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Yenny SW, Julia DS, Lestari AF, Al Hazmi A, Ilmiawati C. A clinical and novel dermoscopic investigation of combined peels as a hand aging treatment. J Cosmet Dermatol 2024. [PMID: 38979887 DOI: 10.1111/jocd.16456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/16/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The hands are one of the areas where skin aging is most noticeable, alongside the face, but limited studies used dermoscopic evaluation on hand aging. The Dermoscopy Photoaging Scale (DPAS) is frequently used to assess face aging but is never used for hand aging. Treating skin aging using chemical peeling is a commonly used method to rejuvenate the skin on the hands, as it is relatively affordable. Using multiple chemical peels may yield more significant results. AIMS To determine the effectiveness of a chemical peeling combination in retarding hand aging and to assess the utility of DPAS in this process. METHODS This study involved 69 Fitzpatrick skin types III-IV volunteers aged 20-69. One hand of each participant was treated with 20% glycolic acid (GA), while the other received a combination of peels consisting of 20% GA and 15% trichloroacetic acid (TCA). The hands were clinically examined before and after the treatments, and dermoscopic examinations were performed using a modified DPAS. RESULTS Four treatments improved clinical and dermoscopic characteristics in both hands. The combined peeling considerably improved pigmentation intensity on the dorsal hand compared to the GA peel (p < 0.001). Post-chemical peeling patient satisfaction increased significantly. CONCLUSIONS The modified DPAS is a valuable instrument to assess the signs of hand aging. The combination of GA and TCA effectively improves skin aging of the hands and offers an accessible and economical option for addressing skin aging.
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Affiliation(s)
- Satya Wydya Yenny
- Department of Dermatology and Venereology, dr. M. Djamil Hospital, Padang, West Sumatera, Indonesia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
- Klinik Utama Griya Satya Estetik, Padang, West Sumatera, Indonesia
| | | | - Andriani Fuji Lestari
- Department of Dermatology and Venereology, dr. M. Djamil Hospital, Padang, West Sumatera, Indonesia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
| | - Auliya Al Hazmi
- Department of Dermatology and Venereology, dr. M. Djamil Hospital, Padang, West Sumatera, Indonesia
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
| | - Cimi Ilmiawati
- Department of Pharmacology and Therapeutic, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
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Guyuron B, Wells MW, Chang IA, Deleonibus A. The Versatile Role of Fat Injection During Various Genioplasties. Aesthetic Plast Surg 2023; 47:2401-2406. [PMID: 37452130 DOI: 10.1007/s00266-023-03469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Fat injection has become increasingly popular in aesthetic surgery, but there is a sparsity of literature regarding its role during genioplasty. In this study, we present the largest series of patients receiving fat injections to the chin for various indications. METHODS Data were collected from January 2016 to December 2021 for patients who underwent chin fat injection for a variety of chin refinements. Patients with chin fat injection were divided into isolated genioplasty with fat injection (CF), combined facial and chin fat injection (CFC) and combined chin fat injection and osseous genioplasty (CFG). Complication rates and reoperations were compared using Fischer's exact test between each cohort. RESULTS 181 patients were included in final analysis, with 14 patients in CF cohort, 130 patients in CFC cohort, 24 patients in CFG cohort, and 13 patients who underwent genioplasty alone. Repeat fat injections were required in 17 (9.4%) patients overall, which included 14 patients (10.8%) of CFC subcohort and three patients (12.5%) of CFG subcohort (p > 0.05). No patients who underwent genioplasty alone or CF required reoperation. There were no significant differences in complications between genioplasty alone group (0%) in comparison to CF (7.1%; p = 1.00), CFC (6.2%; p = .53), or CFG cohorts (7.7%; p = 1.00). CONCLUSION Fat injection can safely correct minor chin deficiency or asymmetry, as either an isolated procedure or in combination with osteotomies. Additionally, fat injection enables advancement of the caudal segment to achieve superior outcomes by preventing unaesthetic deepening of labiomental groove which will not be advanced during sliding osteotomy. 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 .
