Fat Grafting for Facial Rejuvenation Using Stromal Vascular Fraction Gel Injection

Comparison of stromal vascular fraction cell composition between Coleman fat and extracellular matrix/stromal vascular fraction gel

As a mechanically condensed product of Coleman fat, extracellular matrix/stromal vascular fraction gel (ECM/SVF-gel) eliminates adipocytes, concentrates SVF cells, and improves fat graft retention. This study aims to compare SVF cell composition between Coleman fat and ECM/SVF-gel. Matched Coleman fat and ECM/SVF-gel of 28 healthy women were subjected to RNA-seq, followed by functional enrichment and cell-type-specific enrichment analyses, and deconvolution of SVF cell subsets, reconstructing SVF cell composition in the transcriptome level. ECM/SVF-gels had 9 upregulated and 73 downregulated differentially expressed genes (DEGs). Downregulated DEGs were mainly associated with inflammatory and immune responses, and enriched in fat macrophages. M2 macrophages, resting CD4+ memory T cells, M1 macrophages, resting mast cells, and M0 macrophages ranked in the top five most prevalent immune cells in the two groups. The proportions of the principal non-immune cells (e.g., adipose-derived stem cells, pericytes, preadipocytes, microvascular endothelial cells) had no statistical differences between the two groups. Our findings reveal ECM/SVF-gels share the same dominant immune cells beneficial to fat graft survival with Coleman fat, but exhibiting obvious losses of immune cells (especially macrophages), while non-immune cells necessary for adipose regeneration might have no significant loss in ECM/SVF-gels and their biological effects could be markedly enhanced by the ECM/SVF-gel's condensed nature.

Ultrasound to Improve the Anatomic Approach to the Temple and a Retrospective Study on the Efficacy of Large-Volume Autologous Fat Grafting

BACKGROUND

Autologous fat grafting (AFG) has been used widely in temporal-hollowing augmentation, but its efficacy and safety are unclear. The authors examined the use of Doppler ultrasound (DUS) in large-volume lipofilling after performing an anatomic study of the temporal region.

METHODS

To clarify safe and stable levels of AFG of the temporal fat compartments, 5 cadaveric heads (10 sides) were dissected after dye was injected into targeted fat pads with DUS guidance. In addition, the authors retrospectively analyzed 100 patients with temporal fat transplantation, including groups with conventional AFG ( n = 50) and DUS-guided large-volume AFG ( n = 50).

RESULTS

The anatomic study revealed the approach of 5 injection planes and 2 fat compartments in the temporal region: the superficial and deep temporal fat pads. In the AFG study, all patients were female, and there were no statistically significant differences between the groups in age, body mass index, tobacco or steroid use, or previous filling history. Between the conventional AFG group and the DUS-guided large-volume AFG group, the average volume of temporal lipofilling per side was 10.55 ± 2.25 versus 22.32 ± 5.19 mL/side ( P < 0.001), surgeon Likert scale score was 2.86 ± 0.97 versus 4.24 ± 0.66 ( P < 0.001), and rate of satisfaction was 74% versus 92% ( P < 0.05) (statistically significant differences).

CONCLUSIONS

The anatomic approach to the main temporal fat compartment is feasible. DUS-guided large-volume AFG is an effective and safe way to improve temporal hollowing augmentation.

Isolation of the Stromal Vascular Fraction Using a New Protocol with All Clinical-Grade Drugs: From Basic Study to Clinical Application

OBJECTIVE

The purpose of this study was to evaluate the yield, viability, clinical safety, and efficacy of the stromal vascular fraction (SVF) separated with a new protocol with all clinical-grade drugs.

MATERIALS AND METHODS

SVF cells were isolated from lipoaspirate obtained from 13 participants aged from 30 to 56 years by using a new clinical protocol and the laboratory protocol. The cell yield, viability, morphology, mesenchymal stem cell (MSC) surface marker expression, and differentiation abilities of the SVF cells harvested from the two protocols were compared. Furthermore, three related clinical trials were conducted to verify the safety and efficiency of SVF cells isolated by the new clinical protocol.

RESULTS

There were no significant differences in the yield, viability, morphology, and differentiation potential of the SVFs isolated with the clinical protocol and laboratory protocol. Adipose-derived mesenchymal stem cell (ASC) surface marker expression, including that of CD14, CD31, CD44, CD90, CD105, and CD133, was consistent between the two protocols. Clinical trials have demonstrated the effectiveness of the SVF isolated with the new clinical protocol in improving skin grafting, promoting mechanical stretch-induced skin regeneration and improving facial skin texture. No complications occurred.

CONCLUSION

SVF isolated by the new clinical protocol had a noninferior yield and viability to that of the SVF separated by the laboratory protocol. SVFs obtained by the new protocol can be safely and effectively applied to improve skin grafting, promote mechanical stretch-induced skin regeneration, and improve facial skin texture.

