Fat, Stem Cells, and Platelet-Rich Plasma

The Role of Autologous Fat Grafting in the Treatment of Atrophic Post-Acne Scars: A Narrative Review

Numerous techniques have been tried to treat acne scarring. Given its filling properties and the presence of adipose tissue-derived stem cells, autologous fat has been tried for treating acne scars in multiple studies, either alone or combined with other treatment approaches. This review focuses on autologous fat grafting in its different forms, including nanofat and stromal vascular fraction, as an efficient and safe modality for treating acne scars. PubMed, Embase, and Cochrane Library databases were used to search for relevant studies published from January 2017 to December 2022. We used a combination of the following keywords: "acne scar," "acne scars," "autologous fat transplantation," "autologous fat grafting," "fat grafting for acne scars," "stromal vascular fraction," "SVF," and "nanofat." Twelve studies were found utilizing autologous fat grafting in different forms, either used alone or combined with other treatment methods such as lasers and platelet-rich plasma for treating atrophic post-acne scars. Most studies showed that autologous fat grafting effectively treated acne scars with satisfying results.

Evaluation of Perilipin Expression in Centrifuged Fat Grafts on Different Revolutions Per Minute and Duration Combinations

Fat graft applications are one of the most frequently used procedures in reconstructive and aesthetic surgery. Fat graft survival rate is variable and depends on many parameters. Those are the features of recipient area, method of obtaining the fat graft, the procedures applied to the harvest to get pure fat graft and the application techniques. In this study, we aimed to find the optimal revolutions per minute(rpm) and duration to be used in the centrifugation technique, which is one of the most frequently used methods in fat grafting. In our study, we used perilipin protein as a survival marker. Liposuction samples were obtained from 10 Caucasian women individuals; whose age range is between 22 and 29 years without any other reported health problem. Fat grafts from all patients were taken by the same surgical team by the same liposuction procedure. The grafts obtained in our study were divided into 6 different groups, these are A1 group (1 minute-1000 rpm) A2 group (3 minutes-1000 rpm) A3 group (5 minutes-1000 rpm) B1 group (1 minute-3000 rpm) B2 group (3 minutes-3000 rpm) and B3 group (5 minutes-3000 rpm). Perilipin expression measurements were made in the sections taken by immunohistochemistry technique. Three minutes-3000 rpm combination (B2 group) was found to be perilipin stained statistically significantly higher than other combinations. This study seeks to make a notable contribution to the literature by demonstrating the relation between frequently used centrifuge combinations and measuring the expression of perilipin. This protein's role in adipocyte regulation is becoming increasingly apparent.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 .

Technical Precision with Autologous Fat Grafting for Facial Rejuvenation: A Review of the Evolving Science

SUMMARY

The scientific study of facial aging has transformed modern facial rejuvenation. As people age, fat loss in specific fat compartments is a major contributor to structural aging of the face. Autologous fat grafting is safe, abundant, readily available, and completely biocompatible, which makes it the preferred soft-tissue filler in the correction of facial atrophy. The addition of volume through fat grafting gives an aging face a more youthful, healthy, and aesthetic appearance. Harvesting and preparation with different cannula sizes and filter-cartridge techniques have allowed for fat grafts to be divided based on parcel size and cell type into three major subtypes: macrofat, microfat, and nanofat. Macrofat and microfat have the benefit of providing volume to restore areas of facial deflation and atrophy in addition to improving skin quality; nanofat has been shown to improve skin texture and pigmentation. In this article, the authors discuss the current opinions regarding fat grafting and how the evolving science of fat grafting has led to the clinical utility of each type of fat to optimize facial rejuvenation. The opportunity exists to individualize the use of autologous fat grafting with the various subtypes of fat for the targeted correction of aging in different anatomic areas of the face. Fat grafting has become a powerful tool that has revolutionized facial rejuvenation, and developing precise, individualized plans for autologous fat grafting for each patient is an important advancement in the evolution of facial rejuvenation.

Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Report

BACKGROUND

The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications.

METHODS

We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling.

RESULTS

guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively.

CONCLUSIONS

The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

Platelet-Rich Plasma Combined Fat Transplantation for the Treatment of Bleomycin-Induced Murine Scleroderma

BACKGROUND

Low-fat retention induced by inflammation limits the clinical application of fat grafting for treating localized scleroderma (LS) patients. Novel methods to improve the therapeutic outcome are needed.