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Affiliation(s)
- Bahman Guyuron
- Department of Plastic Surgery, Case Western Reserve University School of Medicine, 29017 Cedar Road, Lyndhurst, Cleveland, OH, 44124, USA.
| | - Michael W Wells
- Department of Plastic Surgery, Case Western Reserve University School of Medicine, 29017 Cedar Road, Lyndhurst, Cleveland, OH, 44124, USA
| | - Irene A Chang
- Department of Plastic Surgery, Case Western Reserve University School of Medicine, 29017 Cedar Road, Lyndhurst, Cleveland, OH, 44124, USA
| | - Anthony Deleonibus
- Division of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Khouri AN, Adidharma W, MacEachern M, Haase SC, Waljee JF, Cederna PS, Strong AL. The Current State of Fat Grafting in the Hand: A Systematic Review for Hand Diseases. Hand (N Y) 2023; 18:543-552. [PMID: 35130761 PMCID: PMC10233632 DOI: 10.1177/15589447211066347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat diseases of the hand. Autologous fat grafting is ideal for use in the hand because it is minimally invasive, can restore volume, and has regenerative capabilities. This review summarizes the emerging evidence regarding the safety and efficacy of AFG to the hand in several conditions, including systemic sclerosis, Dupuytren disease, osteoarthritis, burns, and traumatic fingertip injuries. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search on the use of AFG in hand pathologies was performed on October 8, 2020, in Ovid MEDLINE, Elsevier Embase, Clarivate Web of Science, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by 2 independent reviewers and a third reviewer adjudicated when required. Reviewers identified 919 unique hits. Screening of the abstracts identified 22 manuscripts which described the use of AFG to treat an identified hand condition. Studies suggest AFG in the hands is a safe, noninvasive option for the management of systemic sclerosis, Dupuytren contracture, osteoarthritis, burns, and traumatic fingertip injuries. While AFG is a promising therapeutic option for autoimmune, inflammatory, and fibrotic disease manifestations in the hand, further studies are warranted to understand its efficacy and to establish more robust clinical guidelines. Studies to date show the regenerative, immunomodulatory, and volume-filling properties of AFG that facilitate wound healing and restoration of hand function with limited complications.
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Har-Shai L, Ofek SE, Lagziel T, Pikkel YY, Duek OS, Ad-El DD, Shay T. Revitalizing Hands: A Comprehensive Review of Anatomy and Treatment Options for Hand Rejuvenation. Cureus 2023; 15:e35573. [PMID: 37007409 PMCID: PMC10063163 DOI: 10.7759/cureus.35573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
Dorsal hand rejuvenation is gaining popularity as a solitary procedure and adjunct to face and neck rejuvenation treatments. As the hands age, the skin loses elasticity and becomes more translucent, the veins, joints, and tendons appear more prominent, and the bones become more noticeable. These changes are due to intrinsic and extrinsic factors. Current treatment methods include the injection of dermal fillers and autologous fat grafting. Anatomic studies to ensure the successful implementation of rejuvenation procedures identified three separate fascial layers in the dorsum, from superficial to deep. More recent re-evaluations revealed a less distinct, inseparable, sponge-like fascial layer. All authors agree that the superficial dermal layer is probably the optimal location for the injection of volumizing materials because it is free of anatomical structures. Many methods for harvesting, preparing, and injecting fat grafts to the dorsum of the hand have been described in the past three decades. Both filler and fat-graft procedures are performed on an ambulatory basis under local anesthesia. Good results with low postoperative and long-term complication rates and high patient satisfaction have been reported.
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Chandan N, Puyana C, Haber R. Combination Approaches to Hand Rejuvenation: A Review of the Literature and Discussion. Dermatol Surg 2023; 49:164-170. [PMID: 36728067 DOI: 10.1097/dss.0000000000003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Various noninvasive/minimally invasive modalities for hand rejuvenation exist, and the efficacy and safety of these procedures as both monotherapy and same-day procedures is increasingly being studied. OBJECTIVE To review data on the efficacy and safety of hand rejuvenation modalities and suggest a practical combination approach for these procedures. METHODS The PubMed database was queried for peer-reviewed articles regarding hand rejuvenation techniques, including chemical peels, laser and light sources, sclerotherapy, autologous fat transfer, and injectable volumetric fillers. RESULTS Chemical peels have been studied the least, with most studies evaluating the use of fillers and laser/light-based devices. Most studies reported overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with other modalities. Transient erythema, edema, or pain after procedures was common; most studies did not report serious postprocedure complications. Importantly, there was no significant increase in adverse effects after same-day procedures. CONCLUSION Using same-day procedures allows practitioners to address hand rejuvenation from different aspects, seems to improve outcomes, and reduces time spent in the office for patients. The authors suggest a practical framework for combining cosmetic approaches to achieve the most optimal outcome for hand rejuvenation.
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Affiliation(s)
- Neha Chandan
- All authors are affiliated with the Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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Autologous Fat Grafting in the Upper Extremity: Defining New Indications. Plast Reconstr Surg Glob Open 2022; 10:e4469. [PMID: 35999879 PMCID: PMC9390829 DOI: 10.1097/gox.0000000000004469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery. Methods We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded. Results Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42-71). Average volume of fat injected was 15.2 ml (range, 1-37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%). Conclusions Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.