TRIAL REGISTRATION

The trials were registered with the ClinicalTrials.gov (NCT03189628), the Chinese Clinical Trial Registry (ChiCTR2000039317), and the ClinicalTrials.gov (NCT02546882). All the three trials were not patient-funded trials.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Fat or fillers: The dilemma in eyelid surgery

The aging of the periocular region has always aroused great interest. A fresh, young, and attractive sight determined an ever-greater attention to surgical and non-surgical techniques to obtain this result. In particular, the change in the concept of a young look, considered then "full", led to the increasing use of surgical (fat grafting) or medical (hyaluronic acid) filling techniques. Eyelid rejuvenation became increasingly popular in the field of cosmetic treatments, with a focus on achieving a youthful and refreshed appearance. Among the various techniques available, the choice between using fat grafting or fillers presented a clinical dilemma. In particular, what surgery considered of fundamental importance was a long-lasting result over time. On the other hand, aesthetic medicine considered it fundamental not to have to resort to invasive treatments. But what was the reality? Was there one path better than the other, and above all, was there a better path for patients? The minireview aims to explore the physiopathology, diagnosis, treatment options, prognosis, and future studies regarding this dilemma. We analyzed the literature produced in the last 20 years comparing the two techniques. Current literature reveals advancements in biomaterials, stem cell research and tissue engineering held promise for further enhancing the field of eyelid rejuvenation. The choice between fat grafting and fillers in eyelid cosmetic treatments presented a clinical dilemma. Understanding physiopathology, accurately diagnosing eyelid aging, exploring treatment options, assessing prognosis, and conducting future studies were essential for providing optimal care to patients seeking eyelid rejuvenation.

Combining High-Density Fat and Condensed Low-Density Fat Injections for Precise Facial Rejuvenation

BACKGROUND

Facial aging involves ptosis, adipose atrophy, and skeletal resorption. Depletion of adipose tissue primarily affects the deep facial fat compartment, leading to facial depression or ptosis, accompanied by atrophy of the superficial compartment. Restoring volume in the deep fat compartment is crucial for facial rejuvenation, while enhancing its supportive properties is also important. The superficial fat compartment contains small-sized adipocytes, and autologous fat grafting is a popular approach. However, variability in fat retention, homogeneity, and processing methods can impact outcomes, necessitating careful selection of a suitable fat processing material for precise facial fat grafting.

METHOD

A retrospective study was conducted on 50 patients who underwent facial augmentation using combined transplantation of high-density fat (HDF) and condensed low-density fat (CLDF) and 25 patients who underwent conventional Coleman fat grafting. Coleman fat was harvested by standard technique and the adipose tissue was divided into HDF and CLDF fractions through centrifugation. Subsequently, the low-density fat fraction was subjected to a process involving physical disruption followed by additional centrifugation to obtain CLDF. The CLDF fraction was consequently injected into the pre-SMAS subcutaneous layer of the superficial fat compartments. Patient satisfaction was evaluated using a typical Likert scale. Photographs were taken and imageological examinations were performed before and after treatment.

RESULT

The CLDF+HDF grafting group demonstrated a significantly shorter duration of swelling (6.0 ± 1.2 to 12.6 ± 3.3 days) and higher level of patient satisfaction when compared to the Coleman fat group. No serious complications were observed among all the patients who received the injections.

CONCLUSION

The use of this new treatment approach allows for precise fat transplantation in facial regions. The use of high-concentration fat filling for deep facial layers and CLDF filling for superficial layers is a safe and effective treatment plan for facial rejuvenation.

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 .

The investigation and comparison of the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated infraorbital dark circles and wrinkles: A controlled blinded randomized clinical trial

BACKGROUND

To evaluate the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated dark circles and wrinkles under the eyes.

METHOD

This study was a single-blinded randomized clinical trial conducted on patients with suborbital darkening under the eyes that randomly divided into control and case groups. In the control group, 15 patients were treated with one session of nanofat injection only, and five patients of each intervention groups received one session of nanofat+SVF injection, nanofat+PRP injection, and nanofat injection+Nd:YAG laser, respectively. Assessments methods were (1) evaluation of the degree of darkness and repair under the eyes by a blinded dermatologist based on clinical photographs, (2) investigating patient satisfaction, (3) using biometric variables for color, thickness, and density of the skin (only 3 months after the treatment), and (4) recording the possible adverse effects.

CONCLUSION

In terms of the extent of reduction in the intensity of darkness under the eyes, the combined treatment of nanofat injection together with SVF, PRP, and Nd:YAG laser had a much greater therapeutic effect than nanofat injection alone. In all three groups of combined treatments, patients were 100% satisfied. In terms of biometric variables, amount of changes in colorimeter, complete and dermal thickness, complete and dermal density, between the different groups was statistically significant. The use of combined treatments including nanofat with SVF injection, PRP, and 1064 Q-switched Nd:YAG laser may be more effective than nanofat alone, in reducing infraorbital dark circles and wrinkles.