OBJECTIVE

The aim of the study is to investigate the effect of platelet-rich plasma (PRP)-assisted fat transplantation on skin fibrosis and adipose survival in the LS model.

METHODS

The LS model was established by the injection of bleomycin into BALB/C nude mice, which were randomly divided into the following 4 groups: healthy control, LS disease group model, fat transplantation group, and PRP+ fat transplantation group. The mice received a subcutaneous injection at back with phosphate-buffered saline, fat, or 20% PRP+ fat. Factors of immunoregulation, angiogenesis and adipogenesis were measured.

RESULTS

Platelet-rich plasma-combined fat transplantation significantly attenuated dermis fibrosis by reducing the production of type III collagen. The fat retention in the PRP+ fat transplantation group was 43 ± 4 mg, significantly higher than 22 ± 15 mg in the fat transplantation group (P = 0.0416). The level of tumor necrosis factor α and interleukin 2 showed no significant difference between the groups. The expression of angiogenesis factors, vascular endothelial growth factor, hepatocyte growth factor, platelet-derived growth factor, and CD31, significantly increased in the PRP+ fat transplantation group. The expression of adipogenesis factors, insulin-like growth factor 1 receptor, extracellular signal-regulated kinase, anti-CCAAT-enhancer-binding proteins, and peroxisome proliferator-activated receptor γ, also significantly increased in the PRP+ fat transplantation group.

CONCLUSIONS

The results demonstrated that PRP-combined fat transplantation attenuated dermis fibrosis and raised fat survival in the LS model by promoting angiogenesis and adipogenesis through insulin-like growth factor 1 receptor/extracellular signal-regulated kinase signaling pathway.

The Role of Autologous Fat Grafting in Rhinoplasty

Rhinoplasty is one of the most popular aesthetic surgeries worldwide and often includes grafting techniques to achieve optimal results. One of these grafting techniques is autologous fat transfer, which has been used to increase volume, camouflage irregularities, and/or improve the quality of the nasal skin-soft tissue envelope. Moreover, minimally invasive approaches for altering the nasal appearance have recently increased and become known as "liquid" or "nonsurgical rhinoplasty." These nonsurgical approaches include altering the nasal appearance with filler injection to induce volumetric changes in lieu of extensive surgery. The use of fat grafting as a filler is favorable to achieve well-balanced aesthetic results without compromising the nasal skin-soft tissue envelope. This capability is partly because of the regenerative potential of fat grafts, serving to improve the quality of surrounding soft tissues. In contrast, commercial injectable fillers are inert. This article highlights the role of fat grafting in surgical and nonsurgical rhinoplasty to provide surgeons with an overview of the potential of these vastly abundant, biocompatible, and cost-effective grafts.

Current Fat Grafting Practices and Preferences: A Survey from Members of ISPRES

Fat grafting has established its niche in a wide spectrum of aesthetic and reconstructive procedures. A consensus-based method of harvest, processing, enrichment, injection, and assessment is lacking, despite the rising trends in its application. We conducted a survey among plastic surgeons to evaluate and identify trends of fat grafting practices.

Dermatological Management of Aged Skin

The subject of the work concerns the dermatological management of patients mainly with aged skin. The purpose of the work was to present the basic techniques and preparations which are performed by dermatologists in the treatment of aged skin. There are dermatological treatments related to the treatment of skin diseases and cosmetic treatments which are mainly related to skin care. In this work, the method of literature research was applied. On the basis of books and journal articles on dermatological and cosmetic procedures for aged skin, an analysis of treatment types was made. Then, the results of this analysis were presented in the paper under discussion. The paper presents information on the skin and its properties. The structure and functions of the skin, aging processes and characteristics of aged skin were discussed. Then, the possibilities of reducing the visible signs of skin aging through the use of invasive and non-invasive dermatological and cosmetological treatments were given, and the most important components of preparations used supportively in combating skin aging processes were discussed.

