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

Modulation of Cellular Stemness for Enhanced Fat Grafting

Low volumetric retention limits the utility of fat grafting. Although inclusion of stem cells and platelet-rich plasma have been proposed to enhance graft retention, accumulating evidence has failed to show a clear benefit. Here, we propose a strategy to pharmacologically enhance stemness of stem and progenitor cell populations in fat grafts to promote increased volume retention and tissue health. We also propose how to integrate stemness-promoting and differentiation-promoting therapies such as platelet-rich plasma, and viability promoting therapies within the common fat grafting workflow to achieve optimal fat grafting results.

Effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value

Facial fat grafting is a popular cosmetic procedure, and experts are increasingly endorsing the use of high-density fat with adipose stem cell glue for better results. This study aims to explore the effect of high-density fat combined with adipose stem cell glue on the success rate of facial filling and its clinical value. We conducted a randomized trial with 100 patients who underwent facial fat transplantation between August 2020 and August 2022. They were divided into two groups: a control group receiving traditional Coleman fat transplantation and an observation group receiving high-density fat with adipose stem cells. In the observation and control groups, the excellent and good rate was 98.00 and 80.00%. After 3 months of treatment, the thickness of frontal subcutaneous fat and temporal subcutaneous fat in the observation group was higher (P < 0.05). Observation group retention of fat transplantation was noticeably higher 3 months after treatment (P < 0.05). Three months after treatment, the VISIA (facial imaging system) scores of facial color spots, facial pores and facial wrinkles in the observation group were lower (P < 0.05). After treatment, both groups indicated noticeable improvements in physiological functions, health status, social function, mental health, and somatic diseases compared to before treatment. Notably, the observation group had higher scores (P < 0.05). The observation group had a lower complication rate (4.00% vs. 22.00%) and higher satisfaction rate (98.00% vs. 86.00%) than the control group. Using high-density fat combined with adipose stem cell glue for facial fat grafting yields superior results, reduces complications, and boosts patient satisfaction compared to traditional methods. We have complied with all relevant ethical regulations with regard to the use of stem cells.

Pyrroloquinoline Quinone (PQQ) Improves Long-term Survival of Fat Grafts by Alleviating Oxidative Stress and Promoting Angiogenesis During the Early Phase After Transplantation

BACKGROUND

Reducing absorption after autologous fat grafting is a current challenge. Pyrroloquinoline quinone (PQQ) is the strongest known catalyst of redox reactions, which can scavenge reactive oxygen species (ROS) and alleviate oxidative stress.

OBJECTIVES

The aim of this study was to establish an in vivo model of PQQ-assisted lipotransfer and clarify the role of PQQ in reducing oxidative stress, alleviating apoptosis, and promoting angiogenesis during the acute hypoxic phase after grafting. In addition the study was performed to assess whether this intervention would have a positive effect on the improvement of long-term volume retention.

METHODS

Different concentrations of PQQ (low: 10 μM, medium: 100 μM, and high: 1000 μM) were mixed with human adipose tissue and transplanted subcutaneously into nude mice. Meanwhile, a control group of phosphate-buffered saline in an equal volume to PQQ was set up. On the third day after grafting, whole mount fluorescence staining was applied to detect ROS, mitochondrial membrane potential (MMP), apoptosis, adipocyte activity, and angiogenesis. Graft volume retention rate and electron microscopic morphology were evaluated at the third month. Immunohistochemistry and polymerase chain reaction (PCR) were further employed to elucidate the mechanism of action of PQQ.

RESULTS

PQQ-assisted fat grafting improved the long-term volume retention, promoted the quality and viability of the adipose tissue, and reduced the level of fibrosis. The underlying mechanism of PQQ assisted in scavenging the accumulated ROS, restoring MMP, enhancing adipocyte viability, alleviating tissue apoptosis, and promoting timely angiogenesis during the hypoxia stress phase. The most effective concentration of PQQ was 100 μM. Immunohistochemistry and PCR experiments confirmed that PQQ reduced the expression of Bax and cytochrome c in the mitochondrial apoptotic pathway and increased the level of the antiapoptotic molecule Bcl-2.

CONCLUSIONS

PQQ could improve the long-term survival of adipocytes by alleviating hypoxic stress and promoting timely angiogenesis in the early phase following lipotransfer.

LEVEL OF EVIDENCE: 4

Disturbances of the stomatognathic system and possibilities of its correction in patients with craniofacial morphea

Morphea en coup de sabre and progressive hemifacial atrophy are extremely rare connective tissue disorders causing facial deformity. In extreme cases, morphological disorders are accompanied by symptoms of a clear impairment of the stomatognathic system. The aetiology of the above-mentioned diseases is still unknown. Properly planned therapy in the field of maxillofacial orthopaedics makes it possible to correct the asymmetric pattern of hard tissue growth and thus enable rehabilitation. The task of augmentation techniques is the volumetric supplementation of tissue defects resulting from atrophic processes. The degree of destruction and the extent of changes determine the method of correction. Mild and moderate defects are treated mainly with biomaterials and autologous adipose tissue. The severe course of hemifacial atrophy and morphea en coup de sabre and the associated significant tissue atrophy necessitate the search for more complex methods of treatment. In this paper, we summarize the disturbances of the stomatognathic system in patients with craniofacial morphea, together with an analysis of current treatment options.

Evidence-Based Medicine for Lower Facial Rejuvenation

Lower facial rejuvenation is an expanding area in facial plastic surgery with both surgical and nonsurgical treatment options. Evidence-based medicine is essential to providing high-quality care and creating long-lasting results. A systematic approach and understanding of the layers of the aging lower face is important to develop an individualized treatment plan. This review will focus on surgical and nonsurgical treatments for the aging lower face with an emphasis on evidence-based medicine.