One-step stromal vascular fraction therapy in osteoarthritis with tropoelastin-enhanced autologous stromal vascular fraction gel

Background: Osteoarthritis (OA) is a debilitating degenerative joint disease, leading to significant pain and disability. Despite advancements, current regenerative therapies, such as mesenchymal stem cells (MSCs), face challenges in clinical efficacy and ethical considerations. This study aimed to evaluate the therapeutic potential of stromal vascular fraction gel (SVF-gel) in comparison to available treatments like hyaluronic acid (HA) and adipose-derived stem cells (ADSCs) and to assess the enhancement of this potential by incorporating tropoelastin (TE). Methods: We conducted a comparative laboratory study, establishing an indirect co-culture system using a Transwell assay to test the effects of HA, ADSCs, SVF-gel, and TE-SVF-gel on osteoarthritic articular chondrocytes (OACs). Chondrogenic and hypertrophic markers were assessed after a 72-hour co-culture. SVF-gel was harvested from rat subcutaneous abdominal adipose tissue, with its mechanical properties characterized. Cell viability was specifically analyzed for SVF-gel and TE-SVF-gel. The in vivo therapeutic effectiveness was further investigated in a rat model of OA, examining MSCs tracking, effects on cartilage matrix synthesis, osteophyte formation, and muscle weight changes. Results: Cell viability assays revealed that TE-SVF-gel maintained higher cell survival rates than SVF-gel. In comparison to the control, HA, and ADSCs groups, SVF-gel and TE-SVF-gel significantly upregulated the expression of chondrogenic markers COL 2, SOX-9, and ACAN and downregulated the hypertrophic marker COL 10 in OACs. The TE-SVF-gel showed further improved expression of chondrogenic markers and a greater decrease in COL 10 expression compared to SVF-gel alone. Notably, the TE-SVF-gel treated group in the in vivo OA model exhibited the most MSCs on the synovial surface, superior cartilage matrix synthesis, increased COL 2 expression, and better muscle weight recovery, despite the presence of fewer stem cells than other treatments. Discussion: The findings suggest that SVF-gel, particularly when combined with TE, provides a more effective regenerative treatment for OA by enhancing the therapeutic potential of MSCs. This combination could represent an innovative strategy that overcomes limitations of current therapies, offering a new avenue for patient treatment. Further research is warranted to explore the long-term benefits and potential clinical applications of this combined approach.

Stromal Vascular Fraction Gel (SVF-Gel) Combined with Nanofat for Tear Trough Deformity

BACKGROUND

Tear trough deformity makes patients appear tired. Patients with less severe tear trough deformity prefer a less invasive method to correct the deformity. The infraorbital area is a multilayered tissue, and the aging of various components leads to tear trough deformity. To this end, we utilized the different characteristics of different fat derivatives to correct tear trough deformity.

METHODS

Thirty-two patients with Barton Grade I/II tear trough deformity were enrolled in this study between September 2020 and March 2021. We injected Stromal Vascular Fraction Gel (SVF-Gel) into the suborbicularis oculi fat layer and Nanofat into the subcutaneous. After 12 months of follow-up, we evaluated the changes using standardized clinical photogrammetric techniques, volume, global aesthetic improvement scale, and patient self-evaluation.

RESULTS

There were no major complications in any of the 32 patients. The measured data points demonstrated improvements in all aesthetic parameters. The width of the tear trough and the distance from the pupil to the tear trough improved. The Global Aesthetic Improvement Scale (GAIS) showed a high score (2.45±0.64 points), with patient self-assessment showing satisfactory results.

CONCLUSION

SVF-Gel combined with Nanofat injection can effectively correct tear trough deformities.

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 .

A New Minimally Invasive Procedure for Treating Plantar Heel Pain: Stromal Vascular Fraction Gel Grafting

METHODS

Fourteen patients who experienced plantar heel pain and underwent plantar heel SVF-gel grafting between January 2019 and June 2020 were included in this retrospective study. Foot pain and disability were measured at the screening visit and at the 3-, 6-, and 12-month follow-up visits. The volume of the heel fat pad was measured by magnetic resonance imaging.

RESULTS

Four of the patients had bilateral plantar heel pain, and 10 patients had unilateral plantar heel pain. All patients showed significant improvements in pain and foot function at 3 months after SVF-gel grafting compared with the baseline, with the greatest improvement at 6 months and the effect lasting 1 year or more. In addition, the thickness of the heel fat pad was significantly greater than at baseline at 3 months, and the effect lasted for 1 year or more.

CONCLUSION

Stromal vascular fraction gel grafting is a safe, minimally invasive, and effective approach to treat plantar heel pain.

Therapeutic potential of adipose tissue derivatives in skin photoaging

Photoaging, the primary cause of exogenous skin aging and predominantly caused by ultraviolet radiation, is an essential type of skin aging characterized by chronic skin inflammation. Recent studies have shown that oxidative stress, inflammation, skin barrier homeostasis, collagen denaturation and pigmentation are the main contributors to it. As a composite tissue rich in matrix and vascular components, adipose tissue derivatives have been recently gaining attention as potential therapeutic agents for various human diseases with fat-processing technology upgrades. This review analyzes both 'minimally treated' and 'nonminimally treated' fat derivatives to give an overview of the preclinical and clinical relevance of adipose tissue derivatives for antiphotoaging application, highlighting their good clinical prospects as well as discussing their safety and potential risks.