Therapeutic potential of adipose tissue-derivatives in modern dermatology

Stem cell-mediated therapies in combination with biomaterial and growth factor-based approaches in regenerative medicine are rapidly evolving with increasing application beyond the dermatologic field. Adipose-derived stem cells (ADSCs) are the more frequently used adult stem cells due to their abundance and easy access. In the case of volumetric defects, adipose tissue can take the shape of defects, restoring the volume and enhancing the regeneration of receiving tissue. When regenerative purposes prevail on volume restoration, the stromal vascular fraction (SVF) rich in staminal cells, purified mesenchymal stem cells (MSCs) or their cell-free derivatives grafting are favoured. The therapeutic efficacy of acellular approaches is explained by the fact that a significant part of the natural propensity of stem cells to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines and extracellular matrix components. Therefore, the secretome's ability to modulate multiple targets simultaneously demonstrated preclinical and clinical efficacy in reversing pathological mechanisms of complex conditions such atopic dermatitis (AD), vitiligo, psoriasis, acne and Lichen sclerosus (LS), non-resolving wounds and alopecia. This review analysing both in vivo and in vitro models gives an overview of the clinical relevance of adipose tissue-derivatives such as autologous fat graft, stromal vascular fraction, purified stem cells and secretome for skin disorders application. Finally, we highlighted the major disease-specific limitations and the future perspective in this field.

Effect and Related Mechanism of Platelet-Rich Plasma on the Osteogenic Differentiation of Human Adipose-Derived Stem Cells

Objective

Human adipose-derived stem cells (hADSCs) are ideal seed cells for the regeneration of alveolar bone defects. Platelet-rich plasma (PRP), which is rich in growth factors, promotes tissue repair. The purpose of the present study was to investigate whether PRP promotes the osteogenic differentiation of hADSCs and to perform high-throughput sequencing to explore the possible mechanism.

Methods

hADSCs were divided into the three following groups: CON group, OM group, and PRP group. Osteogenesis was detected by Alizarin Red staining on day 14. Total RNA was extracted from the OM and PRP groups for high-throughput sequencing. The target genes of the differentially expressed osteogenic-related miRNAs were predicted, and combined miRNA/mRNA analysis was then performed. The mRNA and protein expression levels of hsa-miR-212-5p, type 1 cannabinoid receptor (CNR1), alkaline phosphatase (ALP), Runx2, osteocalcin (OCN), and collagen 1 A1 (COL1A1) in the OM and PRP groups were detected by qRT–PCR and Western blot analyses. The binding between hsa-miR-212-5p and CNR1 was detected by a dual-luciferase reporter assay.

Results

Both the OM and PRP groups exhibited enhanced proliferation of hADSCs, and the differences at 48 h and 72 h were statistically significant (P < 0.05). The PRP group had significantly more calcium nodules than the CON group (P < 0.05). Through high-throughput sequencing analysis, differential miRNA and mRNA expression profiles were obtained. During hADSC osteogenesis, the expression of hsa-miR-212-5p was downregulated, and the expression of CNR1 was upregulated. hsa-miR-212-5p was found to bind directly to the 3′ UTR of CNR1.

Conclusions

The present findings indicated that downregulation of hsa-miR-212-5p and upregulation of CNR1 may be involved in the process by which PRP promotes the osteogenic differentiation of hADSCs.

Research update of adipose tissue-based therapies in regenerative dermatology

Mesenchymal stromal/stem cells (MSCs) have a spontaneous propensity to support tissue homeostasis and regeneration. Among the several sources of MSCs, adipose-derived tissue stem cells (ADSCs) have received major interest due to the higher mesenchymal stem cells concentration, ease, and safety of access. However, since a significant part of the natural capacity of ADSCs to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines, lipids, and extracellular matrix components, several studies focused on cell-free strategies. Furthermore, adipose cell-free derivatives are becoming more attractive especially for non-volumizing purposes, such as most dermatological conditions. However, when keratinocytes, fibroblasts, melanocytes, adipocytes, and hair follicle cells might not be locally sourced, graft of materials containing concentrated ADSCs is preferred. The usage of extracellular elements of adipose tissue aims to promote a self-autonomous regenerative microenvironment in the receiving area restoring physiological homeostasis. Hence, ADSCs or their paracrine activity are currently being studied in several dermatological settings including wound healing, skin fibrosis, burn, and aging.The present work analyzing both preclinical and clinical experiences gives an overview of the efficacy of adipose tissue-derivatives like autologous fat, the stromal vascular fraction (SVF), purified ADSCs, secretome and extracellular matrix graft in the field of regenerative medicine for the skin.

