of gynecomastia

BACKGROUND

Correction of gynecomastia in males is a frequently performed aesthetic procedure. Various surgical options involving the removal of excess skin, fat, or glandular tissue have been described. However, poor aesthetic outcomes, including a flat or depressed pectoral area, limit the success of these techniques.

OBJECTIVES

The authors sought to determine patient satisfaction with the results of upper chest augmentation by direct intrapectoral fat injection in conjunction with surgical correction of gynecomastia.

METHODS

In this prospective study, 26 patients underwent liposuction and glandular excision, glandular excision alone, or Benelli-type skin excision. All patients received intramuscular fat injections in predetermined zones of the pectoralis major (PM). The mean volume of fat injected was 160 mL (range, 80-220 mL per breast) bilaterally. Patients were monitored for an average of 16 months (range, 8-24 months).

RESULTS

Hematoma formation and consequent infraareolar depression was noted in 1 patient and was corrected by secondary lipografting. Mean patient satisfaction was rated as 8.4 on a scale of 1 (unsatisfactory) to 10 (highly satisfactory).

CONCLUSIONS

Autologous intrapectoral fat injection performed simultaneously with gynecomastia correction can produce a masculine appearance. The long-term viability of fat cells injected into the PM needs to be determined.

LEVEL OF EVIDENCE

4 Therapeutic.

Fat Graft Viability in the Subcutaneous Plane versus the Local Fat Pad

Background:

Fat grafting has been increasingly utilized in both aesthetic and reconstructive surgical procedures, yet the basic scientific understanding of fat grafting has lagged behind the pace of clinical innovation and utilization. This lack of basic scientific understanding has perhaps manifested itself in the wide range of graft viability reported across the literature. This study attempts to further the underlying mechanisms of fat graft take and viability through the comparison of the subcutaneous plane and the local fat pad in athymic rats.

Methods:

Lipoaspirate from a consenting patient was grafted into 2 locations in the subcutaneous plane and into the 2 inguinal fat pads in each of 4 athymic rats. Specimens were then collected after 47 days, and immunohistochemistry was utilized to determine angiogenesis in the fat grafts as a measure of fat graft take. Data were analyzed using the Student’s t test and analysis of variance followed by multiple comparisons.

Results:

There was no statistically significant difference (P = 0.2913) between the inguinal fat pad and the subcutaneous plane when measuring neovascularization. Analysis of variance comparing the graft locations also indicated no statistically significant difference when comparing each of the rats.

Conclusions:

Investigation into fat graft injection location indicates that there is no statistically significant difference in angiogenesis signals between the subcutaneous plane and the local fat pad in the athymic rat model. Further research should aim to continue to close the gap between clinical practice and basic scientific understanding of fat grafting.

Cosmetic doping--when anabolic-androgenic steroids are not enough

Doping is considered to be a major sports problem. This article describes a new threat and challenge to the sport of bodybuilding; the nonmedical use of a chemical in order to mimic muscle hypertrophy. Although muscle fillers are not new, being used for cosmetic purposes in medicine for a long time, the illegal use of muscle fillers has been increasing during the last few years and decades. The history of cosmetic doping, with particular attention to the Brazilian case, is discussed. Limitations are noted and future needed research is suggested.

Fat embolism in liposuction and intramuscular grafts in rabbits

PURPOSE

To evaluate the effects of fat embolism in organs such as lung and liver.

METHODS

Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues.

RESULTS

The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope.

CONCLUSION

The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.

Evaluation of the donor site after liposuction with a syringe in rabbits

PURPOSE

To evaluate the donor site of adipocytes as well as histopathological alterations secondary to liposuction.

METHODS

All animals underwent liposuction with a syringe on the right side of the back. While the left side of the back was used as control and did not undergo intervention. The 10 rabbits were divided into two groups A and B according the postoperative day which were submitted to euthanasia: 90 and 120 days. All adipose tissue from the donor site was analyzed and compared with the control macroscopic and light microscopy. Tissues were weighed and analyzed searching for histological changes and late inflammatory response to trauma such as fibrosis, fat necrosis and inflammation and macrophage infiltration.

RESULTS

There was wide variation in adipose tissue volume between the experimental and the control on macroscopic analysis. The presence of histopathological changes was found in two samples at 90 days.