Progress and obstacles in transplantation of brown adipose tissue or engineered cells with thermogenic potential for metabolic benefits

Transplantation of brown adipose tissue (BAT), engineered thermogenic progenitor cells, and adipocytes have received much attention for the improvement of obesity and metabolic disorders. However, even though the thermogenic and metabolic potential exists early after transplantation, the whitening of the brown fat graft occurs with metabolic function significantly impaired. In this review, specific experiment designs, graft outcomes, and metabolic benefits for the transplantation of BAT or engineered cells will be discussed. The current advancements will offer guidance to further investigation, and the obstacles appearing in previous studies will require innovation of BAT transplantation methods.

Mechanical Micronization of Lipoaspirates Combined with Fractional CO 2 Laser for the Treatment of Hypertrophic Scars

BACKGROUND

Treating hypertrophic scars remains challenging. Stromal vascular fraction (SVF) gel is produced by a purely mechanical process from lipoaspirates, rich in adipose-derived stem cells, and has showed therapeutic potential on scars. However, controversial effects on hypertrophic scars are emerging. This study aimed to assess the therapeutic effects of SVF gel combined with fractional CO 2 laser on hypertrophic scars.

METHODS

A rabbit ear hypertrophic scar model was established. SVF gel combined with fractional CO 2 laser was conducted for hypertrophic scars in rabbits. Scar alleviation in rabbits was observed based on the appearance and histology of scars, and the underlying mechanism was investigated by tissue immunologic analyses and quantitative real time polymerase chain reaction. At last, six patients with hypertrophic scar were treated by SVF gel combined with fractional CO 2 laser. Therapeutic effects were assessed using the Vancouver Scar Scale.

RESULTS

Following the treatments, hypertrophic scars became less apparent and softer, the dermis became thinner, and collagen fibers appeared looser and arranged in a more organized pattern. The SVF gel plus fractional CO 2 laser group showed the most obvious improvement. In addition, SVF gel combined with fractional CO 2 laser increased adipogenesis in scar tissue, and adipose tissue regeneration was observed. Hypertrophic scars in patients were alleviated after treatment with SVF gel combined with fractional CO 2 laser.

CONCLUSIONS

SVF gel transplantation combined with fractional CO 2 laser showed encouraging therapeutic effects on hypertrophic scars. Although further investigation is necessary, this technique has great potential for clinical application to treat hypertrophic scars.

CLINICAL RELEVANCE STATEMENT

This is a new technique for treating hypertrophic scars.

The Retention-Rate Improvement of Stromal Vascular Fraction Gel in Prefrontal Filling With Botulinum Toxin-A Injection: A Retrospective Analysis

BACKGROUND

As a derivative of adipose tissues, stromal vascular fraction gel has been widely utilized in facial soft tissue filling, but it still does not achieve the expected effect in forehead filling. The reason may be related to the corrugator muscles movements.

OBJECTIVES

The authors aimed to evaluate the effect of botulinum toxin-A (BTX-A) on the retention rate of stromal vascular fraction gel by limiting the corrugator muscles movements and to provide a theoretical basis that short-term inhibition of movement in the affected area could improve the effects of the fat graft.

METHODS

From January 2019 to June 2021, patients with stromal vascular fraction gel facial filling (including frontal and temporal parts) were selected. According to whether or not BTX-A treatment was received, patients were divided into injected and the noninjected groups. A questionnaire and the Global Aesthetic Improvement Scale (GAIS) were administered to evaluate 2-dimensional photos. The retention rate and curvature were calculated with 3-dimensional images utilizing Artec Studio 13 Professional and MATLAB software.

RESULTS

The graft retention, forehead curvature, and GAIS scores were all higher in the injected group than the noninjected group (P < .01). On the questionnaire, the injected group also showed more satisfaction with the treatment effect and were more willing to recommend the treatment to their friends.

CONCLUSIONS

BTX-A injection can improve the retention rate of prefrontal stromal vascular fraction gel filling, with higher patient satisfaction and better postoperative effects.

LEVEL OF EVIDENCE: 5

Condensing of Low-Density Fat by Mechanical Process Improves Fat Retention and Reduces Oil Cyst Formation in Breast Reconstruction

BACKGROUND

Although autologous fat grafting is a useful adjunct for breast reconstruction, its indications remain limited as large-volume fat grafting results in high absorption and complication rates. Low-density fat includes small numbers of viable cells and considerable oil, resulting in nodules and oil cysts. This study evaluated the volumization effect and complications with combined fat grafting of condense low-density fat and high-density fat.