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Vermeersch N, De Fré M, Verhoeven V, Hunter JE, Tondu T, Thiessen FE. Autologous fat transfer for hand rejuvenation: systematic review on technique and outcome. JPRAS Open 2022; 32:182-194. [PMID: 35449731 PMCID: PMC9018121 DOI: 10.1016/j.jpra.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Age-related changes to the dorsum of the hand present as dyschromia, soft-tissue atrophy, and volume loss, resulting in wrinkles and prominent deep structures. Volume augmentation by means of autologous fat transfer (AFT) is one of the options to rejuvenate the hand; theoretically, autologous fat is the ideal filler because of durability and biocompatibility. Objective This systematic review aims to summarize and describe the current evidence on the technique, effectiveness, and safety of AFT in hand rejuvenation. Methods Three major databases, PubMed, Embase, and Web of Science, were systematically searched up to November 2020 for studies reporting on AFT and hand rejuvenation. Results A total of 10 articles were included, reporting on a total of 320 patients treated by AFT to improve the aesthetic appearance of the dorsum of the hand. Some degree of postoperative oedema was present in nearly all patients. Other complications were infection (0.67%), cysts/irregularities (1.3%), temporary dysesthesia (5.3%), and ecchymosis (7%). There were no major complications. Of all patients, 97.6% self-reported to be satisfied with the result. Conclusions Overall, by combining the current evidence, AFT is considered a promising and safe technique to rejuvenate the aging hand with very high patient satisfaction. Future research, using validated patient questionnaires, objective volumetric measurements, and longer follow-up, is needed to confirm these results. Level of Evidence 3
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Affiliation(s)
- Nicolas Vermeersch
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, B-2650 Antwerp, Belgium
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, B-2020, Antwerp, Belgium
- Corresponding author: Dr. Nicolas Vermeersch.
| | - Maxime De Fré
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, B-2650 Antwerp, Belgium
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, B-2020, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Judith E. Hunter
- Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Thierry Tondu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, B-2650 Antwerp, Belgium
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, B-2020, Antwerp, Belgium
| | - Filip E.F. Thiessen
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, B-2650 Antwerp, Belgium
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, B-2020, Antwerp, Belgium
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Hung YT, Cheng CY, Chen CB, Huang YL. Ultrasound Analyses of the Dorsal Hands for Volumetric Rejuvenation. Aesthet Surg J 2022; 42:1119-1126. [PMID: 35170732 DOI: 10.1093/asj/sjac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Volumetric hand rejuvenation of the dorsal hands is increasingly applied for aged, skeletonized dorsal hand skin, with prominent veins, tendons, and joints due to volumetric loss of subcutaneous fat. However, the aging process of the fatty laminae remains unexplored. OBJECTIVES We aim to investigate the impact of aging and potential determinants on the fatty laminae to improve the therapeutic effect of volumetric injection. METHODS This cross-sectional study enrolled 105 Taiwanese participants aged ≥20 years, divided into five age groups per decade. Thicknesses of the dorsal superficial lamina (DSL), dorsal intermediate lamina (DIL), and dorsal deep lamina (DDL) were measured via ultrasonography by a single-blinded practitioner. The potential determining factors of the laminae thickness (age, sex, body mass index, and hand dominance) were analyzed. RESULTS The thicknesses of the three laminae decreased with aging, with the mean decrease in thickness from the 20s to >60 years in DSL, DIL, and DDL being 0.21 mm (30.0%), 1.38 mm (63.89%), and 0.31 mm (20.95%), respectively. DIL thickness decrease was the greatest and most significant since the 30s. Multiple linear regression analysis showed age as the only determinant for thicknesses of the 3 laminae (all P<0.001), whereas DIL was significantly thicker in men (P<0.001). CONCLUSIONS Volumetric fat loss was noted in the three fatty laminae of dorsal hands during aging; DIL has the greatest progressive fat loss since the 30s. Volumetric rejuvenation of the 3 laminae may result in the most esthetic appearance, especially in women.