Repairing Effect of Platelet Enriched Plasma on Tendon Healing

To explore the repairing effect of platelet-rich plasma (PRP) on tendon (AT) healing, and provide evidence for PRP therapy to treat tendon-related diseases, 32 New Zealand white rabbits were selected to construct tendinopathy animal model. Leukocyte-rich Platelet-Rich Fibrin (Lr-PRP) and Leukocyte-poor Platelet-Rich Fibrin (Lp-PRP) were prepared, whose biological effects on tendon stem cells (TSCs) were explored. Rabbits were divided into control group, low, medium, and high dose groups regrading concentration of Lp-PRP. The number of fibroblasts, collagen fiber content, tubuloglomerular feedback-β1 (TGF-β1) expression, and biomechanical properties were compared at 15 and 30 days after operation. The results showed that Collagen-III (CoI-III) protein expression levels, interleukin-β (IL-β), and interleukin-6 (IL-6) levels in the Lp-PRP group were significantly higher than Lr-PRP group (P < 0.05). Fibroblasts and collagen fibers in group II and III were significantly higher versus group C 15 and 30 days after operation (P < 0.05). Fibroblasts and of collagen fibers in group III were significantly higher versus group II (P < 0.05). Expression of TGF-β1 in groups II and III was significantly higher than that in group C 15 days after operation (P < 0.05). Tensile load of AT repair site in group III was significantly higher than group C 30 days after operation (P < 0.05). Platelet plasma concentration had a certain repair effect on tendon injury and can effectively improve the quality of healing. In addition, Lp-PRP was better than Lr-PRP in tissue healing. When the concentration of Lp-PRP was 100%, the repair effect was the best.

The Combined Use of Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells Promotes Healing. A Review of Experimental Models and Future Perspectives

Wound healing and tissue regeneration are a field of clinical medicine presenting high research interest, since various local and systematic factors can inhibit these processes and lead to an inferior result. New methods of healing enhancement constantly arise, which, however, require experimental validation before their establishment in everyday practice. Platelet-rich plasma (PRP) is a well-known autologous factor that promotes tissue healing in various surgical defects. PRP derives from the centrifugation of peripheral blood and has a high concentration of growth factors that promote healing. Recently, the use of adipose-derived mesenchymal stem cells (ADMSCs) has been thoroughly investigated as a form of wound healing enhancement. ADMSCs are autologous stem cells deriving from fat tissue, with a capability of differentiation in specific cells, depending on the micro-environment that they are exposed to. The aim of the present comprehensive review is to record the experimental studies that have been published and investigate the synergistic use of PRP and ADMSC in animal models. The technical aspects of experimentations, as well as the major results of each study, are discussed. In addition, the limited clinical studies including humans are also reported. Future perspectives are discussed, along with the limitations of current studies on the long-term follow up needed on efficacy and safety.

Autologous nanofat injection in treatment of scars: A clinico-histopathological study

BACKGROUND

Scars are the unfortunate outcome of most injuries and some diseases. Its psychological impact on patients can deeply affect their quality of life.

AIM

The aim of this study was to evaluate the efficacy of autologous nanofat injection in improving the aesthetic outcome of scars, combined with histopathological correlation of the response.

PATIENTS AND METHODS

Thirty patients with scars of different etiologies undergone one session of nanofat injection and evaluation was done 6 months after the session. Efficacy of treatment was assessed clinically using Vancouver scar scale by two independent blinded dermatologists and histopathologically using image analysis system.

RESULTS

The age of enrolled patients ranged from 18 to 40 years old. There was a statistically significant improvement on the total Vancouver scar scale regarding the height and pliability of the scars. Pathological evaluation showed an increase in epidermal thickness, increased number and density of collagen and elastic fibers along with neovascularization.

CONCLUSION

Evidenced by clinical and pathological improvement, autologous nanofat injection is an effective strategy for treating scars of different etiologies.