CONCLUSIONS

There was a relationship between the presence of fibrosis with the weight and number of days after liposuction surgery in rabbits. The study show macroscopic difference between control and experiment sides in all rabbits.

The facial autologous muscular injection (FAMI) procedure: an anatomically targeted deep multiplane autologous fat-grafting technique using principles of facial fat injection

BACKGROUND

As widely described in the medical literature, facial fat grafting has been limited to the subcutaneous plane, with only vague reference to the muscular plane and deeper tissues. Local infiltration, with or without general anesthesia, is commonly used. The challenges of maintaining volumetric correction, symmetry, and predictability have limited practitioners' confidence in obtaining a desirable result when fat grafting the face. The authors describe a technique for facial fat grafting that targets specific anatomic structures and tissue beds, in effect making the patient's underlying anatomy the template for rejuvenation. Engrafting the muscles of facial expression improves graft retention and therefore predictability and symmetry. The ability to target anatomic structures other than muscle lends itself to the prospect of greater therapeutic advances using adipose-derived stem cells (ADSCs). A set of principles guiding the technique intended to promote successful cellular engraftment is presented.

METHODS

Three illustrative cases are presented, each the result of a single session: two from a 10-year experience of 700 patients by the lead author and one by the corresponding author.

RESULTS

The majority of cases (80-90%) needed only a single session for creation of permanent improvement in facial volumes and contours.

CONCLUSIONS

The facial autologous muscular injection (FAMI) technique offers an anatomically based approach to facial fat grafting with greater predictability and efficiency than current techniques. The principles of the technique put forth apply equally to volumetric enhancements obtained through successful fat grafting and to the promise of ADSCs.

Influence of platelet-rich plasma on the histologic characteristics of the autologous fat graft to the upper lip of rabbits

BACKGROUND

This study evaluated the influence of platelet-rich plasma (PRP) on the histologic characteristics of autologous fat grafts to the upper lip of rabbits.

METHODS

Nine New Zealand white rabbits were used. Eight of the rabbits underwent fat harvest from the groin fat pads using a modified Coleman technique. One side of the upper lip was infiltrated with autologous fat and the other side with fat and PRP. Four of the infiltrated rabbits were killed 8 weeks after the lip augmentation, and the remaining four infiltrated rabbits plus one control case were killed 12 weeks after the procedure. Coronal sections of both upper lips were analyzed microscopically to evaluate the quality of the fat graft, the inflammatory reaction, the presence of oil cysts, the degree of fibrosis, and the neovascularization.

RESULTS

The infiltration of adipose tissue plus PRP presented less inflammatory reaction (p < 0.05) and fewer oil cysts (p < 0.05) than the infiltration of adipose tissue without PRP.

CONCLUSIONS

The infiltration of fat tissue plus PRP generates a lower inflammatory reaction and less formation of oil cysts than the infiltration of isolated fat. Platelet-rich plasma increases the maintenance of the transplanted fat cells.

Doping cosmético: a problemática das aplicações intramusculares de óleos

O doping no mundo esportivo e na subcultura de atletas profissionais e recreacionais de culturismo já é muito conhecido e estudado pela comunidade acadêmica e científica. Porém, uma nova problemática, que definimos como doping cosmético, inseriu-se há algumas décadas no mundo todo, e tem crescido em importância no Brasil nos últimos anos. Trata-se de injeções sistemáticas de substâncias oleosas por via intramuscular, conhecidas como ADE (vitaminas lipossolúveis A, D e E), com intuito de aumentar volumetricamente o músculo per se, podendo levar a necroses, deformidades físicas ou até mesmo ao óbito. Apresentamos a história do uso cosmético dos preenchedores corporais e revisamos os possíveis efeitos deletérios e fatais que podem resultar do seu abuso, assim como os mecanismos envolvidos na evolução clínica da aplicação destas substâncias. Além disto, apresentamos métodos simples para observação potencial do uso. Pretendemos com este trabalho convocar a classe dos profissionais de saúde para que esta publique relatos de casos quando estes usuários forem atendidos devidos às complicações de tal uso, visto que os casos que até hoje apareceram são apenas o início de uma nova problemática de saúde pública que tende a aumentar consideravelmente.

Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force

TASK FORCE STATEMENT: In 2007, the American Society of Plastic Surgeons formed a task force to conduct an assessment regarding the safety and efficacy of autologous fat grafting, specifically to the breast, and to make recommendations for future research. The task force formulated specific issues regarding fat grafting and then compiled them to focus on five broad-based questions: 1. What are the current and potential applications of fat grafting (specifically breast indications, and if data are available, other cosmetic and reconstructive applications)? 2. What risks and complications are associated with fat grafting? 3. How does technique affect outcomes, including safety and efficacy, of fat grafting? 4. What risk factors need to be considered for patient selection at this level of invasiveness? 5. What advancements in bench research/molecular biology potentially impact current or future methods of fat grafting? To answer these questions, the task force reviewed the scientific literature, critically appraised the information available, and developed evidence-based practice recommendations. Although the primary issue of interest was fat grafting to the breast, other aspects of fat grafting were evaluated.

Treatment of infraorbital dark circles by autologous fat transplantation: a pilot study

BACKGROUND

Infraorbital dark circles are a cosmetic concern for a large number of individuals. However, the exact definition and precise cause has not been elucidated clearly. In our experience infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle can be treated successfully with autologous fat transplantation.

OBJECTIVES

This study was conducted to clarify the nature of dark circles under the eyes and determine the efficacy of autologous fat transplantation.

PATIENTS AND METHODS

Ten patients with dark circles due to increased vascularity and translucency of the skin were included. They received at least one autologous fat transplantation and follow-up evaluations were conducted at least 3 months after the last treatment.

RESULTS

An average of 1.6 autologous fat transplantations were done in both infraorbital areas. Patients showed an average of 78% improvement (average grading scale: 2.6 out of 4). Most of the patients showed improvement in the infraorbital darkening and contour of the lower eyelids.

CONCLUSIONS

Autologous fat transplantation is an effective method for the treatment of infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle.

Infraorbital dark circles: definition, causes, and treatment options

BACKGROUND

Infraorbital dark circles refer to the conditions that present with darkness of the infraorbital eyelids. Although it is not a medical concern, it can be a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes have not been elucidated.

OBJECTIVE

To review the possible causes and treatment options for infraorbital dark circles.

METHODS

The article is based on a review of the medical literature and the author's clinical experience in treating infraorbital dark circles.

CONCLUSION

Possible causative factors of infraorbital dark circles include excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough, but because multiple factors cause infraorbital dark circles in the majority of patients, it is essential to identify the cause and choose the appropriate treatment according to the cause.

Autologous Fat Transfer for Facial Recontouring: Is There Science behind the Art?

BACKGROUND

Clinical use of autologous fat grafts for facial soft-tissue augmentation has grown in popularity in the plastic surgery community, despite a perceived drawback of unpredictable results.

METHODS

The authors' review of the literature and their current techniques of autologous fat transfer focused on (1) the donor site, (2) aspiration methods, (3) local anesthesia, (4) centrifugation and washing, (5) exposure to cold and air, (6) addition of growth factors, (7) reinjection methods, and (8) longevity of fat grafts.

RESULTS

Clinical experience and basic science data showed a slight preference for the following: harvesting abdominal fat with "nontraumatic," blunt cannula technique, preparation by means of centrifugation without washing or addition of growth factors, and immediate injection of small amounts of fat by means of multiple passes. Quantitative evidence of clinical fat survivability and predictability of volume restoration does not exist, yet reports of patient satisfaction with this procedure do. Clinicians report the need for revisionary procedures to optimize results.

CONCLUSIONS

Although there is an increased trend in replacement of soft-tissue volume with autologous fat transfer, the literature fails to provide definitive evidence of fat survival. A large-scale clinical assessment using three-dimensional volumetric imaging would provide useful outcome data.

Fat Injection: A 20-Year Revision

In the last 20 years, several different techniques of lipoinjection have been developed. Nevertheless, a standard procedure has not been adopted by all practitioners. There is no agreement as to the best way of processing the fat to ensure maximal take and viability of the graft. Other controversial issues include the ideal cannula for harvesting and reinjection, the presence of blood in the transplanted fat, trauma, air exposure, contamination of the graft, durability, and fat cell survival. Newly emerging approaches to fat tissue engineering with the use of cultured autologous preadipocytes may improve the technique of fat injection and transplant.