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Affiliation(s)
- Yi-Teng Hung
- Department of Dermatology and Department of Aesthetic Medicine, Chang Gung Memorial Hospital, Linkou, Taipei, Taoyuan, Taiwan
| | - Chun-Yu Cheng
- Department of Dermatology and Department of Aesthetic Medicine, Chang Gung Memorial Hospital, Linkou, Taipei, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology and Department of Aesthetic Medicine, Chang Gung Memorial Hospital, Linkou, Taipei, Taoyuan, Taiwan
| | - Yau-Li Huang
- Department of Dermatology and Department of Aesthetic Medicine, Chang Gung Memorial Hospital, Linkou, Taipei, Taoyuan, Taiwan
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McGuire C, Boudreau C, Tang D. Hand Rejuvenation: A Systematic Review of Techniques, Outcomes, and Complications. Aesthetic Plast Surg 2022; 46:437-449. [PMID: 34382097 DOI: 10.1007/s00266-021-02519-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hand rejuvenation is an increasingly popular cosmetic procedure for hand atrophy and aging. The objective of this study is to systematically evaluate the techniques, outcomes, and complications of surgical hand rejuvenation. METHODS A systematic review was undertaken using a computerized search. Publication descriptors, methodological details, techniques, outcomes, and complications were extracted. Articles were assessed using the MINORS and Cochrane instruments. RESULTS Thirty-one studies were included. Most studies were published in the last five years (51.6 percent) and were prospective case series (35.5 percent). The mean age of patients was 56 (range 21-82), while the mean sample size was 47 (range 10-220). The most commonly examined interventions were Radiesse (32.2 percent) and fat grafting (32.2 percent). Major complications were not observed in any study, while minor complications such as edema and pain were temporary. Injection techniques varied, however, the proximal to distal fanning technique and using a cannula was associated with a lower risk of complications. Both Radiesse and fat grafting had robust long-term esthetic outcomes. CONCLUSIONS Hand rejuvenation is a safe and efficacious surgical intervention to reduce dorsal hand atrophy. Further studies are needed to compare the long-term outcomes of common interventions. 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 .
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Homer NA, Patel AS, Epstein A, Durairaj VD, Nakra T. Autologous Fat Transfer Harvest-site Complications: Incidence, Risk Factors, and Management. Ophthalmic Plast Reconstr Surg 2022; 38:65-67. [PMID: 33927171 DOI: 10.1097/iop.0000000000001989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Autologous fat transfer is an effective tool for volume restoration to the aging face. Although numerous reports exist regarding injection site complications, there is limited data on donor-site morbidity in the cosmetic surgery literature. METHODS This study is a large-scale retrospective review to determine incidence of fat harvest-site complications, identify risk factors, and describe management strategies. Records of all patients who underwent autologous fat harvesting and facial grafting at a single oculofacial plastic surgery practice from 2010 to 2019 were reviewed. Patient demographics and clinical data were collected and assessed. A statistical analysis was performed using a two-tailed T-test with p values of <0.05 considered significant. RESULTS Four-hundred sixteen patients were followed for an average of 6.2 months postoperatively. There was an overall 5.5% harvest-site complication rate. There was no correlation of harvest-site complications with gender (p = 0.249) or age (p = 0.881). Harvest location did not significantly correlate with complication rate. The most common complications were contour irregularities, prolonged induration, and prolonged erythema. Low body mass index was associated with higher complication rate (p = 0.003), even when excluding those patients with contour irregularities (p = 0.001). Various treatment modalities were used to manage donor-site morbidity with consistent improvement. CONCLUSIONS Autologous fat transfer used for facial volume augmentation has low donor-site morbidity. Minor harvest-site complications occur more commonly in patients with low body mass index, irrespective of age, gender, or fat source.