METHODS

This retrospective, single-center study included 25 patients who underwent combined grafting of condensed low-density fat and high-density fat (CLDF + HDF) and 20 patients who underwent conventional Coleman fat grafting for breast reconstruction from December 2017 to January 2022. Retention rates and complications were evaluated by magnetic resonance imaging and ultrasound rates. Patient satisfaction was evaluated using a typical Likert scale. Photographs were taken and imageological examinations were performed before and after treatment.

OUTCOMES

Graft retention rate was higher in patients who underwent CLDF + HDF than Coleman fat grafting for breast reconstruction (38.40 ± 4.41% vs. 31.43 ± 5.43%, p <0.05). One patient in the CLDF + HDF grafting group, compared with twelve in the Coleman fat grafting group, developed oil cysts exceeding 1 cm. Patient satisfaction rate was higher in the CLDF + HDF grafting group.

CONCLUSIONS

Mechanical processes can concentrate the cellular content of LDF and remove oil, condensing LDF to the level of HDF. Combined grafting of CLDF optimized by mechanical processing and HDF is effective for breast reconstruction, with a higher retention rate and a lower incidence of complications than conventional Coleman fat grafting.

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 .

Supplementation of Facial Fat Grafting to Increase Volume Retention: A Systematic Review

BACKGROUND

For decades, facial fat grafting has been used in clinical practice for volume restoration. The main challenge of this technique is variable volume retention. The addition of supplements to augment fat grafts and increase volume retention has been reported in recent years.

OBJECTIVES

The aim of this systematic review was to investigate which supplements increase volume retention in facial fat grafting as assessed by volumetric outcomes and patient satisfaction.

METHODS

Embase, Medline, Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to November 30, 2020. Only studies assessing volume after facial fat grafting with supplementation in human subjects were included. Outcomes of interest were volume or patient satisfaction. The quality of the studies was assessed with the Effective Public Health Practice Project tool.

RESULTS

After duplicates were removed 3724 studies were screened by title and abstract. After reading 95 full-text articles, 27 studies were eligible and included for comparison. Supplementation comprised of platelet-rich plasma, platelet-rich fibrin, adipose tissue-derived stromal cells or bone marrow-derived stromal cells, cellular or tissue stromal vascular fraction, or nanofat. In 13 out of 22 studies the supplemented group showed improved volumetric retention and 5 out of 16 studies showed greater satisfaction. The scientific quality of the studies was rated as weak for 20 of 27 studies, moderate for 6 of 27 studies, and strong for 1 study.

CONCLUSIONS

It remains unclear if additives contribute to facial fat graft retention and there is a need to standardize methodology.

LEVEL OF EVIDENCE: 4

Contouring and augmentation of the temple using stromal vascular fraction gel grafting

Background

Hollowing temples are common in aging Asians. Stromal vascular fraction (SVF) gel is a novel, mechanically processed adipose-derived product containing condensed adipose-derived stem cells and native extracellular matrix, allowing improved fat grafting. The present study evaluated the effectiveness of SVF-gel treatment on temple hollowing.

Methods

This prospective, single-center study included an SVF-gel grafting group (n = 34) and a Coleman's fat grafting group (n = 29). Temple contour was assessed using preoperative and postoperative photographs. Temple augmentation was quantified using three-dimensional (3D) technology and an MVS-600 3D scanner system. Patient satisfaction was assessed postoperatively.

Results

At 12 months follow-up, the minimal forehead width/forehead width ratio and the width of the temporal peak were increased in both groups (p < 0.05).; and the retention rate (41.2% ± 8.4%) of the SVF-gel group was significantly higher than that of Coleman's fat group (32.6% ± 8.8%; p < 0.05). Moreover, patients in the SVF-gel group reported higher satisfaction scores than those in Coleman's fat group.

Conclusions

SVF-gel is effective for temple contouring and augmentation., with increased efficacy compared with Coleman's fat.

Sequential Grafting of Fresh and Cryopreserved Fat After Mechanical Processing is a Safe and Effective Facial Rejuvenation Strategy

BACKGROUND

The survival rate of fat transplants is variable and consequently multiple operations are often required to achieve satisfactory results. Fat cryopreservation technology is a good solution to this problem. At present, cryopreservation of fats needs to be added with cryopreservation agents, which brings unsafety and operational complexity to clinical applications. An efficient and safe strategy for fat cryopreservation must be developed.

METHODS

A retrospective study was performed of all patients who underwent facial fat grafting and agreed to have their fat tissue cryopreserved from January 2018 to May 2021. Fat samples were physically processed to obtain SVF-gel, which was cryopreserved at - 20 °C for up to 3 months and injected after thawing. Images acquired by pre- and post-operative 3D scanning of the temporal region were compared to evaluate the retention rate of transplanted cryopreserved SVF-gel.

RESULTS

No patients experienced serious complications after receiving cryopreserved fat transplantation. The retention rate of cryopreserved SVF-gel was 46.3 ± 7.7% at 3 months and 43.1 ± 7.2% at 6 months after transplantation. The swelling duration was significantly shorter after cryopreserved SVF-gel transplantation (5.5 ± 0.8 days) than after fresh fat transplantation (7.5 ± 0.7 days) (p < .031).