The Future of Fat Grafting

One of the earliest reported cases of autologous fat grafting (AFG) was by Neuber in 1893 and consisted of the transfer of small lobules of fat from the upper arm for cicatrical depression of the face. He advocated the use of smaller grafts, noting that pieces larger than the size of a bean would form cysts. In 1895, Czerny excised a lumbar lipoma and transplanted it to the chest for breast reconstruction. Since these early reports, the knowledge base around AFG has expanded exponentially, as illustrated by the other papers within this special topic. As we embark on the next phase of AFG in the clinical setting, there are several directions which are near-clinical translation. This paper discusses future directions in fat grafting that build on optimization of our current techniques as clinical indications expand, such as supplementing purified lipoaspirate and the associated regulatory burden, or deconstructing adipose tissue to selectively use adipose graft components for a variety of regenerative indications.

Fat Augmentation as Adjunct to CORE Facelift Surgery

Ruling out cases with strong jawlines, well-developed mid-cheek regions, and good fat presence, if done artistically, fat augmentation strongly assists midface definition and can replenish hollowed regions of the face. This is particularly true for candidates with low bodyfat or smaller skull structures. Hence, fat grafting is a strong adjunct to conventional excisional techniques in facial rejuvenation surgery, regardless of experience, technique, or geographical embedding. While CORE facelift techniques remain the golden standard that define the top level of facelift surgery, fat augmentation has its unique place along the full stretch of an individual surgeon's learning scope, as it will potentially improve results regardless of where one stands.

Histological Evaluation of the Skin After Fat Grafting: A Blinded, Randomized, Controlled Clinical Study

BACKGROUND

Autologous fat graft is often employed to treat body contour defects. There is currently increased interest in the regenerative properties of fat grafting.

OBJECTIVES

The authors evaluated the histological changes of fat grafting in a blinded randomized controlled trial of staged fat grafting-abdominoplasty.

METHODS

Ten women between 24 and 55 years of age with a body mass index <30 kg/m2 and previous cesarean scar were submitted to fat grafting followed by staged abdominoplasty. The C-section scar served as a landmark for standardization of fat grafting site and control. One side of the abdomen was fat grafted and the other was left intact (control). At the time of abdominoplasty, 4 months later, a full-thickness skin sample from each hemi abdomen (fat-grafted area and control) was collected and sent to histological analysis.

RESULTS

All of the fat-grafted samples showed extracellular lipids and signs of fat graft viability, whereas no such changes occurred in the control group. There were no statistically significant differences in fat-grafted vs control samples regarding skin inflammatory infiltrate (P = 0.582), dermis thickness (P = 0.973), vascular density (P = 0.326), and amount of elastic fibers (P = 1).

CONCLUSIONS

The histological evaluation of women's abdominoplasty surgical site skin after 4 months of fat grafting showed signs of fat graft in 100% of the grafted sides but no change in skin inflammatory infiltrate, dermis thickness, vascularity density, or elastic fiber quantity.

Platelet-Rich Plasma Enhances Distal Flap Viability and Underlying Vascularity in a Radiated Rotational Flap Rodent Model

Importance: Autologous platelet-rich plasma (PRP) has received widespread attention due to its physiologic healing properties, augmenting the body's natural healing process through platelet activation and release of growth factors. The effects of PRP on radiated tissue have been inadequately studied in vivo. Objective: To determine whether PRP can be used to improve viability of radiated tissue subjected to a clinically meaningful stressor, in this case a rotational skin flap. Design, Setting, Participants: This is a prospective trial using a radiated rat abdominal rotational flap model in the laboratory. Male Sprague-Daley rats were used in this study. Harvested PRP or saline control was injected into rotational flaps immediately after surgery. Progression of necrosis was documented with photo analysis. After 1 week, animals were sacrificed and flap tissue was stained and analyzed for presence of vascular tissue. Intervention: PRP versus control injection into radiated skin tissue. Main Outcomes and Measures: Percentage necrosis of rotational flap and number of vascular channels stained with CD31 present in flap tissue. Results: PRP administration helped rescue the distal flap from necrosis, achieving viability similar to nonradiated controls. Superficial vascularity was similarly increased fivefold in radiated tissue if PRP was given postoperatively, mirroring the vascular density of nonradiated tissue. Conclusions and Relevance: PRP may enhance distal rotational flap viability after radiation, possibly by protecting superficial vessels from tissue necrosis when administered at the time of surgery.

Photoaging Skin Therapy with PRP and ADSC: A Comparative Study

BACKGROUND

Stem cells from adipose tissue (ADSCs) and platelet-rich plasma (PRP) are innovative modalities that arise due to their regenerative potential.