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Affiliation(s)
- Natalie A Homer
- Division of Ophthalmic Plastic and Orbital Surgery, University of California Davis Eye Center, Sacramento, California
| | - Anika S Patel
- University of California Los Angeles, Los Angeles, California
| | | | - Vikram D Durairaj
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas, U.S.A
| | - Tanuj Nakra
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, Texas, U.S.A
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Jeyaraman M, Muthu S, Sharma S, Ganta C, Ranjan R, Jha SK. Nanofat: A therapeutic paradigm in regenerative medicine. World J Stem Cells 2021; 13:1733-1746. [PMID: 34909120 PMCID: PMC8641019 DOI: 10.4252/wjsc.v13.i11.1733] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/15/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Adipose tissue is a compact and well-organized tissue containing a heterogeneous cellular population of progenitor cells, including mesenchymal stromal cells. Due to its availability and accessibility, adipose tissue is considered a “stem cell depot.” Adipose tissue products possess anti-inflammatory, anti-fibrotic, anti-apoptotic, and immunomodulatory effects. Nanofat, being a compact bundle of stem cells with regenerative and tissue remodeling potential, has potential in translational and regenerative medicine. Considering the wide range of applicability of its reconstructive and regenerative potential, the applications of nanofat can be used in various disciplines. Nanofat behaves on the line of adipose tissue-derived mesenchymal stromal cells. At the site of injury, these stromal cells initiate a site-specific reparative response comprised of remodeling of the extracellular matrix, enhanced and sustained angiogenesis, and immune system modulation. These properties of stromal cells provide a platform for the usage of regenerative medicine principles in curbing various diseases. Details about nanofat, including various preparation methods, characterization, delivery methods, evidence on practical applications, and ethical concerns are included in this review. However, appropriate guidelines and preparation protocols for its optimal use in a wide range of clinical applications have yet to be standardized.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
| | - Shilpa Sharma
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, New Delhi, India
| | - Charan Ganta
- Indian Stem Cell Study Group, Lucknow 226010, Uttar Pradesh, India
- Department of Stem Cells and Regenerative Medicine, Kansas State University, Manhattan, United States 10002, United States
| | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201306, Uttar Pradesh, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University , Greater Noida 201306, Uttar Pradesh, India
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Park JA, Lee SH, Hwang SJ, Koh KS, Song WC. Anatomic, histologic, and ultrasound analyses of the dorsum of the hand for volumetric rejuvenation. J Plast Reconstr Aesthet Surg 2021; 74:1615-1620. [DOI: 10.1016/j.bjps.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 02/01/2023]
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Irmak F, Sizmaz M, Sirvan SS, Karsidag S, Ozagari A. The Effects of Vasonatrin Peptide on Fat Graft Viability: An Experimental Study. Facial Plast Surg 2021; 38:81-87. [PMID: 34100270 DOI: 10.1055/s-0041-1730387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Vasonatrin peptide (VNP) is a synthetic peptide that possesses vasodilatory, natriuretic, and anti-inflammatory properties. The authors aimed to analyze the effects of VNP on fat graft survival. Twenty Sprague-Dawley rats are randomly divided into two groups of 10. Fat grafts are harvested from the right inguinal region. After preparation, fat grafts are placed to the interscapular region. The first group of rats were administered VNP after their fat injection, while the second group received tail-vein injections of an equal volume of sterile saline following their fat injection. Experiment and control groups are evaluated according to their level of degeneration of adipocytes, fat necrosis, vacuolization, cyst formation in adipocytes, fibrosis of the fat tissue, capillary density, and CD31 immunohistochemical staining. Degeneration, vacuolization, and cyst formation in adipocytes were lower in the experiment group. Increased capillary density in the experiment group was demonstrated by CD31 antibody staining and by counting capillary density under a microscope. The average percentage of change in weight of the fat grafts in the experiment group was lower than that in the control group. The results indicate that VNP has some beneficial effects on fat graft survival by multiple independent mechanisms that influence both local and systemic homeostasis.
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Affiliation(s)
| | - Mert Sizmaz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selami Serhat Sirvan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Semra Karsidag
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Aysim Ozagari
- Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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A Review of Hand Feminization and Masculinization Techniques in Gender Affirming Therapy. Aesthetic Plast Surg 2021; 45:589-601. [PMID: 32997239 DOI: 10.1007/s00266-020-01963-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Anatomical characteristics that are incongruent with an individual's gender identity can cause significant gender dysphoria. Hands exhibit prominent dimorphic sexual features, but despite their visibility, there are limited studies examining gender affirming procedures for the hands. This review is intended to cover the anatomical features that define masculine and feminine hands, the surgical and non-surgical approaches for feminization and masculinization of the hand, and to adapt established aesthetic hand techniques for gender affirming care. METHODS The authors performed a comprehensive database search of PubMed, Embase OVID and SCOPUS to identify articles on the characterization of masculine or feminine hands, hand treatments related to gender affirmation, and articles related to techniques for hand masculinization and feminization in the non-transgender population. RESULTS From 656 possibly relevant articles, 42 met the inclusion criteria for the current literature search. There is currently no medical literature specifically exploring the surgical or non-surgical options for hand gender affirmation. The available techniques for gender affirming procedures discussed in this paper are appropriated from those more commonly used for hand rejuvenation. CONCLUSION There is a dearth of literature addressing the options for transgender individuals seeking gender affirming procedures of the hand. Though established procedures used for hand rejuvenation may be utilized in gender affirming care, further study is required to determine relative salience of various hand features to gender dysphoria in transgender patients of various identities, as well as development of novel techniques to meet these needs. 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. .
