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

Three-Dimensional Volumetric Analysis of the Effect of Interval Time in Autologous Fat Graft Breast Augmentation

BACKGROUND

Autologous adipose tissue has become increasingly popular in cosmetic and plastic reconstructive surgery, especially breast augmentation surgery. However, the volume retention rate after transplantation significantly varies and may be unsatisfactory. Many patients need two or more autologous fat graft breast augmentations to achieve the expected effect. There are currently no studies on optimal timing between fat injections.

METHODS

We identified target patients with secondary or multiple autologous fat transplantations by inclusion and exclusion criteria and used three-dimensional scanning technology to calculate the volume retention. Patients were divided into two groups according to the dates of the first and second operations (group A: interoperative time < 120 days, group B: interoperative time ≥ 120 days). We used SPSS 26 for statistical calculations.

RESULTS

We included 161 patients in this retrospective study, with an average volume retention rate of 36.56% in group A (n = 85) and 27.45% in group B (n = 76). The independent sample t test showed that the volume retention rate in group A was higher than that in group B (P < 0.001). And the paired t test showed there is a significant improvement of volume retention rate after the second fat graft session (P < 0.001). Multivariate regression analysis showed that the interval time was an independent factor affecting the postoperative volume retention rate.

CONCLUSION

The interval time between autologous fat transplantation for augmentation mammaplasty was an independent factor affecting the postoperative volume retention rate. The postoperative volume retention rate of the < 120 days group was higher than that of the ≥ 120 days group.

LEVEL OF EVIDENCE IV

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Effectiveness of fat grafting in scar reduction: A systematic review and meta-analysis

BACKGROUND

Scar brings great physical and mental pain to patients. Fat grafting may be a new and simple way to treat scar. This review aimed to systematically evaluate the correlation between fat grafting and scar reduction.

METHODS

The author searched Chinese and English literature databases such as CNKI, Wanfang Data, Cqvip, Pubmed, Web of Science, Embase, CBM, etc. for articles published in the period from 2011 to 2021 about the randomized controlled trials (RCTs) to assess the effect of fat grating on scar reduction, and then performed meta-analysis with Review Manager 5.4.

RESULTS

A total of nine articles were included in the assessment of the effect of fat grafting on scar reduction, with meta-analysis suggesting statistical significance (OR = 5.63, 95% CI: 3.01-10.53, p < 0.01). There was statistical significance in the difference observed between the simple fat grating group (p = 0.004) and the group of existing therapies combined with fat grafting (p < 0.0001).

CONCLUSION

Fat grafting may be a good method for scar treatment, especially when it's combined with other therapies. Still, due to the limitations of included RCTs, more large-scale high-quality RCTs must be carried out before solid conclusions can be drawn.

Autologous Lipofilling Improves Clinical Outcome in Patients With Symptomatic Dermal Scars Through Induction of a Pro-Regenerative Immune Response

BACKGROUND

Autologous lipofilling is an emerging procedure to treat and possibly reverse dermal scars and to reduce scar-related pain, but its efficacy and mechanisms are poorly understood.

OBJECTIVES

The aim of this study was to test the hypothesis that repeated lipografts reverse dermal scars by reinitiation of wound healing.

METHODS

In a prospective, non-placebo-controlled clinical study, 27 adult patients with symptomatic scars were given 2 lipofilling treatments at 3-month intervals. As primary outcome, clinical effects were measured with the Patient and Observer Scar Assessment Scale (POSAS). Scar biopsies were taken before and after treatments to assess scar remodeling at a cellular level.

RESULTS

Twenty patients completed the study. Patients' scars improved after lipofilling. The total POSAS scores (combined patient and observer scores) decreased from 73.2  [14.7] points (mean [standard deviation]) pretreatment to 46.1 [14.0] and 32.3 [13.2] points after the first and second lipofilling treatment, respectively. Patient POSAS scores decreased from 37.3 [8.8] points to 27.2 [11.3] and 21.1 [11.4] points, whereas observer POSAS scores decreased from 35.9 [9.5] points to 18.9 [6.0] and 11.3 [4.5] points after the first and second treatment, respectively. After each lipofilling treatment, T lymphocytes, mast cells, and M2 macrophages had invaded scar tissue and were associated with increased vascularization. In addition, the scar-associated epidermis showed an increase in epidermal cell proliferation to levels similar to that normal in skin. Moreover, lipofilling treatment caused normalization of the extracellular matrix organization towards that of normal skin.

CONCLUSIONS

Autologous lipofilling improves the clinical outcome of dermal scars through the induction of a pro-regenerative immune response, increased vascularization, and epidermal proliferation and remodeling of scar tissue extracellular matrix.

LEVEL OF EVIDENCE: 4