CONCLUSION

Injection of cryopreserved SVF-gel achieves good retention rate for facial rejuvenation and has few side effects. Cryopreservation of SVF-gel is a safe and effective strategy for serial fat grafting for facial rejuvenation.

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 .

Adipose-Derived Stem Cells for Facial Rejuvenation

The interest in regenerative medicine is increasing, and it is a dynamically developing branch of aesthetic surgery. Biocompatible and autologous-derived products such as platelet-rich plasma or adult mesenchymal stem cells are often used for aesthetic purposes. Their application originates from wound healing and orthopaedics. Adipose-derived stem cells are a powerful agent in skin rejuvenation. They secrete growth factors and anti-inflammatory cytokines, stimulate tissue regeneration by promoting the secretion of extracellular proteins and secrete antioxidants that neutralize free radicals. In an office procedure, without cell incubation and counting, the obtained product is stromal vascular fraction, which consists of not only stem cells but also other numerous active cells such as pericytes, preadipocytes, immune cells, and extra-cellular matrix. Adipose-derived stem cells, when injected into dermis, improved skin density and overall skin appearance, and increased skin hydration and number of capillary vessels. The main limitation of mesenchymal stem cell transfers is the survival of the graft. The final outcomes are dependent on many factors, including the age of the patient, technique of fat tissue harvesting, technique of lipoaspirate preparation, and technique of fat graft injection. It is very difficult to compare available studies because of the differences and multitude of techniques used. Fat harvesting is associated with potentially life-threatening complications, such as massive bleeding, embolism, or clots. However, most of the side effects are mild and transient: primarily hematomas, oedema, and mild pain. Mesenchymal stem cells that do not proliferate when injected into dermis promote neoangiogenesis, that is why respectful caution should be taken in the case of oncologic patients. A longer clinical observation on a higher number of participants should be performed to develop reliable indications and guidelines for transferring ADSCs.

The Emerging Field of Regenerative Aesthetics-Where We Are Now

BACKGROUND

Regenerative aesthetics is an emerging branch of regenerative medicine with therapies aimed at recapturing youthful structure and function using the body's own systems.

OBJECTIVE

To introduce the field of regenerative aesthetics, and to explore themes and evidence surrounding current and emerging therapies in the field.

MATERIALS AND METHODS

A review of the literature was performed for each of the 3 pillars of regeneration; namely, stem cells, biochemical cues, and scaffolds.

RESULTS

Herein, we provide an overview of the field of regenerative aesthetics, a discussion surrounding the 3 pillars of regeneration, and an overview of the evidence supporting current and emerging therapeutic modalities that could play a pivotal role in the future of aesthetic treatments.

CONCLUSION

An enhanced understanding of this field can serve to further enhance our awareness about the regenerative effects of therapies we already offer, in addition to providing inspiration for future innovation.

Total Stromal Fraction (TSF) - Fortified Adipose Tissue-Derived Stem Cells Source: An Emerging Regenerative Realm Against COVID-19 Induced Pulmonary Compromise

:

The inception of the COVID-19 pandemic has jeopardized humanity with markedly dampening of worldwide resources. The viral infection may present with varying signs and symptoms, imitating pneumonia and seasonal flu. With a gradual course, this may progress and result in the deadliest state of acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). Moreover, following recovery from the severe brunt of COVID-19 infection, interstitial portions of alveoli have been found to undergo residual scarring and further to have compromised air exchange. Such alterations in the lung microenvironment and associated systemic manifestations have been recognized to occur due to the extensive release of cytokines. The mortality rate increases with advancing age and in individuals with underlying co-morbidity. Presently, there is no availability of specific antiviral therapy or any other definitive modality to counter this progressive worsening. However, we believe principles and advancing cell-based therapy may prove fruitful in subjugating such reported worsening in these patients. This article reviews eminent knowledge and relevant advancements about the amelioration of lung damage due to COVID-19 infection using adipose tissue- derived - total stromal fraction (TSF).

Effect of Co-transplanting Stromal Vascular Fraction-Gelatin and Platelet-Rich Fibrin on the Long-Term Maintenance of Fat Volume

OBJECTIVE

In the present study, we aimed to investigate the survival of stromal vascular fraction-gelatin (SVF-gel) grafts and determine whether co-transplantation of SVF-gel and platelet-rich fibrin (PRF) improves long-term maintenance of fat volume (Wei et al. in Oncotarget 8:68542-68556, 2017) in a rabbit model.

METHODS

SVF-gel was transplanted into the ears of 12 rabbits with (experimental group) or without PRF (control group). Transplantation retention was evaluated based on weight, histology, and immunohistochemistry.