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Betz VM, Ren B, Betz OB, Jansson V, Müller PE. Osteoinduction within adipose tissue fragments by heterodimeric bone morphogenetic Proteins-2/6 and -2/7 versus homodimeric bone morphogenetic protein-2: Therapeutic implications for bone regeneration. J Gene Med 2021; 23:e3311. [PMID: 33527563 DOI: 10.1002/jgm.3311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Fragments of subcutaneous adipose tissue that have been genetically modified to express bone morphogenetic protein-2 (BMP-2) regenerate large segmental osseous lesions in rodents. Gene-activated adipose tissue can be implanted into osseous defects without prior cell extraction and cell culture. The present study aimed to explore whether the heterodimers BMP-2/6 or BMP-2/7 exceed the osteoinductive effect of BMP-2 on adipose tissue. METHODS In an in vitro tissue culture system, freshly harvested rat subcutaneous adipose tissue was cultivated in the presence of either BMP-2 or BMP-2/6 or BMP-2/7 at a high (200 ng/ml) and low (50 ng/ml) concentration. Gene expression analysis as well as histological and immunohistochemical methods were applied to test for osteoinduction. RESULTS A concentration of 200 ng/ml of homodimeric BMP-2 induced osteogenic differentiation most potently, showing more calcification and a higher expression level of bone markers than both concentrations of BMP-2/6 or -2/7. A concentration of 50 ng/ml of BMP-2 was a significantly stronger osteogenic inducer than both concentrations of BMP-2/6 and the low concentration of BMP-2/7. The most potent heterodimeric driver of osteoinduction was BMP-2/7 at a high concentration, demonstrating effects similar to those of BMP-2 at a low concentration. CONCLUSIONS Homodimeric BMP-2 evoked osteoinduction within adipose tissue more potently and at a lower concentration than heterodimeric BMP-2/6 or BMP-2/7. This result agrees well with the fact that it might be easier to translate adipose grafts activated by homodimeric BMP-2 clinically. Preclinical in vivo gene transfer studies are necessary to confirm the results of the present study.
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Affiliation(s)
- Volker M Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Bin Ren
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Oliver B Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, LMU, Munich, Bavaria, Germany
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Bayat M, Bahrami N, Mesgari H. Rhinoplasty with Fillers and Fat Grafting. Oral Maxillofac Surg Clin North Am 2020; 33:83-110. [PMID: 33246548 DOI: 10.1016/j.coms.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonsurgical rhinoplasty is one choice for cases in which open surgery may be harmful, the deformity is not indicated to correct with open surgery, or in patients who have phobia of general anesthesia or any type of surgery. Autologous fat injection or fillers are most common materials currently available in the market. In this article, we explain the indications, contraindications, methods, and complications of this treatment.
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Affiliation(s)
- Mohammad Bayat
- Department of Oral & Maxillofacial Surgery, Shariati Hospital, Tehran University of Medical Sciences, north kargar ave, Tehran Iran.
| | - Naghmeh Bahrami
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, north kargar ave, Tehran Iran; Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Mesgari
- Facial Esthetic Surgery, Tehran University of Medical Sciences, north kargar ave, Tehran Iran
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Abu-Ghname A, Perdanasari AT, Reece EM. Principles and Applications of Fat Grafting in Plastic Surgery. Semin Plast Surg 2019; 33:147-154. [PMID: 31384229 DOI: 10.1055/s-0039-1693438] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Autologous fat transplantation has become increasingly popular in recent years. Its biocompatable properties and availability made it a widely used treatment modality for soft tissue augmentation and volume replacement in both reconstructive and aesthetic plastic surgery. Multiple protocols and clinical applications have been described in the literature, with wide variations in the harvesting, processing, and injection techniques. In this review, the authors will discuss the basic principles and clinical applications of fat grafting in plastic and reconstructive surgery. The article will then conclude with a discussion of fat grafting limitations as well as potential future applications, giving the reader a well-rounded understanding of autologous fat transfer.
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Affiliation(s)
- Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Role of Ancillary Procedures in Facial Rejuvenation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2075. [PMID: 31624657 PMCID: PMC6635208 DOI: 10.1097/gox.0000000000002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Abstract
Face-lift techniques have evolved beyond the concept of lifting and now include incorporating superficial and deep filling of facial fat compartments to address volume deflation and aging. In addition to traditional face-lift methods involving the excision and tightening of skin and the underlying soft tissues, the following ancillary procedures have become paramount in achieving an optimal result: blending the lid-cheek junction; chin augmentation; lobule augmentation; hand rejuvenation; perioral rejuvenation; chemical peels; and laser resurfacing. We presented a summary of these integral techniques.