OBJECTIVE

The aim of this study was to characterize possible histological changes induced by PRP and ADSC therapies in photoaged skin.

METHODS

A prospective randomized study involving 20 healthy individuals, showing skin aging. They underwent two therapeutic protocols (protocol 1: PRP; protocol 2: ADSCs). Biopsies were obtained before and after treatment (4 months).

RESULTS

PRP protocol showed unwanted changes in the reticular dermis, mainly due to the deposition of a horizontal layer of collagen (fibrosis) and elastic fibers tightly linked. Structural analyses revealed infiltration of mononuclear cells and depot of fibrotic material in the reticular dermis. The ADSC protocol leads to neoelastogenesis with increase of tropoelastin and fibrillin. There was an improvement of solar elastosis inducing an increment of macrophage polarization and matrix proteinases. These last effects are probably related to the increase of elastinolysis and the remodeling of the dermis.

CONCLUSIONS

The PRP promoted an inflammatory process with an increase of reticular dermis thickness with a fibrotic aspect. On the other hand, ADSC therapy is a promising modality with an important antiaging effect on photoaged human skin.

Autologous Fat Grafting Restores Soft-tissue Contour Deformities after Vascular Anomaly Surgery

Soft-tissue loss is expected after resection of large vascular lesions. Autologous fat transfer improves asymmetries; however, systematic outcomes are not previously described for vascular anomaly reconstruction.

Micro-Autologous Fat Transplantation Combined With Platelet-Rich Plasma for Facial Filling and Regeneration: A Clinical Perspective in the Shadow of Evidence-Based Medicine

Despite the popularity of lipofilling procedures in recent years, the presence of older habits still in fat graft harvesting and processing seems to be the biggest obstacle to the final better outcome of fat grafting. Our study is aimed to highlight some strategies what should be done in fat grafting in the shadow of evidence-based medicine and patient-reported outcomes which might be of interest to the clinicians. Between 2015 and 2017, 14 patients were included who underwent facial micro-autologous fat transplantation with platelet-rich plasma injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules, which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures. Surveys conducted were modules of satisfaction with facial appearance, satisfaction with cheeks, satisfaction with skin, psychological function, social function, aging appearance appraisal, and satisfaction with the outcome. All patients were followed up minimum 9 months. No major complications were recorded. The patient-reported FACE-Q satisfaction and FACE-Q quality-of-life presurgery and postsurgery results showed statistically significant improvement (<0.001). Overall satisfaction with the outcome was 87.6 ± 16.8 (range 55-100). A combination of platelet-rich plasma and micro-fat grafting with soft harvesting and processing could be seen a good surgical technique to restore volume and enhance skin quality in facial soft tissue augmentation. The authors believe that with minimum detrimental effect on fat grafting while harvesting, processing, and with the addition of platelet-rich plasma while applying may increase the surgeon's and patient's satisfaction with the outcome.

Utility of Adipocyte Fractions in Fat Grafting in an Athymic Rat Model

BACKGROUND

Multiple processing and handling methods of autologous fat yield to variations in graft retention and viability, which results in unpredictable clinical outcomes.

OBJECTIVES

This study aims to understand the skin effects of fat graft preparations that contain a varying ratio of free-lipid and stem-cell-bearing stromal vascular fractions (SVF).

METHODS

Lipoaspirates from consenting patients were processed into emulsified fat and then SVF and adipocyte fractions (free-lipid). SVF enriched with 0%, 5%, and 15% free-lipid were grafted along the dorsum of athymic rats. The xenografts were collected 45 days after grafting and then prepped for immunostaining.

RESULTS

Xenografts resulted in viable tissue mass under the panniculus carnosus of rats as confirmed with human specific markers. A low percentage of human cells was also detected in the lower reticular dermis. Although grafts with SVF formed adipocytes of normal architecture, grafts formed with free-lipid alone resulted in large lipid vacuoles in varying sizes. Among graft preparations, SVF with 10% free-lipid resulted in much-developed adipocyte architecture with collagen and elastin. Compared with SVF alone grafts, SVF with free-lipid had higher CD44 expression, suggesting a localized immune response of adipocytes.

CONCLUSIONS

Current studies suggest that SVF enriched with approximately 10% free-lipid provides the best conditions for fat graft differentiation into viable fat tissue formation as well as collagen and elastin production to provide mechanical support for overlaying skin in an athymic rat model. Additionally, application of this therapeutic modality in a simple clinical setting may offer a practical way to concentrate SVF with free-lipid in a small volume for the improvement of clinical defects.