RESULTS

In the 2nd and 4th weeks, the volume of fat was larger in the experimental group than in the control group. In the 6th week, the absorption of fat was noticeable in both groups, and there was no significant difference in the fat survival rate between the two groups (experimental group: 1.051 ± 0.144 and control group: 0.789 ± 0.232, P > 0.05). HE staining results: At week 2, adipocytes were observed in the experimental group and tended to mature over time. These adipocytes also exhibited an ordered arrangement. Adipocytes with abnormal morphology appeared in the control group in the 4th week. At different weeks, there were more inflammatory cells and fibroblasts in the experimental group than in the control group, and they were arranged in an ordered fashion. Immunohistochemical results: More brown areas were observed in the experimental group than in the control group, and the morphology and distribution of adipocytes in the experimental group were better than those in the control group. The distribution of fibrocytes was also more regular in the experimental group than in the control group.

CONCLUSION

SVF-gel cannot maintain long-term filling in rabbit ears. The addition of PRF has no influence, although PRF can induce SVF-gel to transform into adipocytes, and the anti-inflammatory effect is noticeable in the early period following the procedure. Co-transplantation also helped to ensure orderly arrangement of fibrin. There were no "volume preservation differences in this experimental model" perhaps there are differences if other models/methodology are employed. No Level Assigned 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 Table of Contents or online Instructions to Authors - www.springer.com/00266 .

Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis

Background

In recent years, autologous fat grafting (AFG), also known as fat transfer or lipofilling, has been widely performed for periorbital rejuvenation and defect correction, although the evidence regarding its efficacy and safety is still lacking. Besides, with respect to the periorbital region, it is invariably the earliest appearance area of the facial aging phenomenon. Therefore, a systematic review and meta-analysis is needed to evaluate the efficacy and safety of this technique.

Methods

A literature search was performed in PubMed, Embase, and the Cochrane library databases on November 20, 2020, adhering to the PRISMA guidelines, to identify all relevant articles. Then, a data extraction and standardization process was performed to assess all outcome data. Ultimately, the data were assessed using a random effects regression model with comprehensive meta-analysis software.

Results

Thirty-nine studies consisting of 3 cohorts and 36 case series with a total of 4046 cases were included. Meta-analysis revealed a relatively high satisfaction rate of 90.9% (95% CI, 86.4%–94.0%). Frequent complications in 4046 patients receiving AFG were edema, chemosis, and contour irregularity, with an overall complication rate of 7.9% (95% CI, 4.8%–12.8%).

Conclusion

This systematic review and meta-analysis showed that AFG for rejuvenation of eyelids and periorbital area provided a high satisfaction rate and did not result in severe complications. Therefore, AFG might be performed safely for periorbital rejuvenation and reconstruction.

Stromal vascular fraction and emulsified fat as regenerative tools in rejuvenation of the lower eyelid area

In the lower eyelid area, dermal melanocytosis, fine lines, skin atrophy, dryness, and loss of subcutaneous fat tissue represent the initial signs of aging. Beside the addition of volume, adipose tissue injections can also improve pigmentation and skin texture. Clinical studies of simultaneous stromal vascular fraction (SVF) and emulsified fat transfers have not been reported so far. Our aim was to investigate the clinical results of transferring SVF and emulsified fat into the lower eyelid area. A total of 16 patients underwent tumescent liposuction and injection of SVF and emulsified fat into the lower eyelid area. For preparation of SVF and emulsified fat, ACP double syringes with 2.4, 1.4, and 1.2 mm connectors, and a swing-out rotor centrifuge, were used. At follow-up, improvements on before and after pictures were rated by the treating physician and two independent physicians, using the global aesthetic improvement scale (GAIS). Clinical outcomes were rated as exceptional, very improved, or improved in all patients, with an average GAIS score of 1.6. No serious adverse events occurred. Our initial results suggest that SVF and emulsified fat are safe and effective tools for skin rejuvenation and correction of volume deficiencies in the lower eyelid area. More studies need to be conducted to corroborate these encouraging findings.

Facial Rejuvenation with Concentrated Lipograft-A 12 Month Follow-Up Study

Lipofilling is a popular technique to treat volume loss in aging patients. The isolated adipose tissue is composed of adipocytes and stromal vascular fraction cells, which include adipose-derived stem cells (ASC). We hypothesize that the patient’s wrinkle severity scale (WSS) and patient’s satisfaction on the global aesthetic improvement scale (GAIS) can be improved after using concentrated lipoaspirate. Fourteen patients (54 years ± 11.09 years) with volume loss in the midface area underwent waterjet-assisted liposuction (Human Med AG, Schwerin, Germany). Fat was centrifuged in an ACP Double Syringe (Arthrex GmbH, Munich, Germany) using Rotofix 32A centrifuge (Andreas Hettich, GmbH & Co.KG, Tuttlingen, Germany). Homogenization was performed using the double syringe and a 1.4 mm female–female luerlock connector. After a second centrifugation, patients received periorbital (PO) and nasolabial (NL) lipografting. ASC count was performed after enzymatical digestion. Vitality of cells was assessed using a resazurin assay. During long-term follow up (12 months, n = 10), we found a high patient’s satisfaction (GAIS 1+/−0.52) and a good improvement of the WSS during short- and long-term follow-up. The ASC count of processed lipoaspirate was 2.1-fold higher than of unprocessed lipoaspirate (p < 0.001). The difference of ASC in sedimented and simply centrifuged lipoaspirate was also significant (p < 0.05). Facial rejuvenation with concentrated fat graft offers good results concerning objective aesthetic outcome and patient’s satisfaction.