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Ren B, Betz VM, Thirion C, Salomon M, Klar RM, Jansson V, Müller PE, Betz OB. Gene activated adipose tissue fragments as advanced autologous biomaterials for bone regeneration: osteogenic differentiation within the tissue and implications for clinical translation. Sci Rep 2019; 9:224. [PMID: 30659209 PMCID: PMC6338750 DOI: 10.1038/s41598-018-36283-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023] Open
Abstract
Cost-effective, expedited approaches for bone regeneration are urgently needed in an ageing population. Bone Morphogenetic Proteins (BMPs) stimulate osteogenesis but their efficacy is impeded by their short half-life. Delivery by genetically modified cells can overcome this problem. However, cell isolation and propagation represent significant obstacles for the translation into the clinic. Instead, complete gene activated fragments of adipose tissue hold great potential for bone repair. Here, using an in-vitro culture system, we investigated whether adenoviral transduction with human BMP-2 can promote osteogenic differentiation within adipose tissue fragments. Osteoinduction in adipose tissue fragments was evaluated by quantitative reverse transcriptase polymerase chain reaction, immunohistology and histomorphometry. BMP-2 transduced adipose tissue synthesized BMP-2 protein over 30 days peaking by day six, which significantly promoted osteogenic differentiation as indicated by increased calcium depositions, up-regulation of bone marker genes, and bone-related protein expression. Our results demonstrate that cells within adipose tissue fragments can differentiate osteogenically after BMP-2 transduction of cells on the surface of the adipose tissue. BMP-2 gene activated adipose tissue represents an advanced osteo-regenerative biomaterial that can actively contribute to osteogenesis and potentially enable the development of a novel, cost-effective, one-step surgical approach to bone repair without the need for cell isolation.
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Affiliation(s)
- Bin Ren
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - Volker M Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Christian Thirion
- Sirion Biotech GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Michael Salomon
- Sirion Biotech GmbH, Am Klopferspitz 19, 82152, Martinsried, Germany
| | - Roland M Klar
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Oliver B Betz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
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Adipose Stromal Vascular Fraction Gel Grafting: A New Method for Tissue Volumization and Rejuvenation. Dermatol Surg 2018; 44:1278-1286. [PMID: 29781904 DOI: 10.1097/dss.0000000000001556] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The clinical outcomes of fat grafting vary and are technique-dependent. Stromal vascular fraction (SVF) gel is a novel, mechanically processed fat product with high concentrations of adipose tissue-derived stem cells and other SVF cells. This study evaluated the volumization and rejuvenation effects of SVF-gel. OBJECTIVE This study evaluated the volumization and rejuvenation effects of SVF-gel. METHODS This retrospective, single-center study included 126 patients who underwent SVF-gel grafting and 78 who underwent conventional lipoinjection for various indications from March 2015 to February 2017. Patient satisfaction and secondary surgery rates were evaluated. Samples of transferred SVF-gel were harvested and examined histologically. RESULTS All patients showed improvements in facial augmentation and contour. Patients in the SVF-gel group experienced mild postoperative swelling and a low secondary surgery rate (10.9%). Assessment of patient-rated satisfaction on a 5-point Likert scale found that 77.3% of patients in the SVF-gel group were satisfied (54.5%) or very satisfied (22.8%) with their outcomes. By comparison, 53.8% of patients who underwent conventional lipoinjection were satisfied (48.7%) or very satisfied (5.1%). Moreover, SVF-gel showed effective antiwrinkle and skin rejuvenation effects. Hematoxylin-eosin staining showed a normal adipose tissue structure in transferred SVF-gel. CONCLUSION Stromal vascular fraction gel is effective for both volumization and rejuvenation, and may be superior to conventional lipoinjection for facial recontouring.
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Cho KH, Uthaman S, Park IK, Cho CS. Injectable Biomaterials in Plastic and Reconstructive Surgery: A Review of the Current Status. Tissue Eng Regen Med 2018; 15:559-574. [PMID: 30603579 PMCID: PMC6171701 DOI: 10.1007/s13770-018-0158-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/03/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Injectable biomaterials have attracted increasing attention for volume restoration and tissue regeneration. The main aim of this review is to discuss the current status of the injectable biomaterials for correction of tissue defects in plastic and reconstructive surgery. METHODS Requirements of injectable biomaterials, mechanism of in situ gelation, characteristics, and the combinational usage of adipose-derived stem cells (ADSCs) and growth factors were reviewed. RESULTS The ideal injectable biomaterials should be biocompatible, non-toxic, easy to use, and cost-effective. Additionally, it should possess adequate mechanical properties and stability. In situ gelation method includes physical, chemical, enzymatic and photo-initiated methods. Natural and synthetic biomaterials carry their pros and cons due to their inherent properties. The combined use of ADSCs and growth factors provides enhanced potential for adipose tissue regeneration. CONCLUSIONS The usage of injectable biomaterials has been increasing for the tissue restoration and regeneration. The future of incorporating ADSCs and growth factors into the injectable biomaterials is promising.