LEVEL OF EVIDENCE 5

Fat Injection: A Systematic Review of Injection Volumes by Facial Subunit

BACKGROUND

Fat grafting to the aging face has become an integral component of esthetic surgery. However, the amount of fat to inject to each area of the face is not standardized and has been based mainly on the surgeon's experience. The purpose of this study was to perform a systematic review of injected fat volume to different facial zones.

METHODS

A systematic review of the literature was performed through a MEDLINE search using keywords "facial," "fat grafting," "lipofilling," "Coleman technique," "autologous fat transfer," and "structural fat grafting." Articles were then sorted by facial subunit and analyzed for: author(s), year of publication, study design, sample size, donor site, fat preparation technique, average and range of volume injected, time to follow-up, percentage of volume retention, and complications. Descriptive statistics were performed.

RESULTS

Nineteen articles involving a total of 510 patients were included. Rhytidectomy was the most common procedure performed concurrently with fat injection. The mean volume of fat injected to the forehead is 6.5 mL (range 4.0-10.0 mL); to the glabellar region 1.4 mL (range 1.0-4.0 mL); to the temple 5.9 mL per side (range 2.0-10.0 mL); to the eyebrow 5.5 mL per side; to the upper eyelid 1.7 mL per side (range 1.5-2.5 mL); to the tear trough 0.65 mL per side (range 0.3-1.0 mL); to the infraorbital area (infraorbital rim to lower lid/cheek junction) 1.4 mL per side (range 0.9-3.0 mL); to the midface 1.4 mL per side (range 1.0-4.0 mL); to the nasolabial fold 2.8 mL per side (range 1.0-7.5 mL); to the mandibular area 11.5 mL per side (range 4.0-27.0 mL); and to the chin 6.7 mL (range 1.0-20.0 mL).

CONCLUSIONS

Data on exactly how much fat to inject to each area of the face in facial fat grafting are currently limited and vary widely based on different methods and anatomical terms used. This review offers the ranges and the averages for the injected volume in each zone.

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 .

Platelet-Rich Plasma for Skin Rejuvenation and Tissue Fill

Platelet preparations, including platelet-rich plasma and platelet-rich fibrin matrix, have been used to improve wound healing, recovery time, and cosmetic outcomes for facial rejuvenation. Bioactive growth factors released from platelets are the putative agents in producing a reparative tissue reaction in the treated area. Different methods of processing the patients' blood will yield different types of platelet preparations with different components and properties, and it is important to understand these differences and their potential implications. More robust studies are necessary to better understand the nuances of these preparations and their optimal use.

Pedicled buccal fat pad for the augmentation of facial depression deformity: A case report

RATIONALE

Tissue augmentation of facial depression deformities can be achieved by volume replacement with autologous fat injection, dermal filler injection, etc. Here, we report a case of tissue augmentation of a facial depression deformity using a pedicled buccal fat pad (BFP).

PATIENT CONCERNS

A 64-year-old woman was referred with a chief complaint of facial depression deformity.

DIAGNOSES

Her molars had been removed at another hospital 12 years prior to this referral, and the patient suffered from a left cheek depression deformity as a sequela of a postextraction infection.

INTERVENTIONS

An incision was made in the left gingivobuccal sulcus under local anesthesia, and BFP was carefully excised from its normal location. The subcutaneous scar tissue was dissected, and a pocket was created via the same mucosal incision. BFP was then pushed into the pocket.

OUTCOMES

The depression deformity immediately disappeared postoperatively. The transplanted BFP remained unabsorbed and soft 43 months postoperatively. The patient did not have any complications.

LESSONS

This novel procedure has 2 advantages. First, the pedicled BFP is a vascularized tissue and is not absorbed postoperatively; control of contour is easy, and only 1 treatment session is required. Complications associated with fat necrosis can be avoided. Second, only a single intraoral incision is required; the risk of donor-site morbidity is very low, and scar formation does not occur on exposed skin. Third, this procedure can be performed without special instruments and equipment. The main disadvantages are limited rotation arc and volume of pedicled BFP. Despite its limited application, this procedure is simple and useful, with low invasiveness.