Quantifiable clinical efficacy of injectable porcine collagen for the treatment of structural dark circles

BACKGROUND

Dark circles are one of the most perplexing cosmetic problems for modern people. Nowadays, a new porcine collagen filler has been popular in China and many countries and has high safety.

AIMS

The purpose of this study is to explore and quantify the efficacy of this collagen filler in treating structured dark circles objectively and systematically.

METHODS

This is a prospective study. Twenty patients were included and took standard facial photographs at preoperative (Tp), immediately postoperative (T0), 1 week (T1), 2 weeks (T2), 4 weeks (T4), 8 weeks (T8), and 12 weeks (T12). The efficacy was quantified by measuring the depression of the tear trough and infraorbital melanin content. Three dermatologists blinded to the treatment were responsible for completing the subjective evaluations.

RESULTS

The depression volume, depression-affected area, and depression maximum depth of the tear trough decreased significantly immediately postoperation, and then all values increased slowly with time (P <.05). After 3-month observation, we found that the residual effect of the treatment is 45.08% ± 15.53% (T8) and 17.37% ± 16.79% (T12). The melanin contents at the medial point (A), the middle point (B), and the lateral point (C) all decreased instantly after injection (A: 8.23% ± 5.07%, B: 6.29% ± 5.05%, C: 5.11% ± 5.44% ), which suggested that collagen filler had an instant covering effect for structural dark circles. Patients showed only slight redness and swelling after the treatment.

CONCLUSION

Collagen filler is a very effective treatment method for structural dark circles. Besides, it may also have a certain therapeutic effect on the other three dark circles types.

Correction of the Tear Trough Deformity and Concomitant Infraorbital Hollows With Extracellular Matrix/Stromal Vascular Fraction Gel

BACKGROUND

The tear trough deformity is a sign of eye aging. Filling is an ideal choice for the tear trough accompanied by infraorbital hollows.

OBJECTIVE

To evaluate the efficacy and safety of stromal vascular fraction gel (SVF-gel) as a filler for the tear trough deformity which is combined with infraorbital hollows.

MATERIALS AND METHODS

From July 2017 to June 2018, 33 patients underwent autologous fat aspiration and were followed up successfully. Stromal vascular fraction gel was used to correct patients with bilateral Barton I/II; tear trough deformity and infraorbital hollows. Improvement was evaluated by measuring skin-periosteal depth, 3D volume, global aesthetic improvement scale (GAIS), and patient self-assessment.

RESULTS

Skin-periosteal depth improved significantly (p < .001). The volumetric increment of the tear trough and infraorbital regions increased 2.132 ± 0.671 mL, and the retention rate was excellent (72.87 ± 10.23%). The GAIS showed a high score (2.5 ± 0.5 points), with patient self-assessment showing satisfactory results for all 7 questions on the questionnaire.

CONCLUSION

The high retention rate of SVF-gel suggests that it can provide an effective solution to tear trough deformity accompanied by infraorbital hollows.

New Mechanical Fat Separation Technique: Adjustable Regenerative Adipose-tissue Transfer (ARAT) and Mechanical Stromal Cell Transfer (MEST)

Background

Adipose tissue is not only a very important source of filler but also the body's greatest source of regenerative cells.

Objectives

In this study, adipose tissue was cut to the desired dimensions using ultra-sharp blade systems to avoid excessive blunt pressure and applied to various anatomical areas-a procedure known as adjustable regenerative adipose-tissue transfer (ARAT). Mechanical stromal cell transfer (MEST) of regenerative cells from fat tissue was also examined.

Methods

ARAT, MEST, or a combination of these was applied in the facial area of a total of 24 patients who were followed for at least 24 months. The integrity of the fat tissue cut with different diameter blades is shown histopathologically. The number and viability of the stromal cells obtained were evaluated and secretome analyses were performed. Patient and surgeon satisfaction were assessed with a visual analog scale.

Results

With the ARAT technique, the desired size fat grafts were obtained between 4000- and 200-micron diameters and applied at varying depths to different aesthetic units of the face, and a guide was developed. In MEST, stromal cells were obtained from 100 mL of condensed fat using different indication-based protocols with 93% mean viability and cell counts of 28.66 to 88.88 × 10⁶.

Conclusions

There are 2 main complications in fat grafting: visibility in thin skin and a low retention rate. The ARAT technique can be used to prevent these 2 complications. MEST, on the other hand, obtains a high rate of fat and viable stromal cells without applying excessive blunt pressure.

Level of Evidence 4