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Affiliation(s)
- Ki-Hyun Cho
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195 USA
| | - Saji Uthaman
- Department of Polymer Science and Engineering, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon, 34134 Republic of Korea
| | - In-Kyu Park
- Department of Biomedical Sciences, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju, 61469 Republic of Korea
| | - Chong-Su Cho
- Research Institute for Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Republic of Korea
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Sterodimas A, Boriani F, Nicaretta B, Pereira LH. Hand rejuvenation by stromal enriched lipograft. J Plast Reconstr Aesthet Surg 2018; 71:1507-1517. [PMID: 30139666 DOI: 10.1016/j.bjps.2018.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/24/2018] [Accepted: 07/28/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Aris Sterodimas
- Department of Plastic Surgery IASO General Hospital, Athens, Greece
| | - Filippo Boriani
- Department of Plastic Surgery, Gruppioni Hospital, Bologna, Italy.
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Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1870. [PMID: 30324057 PMCID: PMC6181489 DOI: 10.1097/gox.0000000000001870] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/01/2018] [Indexed: 01/13/2023]
Abstract
In 2009, the American Society of Plastic Surgeons Task Force on Autologous Fat Grafting (AFG) determined that autologous fat grafting was a safe procedure with a relatively low rate of complications. This consensus opinion unleashed a wave of popularity as plastic surgeons discovered the procedures' efficacy in a wide variety of cosmetic and reconstructive indications. Frequently reported cosmetic applications include soft-tissue augmentation of breast, buttocks, hips, face, and hands, whereas reconstructive applications include adjunct for breast reconstruction contour problems, plantar fat pad improvement, and correction of various posttraumatic and surgical contour deformities. Recognition of other regenerative effects of fat grafting expanded the use AFG for improvement of hypertrophic scar tissue, postradiation sequelae, lipodystrophy, hyperpigmentation, senile skin changes, and actinic damage. The popularity of AFG is supported by a remarkably low risk of complications, minimal scars, and readily available donor sites. Despite recognition of the advantages of AFG, there still is no consensus regarding optimal techniques of harvest, graft preparation, and injection. Further, the yield of permanent volume falls within a very wide range. In this article, we review the basic science of fat grafting, proposed methods offered to improve engraftment, and reported outcomes of AFG procedures.
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Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons. J Hand Surg Am 2018; 43:558-563. [PMID: 29622410 DOI: 10.1016/j.jhsa.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 04/14/2017] [Accepted: 03/04/2018] [Indexed: 02/02/2023]
Abstract
Corticosteroid injections (CIs) are frequently used by hand surgeons to treat a wide range of pathology including de Quervain tenosynovitis and lateral epicondylitis. Although generally viewed as a benign modality, and a way to potentially avoid or postpone surgical intervention, common complications from CI should be considered and discussed with patients before the procedure. One such complication is local soft tissue atrophy and hypopigmentation after injection. We discuss the incidence of soft tissue-related adverse effects from CI, the pathophysiology and influence of different steroid preparations on soft tissues, and potential treatment options once atrophy has occurred.
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Yun-Nan L, Shu-Hung H, Tsung-Ying L, Chih-Kang C, Yu-Hao H, Hidenobu T, Chung-Sheng L, Sin-Daw L, Tsai-Ming L. Micro-autologous fat transplantation for rejuvenation of the dorsal surface of the aging hand. J Plast Reconstr Aesthet Surg 2018; 71:573-584. [DOI: 10.1016/j.bjps.2017.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022]
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Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond) 2017; 24:65-73. [PMID: 29188051 PMCID: PMC5694962 DOI: 10.1016/j.amsu.2017.11.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Adipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation. MATERIAL AND METHODS The purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable. RESULTS A standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue.He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. CONCLUSION Adipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles.Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.
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Affiliation(s)
- Elisa Bellini
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele P. Grieco
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 2017; 20:49-60. [PMID: 28702187 PMCID: PMC5491488 DOI: 10.1016/j.amsu.2017.06.059] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. PATIENTS AND METHODS Literature review of publications concerning autologous fat grafting. RESULTS Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. CONCLUSIONS Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.
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Affiliation(s)
- Francesco Simonacci
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Michele Pio Grieco
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Eugenio Grignaffini
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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