Improved Adipocyte Viability in Autologous Fat Grafting With Ascorbic Acid–Supplemented Tumescent Solution

Increased Total Antioxidant Capacity Value Improves Survival of Fat Grafts in Rat Model

BACKGROUND

Although studies aiming to increase fat graft survival continue, in this study, the authors aimed to investigate the effects of different antioxidants on total antioxidant capacity (TAC) and their effect on graft survival.

METHODS

Thirty-two male Wistar rats were divided into four equally sized groups, including a control group and three antioxidant groups receiving either melatonin (10 mg/kg), zinc (2 mg/kg), or vitamins E and C (100 mg/kg). Autologous fat grafts (1.7 ± 0.4 g) were transferred to the dorsal subcutaneous region, and total antioxidant capacity was measured on days 0 and 1, week 1, and monthly until the third month. Transferred graft volume and mass (1.3 ± 0.4 g) were measured using the liquid overflow method and precision scales at the end of the study. Routine hematoxylin and eosin staining and immunohistochemistry against perilipin were performed for semiqualitative analysis and H-score for viable adipose cells, respectively.

RESULTS

Collected fat grafts measured significantly less in weight and volume and the survival rate was lower in the control group ( P < 0.01). The control group exhibited a reduction in TAC, whereas all groups receiving antioxidants had an increase in TAC during the first week ( P = 0.02, P = 0.008, and P = 0.004 for melatonin, zinc, and vitamins, respectively). Immunohistochemistry of the antioxidant group demonstrated a statistically significant excess and reactivity of cells staining with perilipin antibodies.

CONCLUSION

In this animal study, the beneficial effect of antioxidants on fat graft survival can be related to the significant increase in TAC following the first week of their administration.

CLINICAL RELEVANCE STATEMENT

Antioxidants improve fat graft survival and quality in this rat model, by increasing total antioxidant capacity in the first week of administration.

Analysis of Fat Graft Survival and Platelet-Rich Plasma Effects: The Transcriptomic Differences

INTRODUCTION

Fat graft survival has been studied numerously but has not gone beyond hypothetical solutions. The molecular changes in survival of standard fat grafts and enhanced survival by platelet-rich plasma (PRP) are compared in this study to reveal the etiology that causes the loss of fat grafts after transplantation.

MATERIALS AND METHODS

A New Zealand rabbit's inguinal fat pads were excised and divided into three groups: Sham, Control (C), and PRP. Each weighing 1 g, C and PRP fat were placed into the bilateral parascapular area of the rabbit. After 30 days, the remaining fat grafts were harvested and weighed (C = 0.7 g, PRP = 0.9 g). All three specimens were put into transcriptome analysis. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes Analysis were done to compare the genetic pathways between the specimens.

RESULTS

Transcriptome analysis showed similar differential expressions in Sham vs. PRP and Sham vs. C comparisons, indicating the dominance of the cellular immune response in both C and PRP specimens. C and PRP comparison resulted in inhibited migration and inflammation pathways in PRP.

CONCLUSION

Fat graft survival is more related to immune responses than any other physiological process. PRP enhances survival by attenuating cellular immune reactions.

Quality and Vitality of Autologous Fat Grafts Harvested by Different Techniques: A Clinical Comparison Study

BACKGROUND

Unpredictable outcomes with autologous fat grafting due to reabsorption processes present a major challenge for healthcare providers and patients. A higher number of viable adipocytes is considered to result in a higher volume being retained. Although various adverse factors have been extensively researched, other potential parameters have been less investigated or even neglected.

OBJECTIVE

The aim of this study was to investigate the harvesting process of adipose tissue as the primary cause of cell damage and to determine the risk factors associated with low cell survival.

METHODS

Thirty-nine male and female subjects undergoing planned elective liposuction or abdominoplasty were enrolled. Forty-seven lipoaspirates harvested by different liposuction techniques were analyzed. RNA isolation and real-time polymerase chain reaction was performed to elucidate differences in the expression of various adipocyte markers. Furthermore, scanning electron microscopy was performed on various samples to determine the cell damage caused by the different techniques.

RESULTS

A statistically significant lower expression of peroxisome proliferator-activated receptor γ was detected in subjects with a higher BMI. A trend towards a lower expression of perilipin 1 in lipoaspirates harvested by a super wet + ultrasound technique, compared with dry and super wet techniques, was shown. The lowest level of cell damage determined from scanning electron microscopy images was in lipoaspirates harvested by the super wet + ultrasound technique, and this level was statistically significantly different from those obtained by the 2 other techniques.

CONCLUSIONS

Optimization of the outcome in autologous fat grafting may be feasible by targeting and optimizing the harvesting process as a main risk factor for impaired adipocyte viability. Ultrasound-assisted liposuction might be considered a suitable harvesting technique.

LEVEL OF EVIDENCE: 5

Surgical Decision Making in Autologous Fat Grafting: An Evidence-Based Review of Techniques to Maximize Fat Survival

Autologous fat grafting is an important tool in plastic surgery and is widely used for a variety of applications, both aesthetic and reconstructive. Despite an ever-increasing list of indications and extensive research over many years into improving outcomes, fat grafting remains plagued by incomplete and often unpredictable graft survival. Decisions made at each stage of surgery can potentially contribute to ultimate success, including donor site selection and preparation, fat harvest, processing, and purification of lipoaspirate, recipient site preparation, and delivery of harvested fat to the recipient site. In this review, we examine the evidence for and against proposed techniques at each stage of fat grafting. Areas of consensus identified include use of larger harvesting and grafting cannulas and slow injection speeds to limit cell damage due to shearing forces, grafting techniques emphasizing dispersion of fat throughout the tissue with avoidance of graft pooling, and minimizing exposure of the lipoaspirate to the environment during processing. Safety considerations include use of blunt-tipped needles or cannulas to avoid inadvertent intravascular injection as well as awareness of cannula position and avoidance of danger zones such as the subgluteal venous plexus. We believe that using the evidence to guide surgical decision-making is the key to maximizing fat grafting success. Level of Evidence: 4.

Cosmetic Fat Transplantation: A Review

AIM

To review current techniques used in fat grafting to optimise graft persistence and achieve optimal cosmetic outcomes.

BACKGROUND

Fat transplantation has been used extensively in the reconstruction and cosmetic industry for many years. However, there is significant adipocyte loss and reabsorption rates, leading to the loss of external cosmetic volume and the need for repeat procedures. Adipocyte loss can occur at all four stages of transplantation and this review discusses each of these methods with the aim being to optimise graft outcome.

RESULTS

Several new techniques have been discussed including liposuction techniques, fat processing, and assisted fat grafting which show an improvement in adipocyte survival, revasculisation and graft outcomes.

CONCLUSION

There have been many improvements in fat grafting and the implementation of these will optimise surgical outcomes but there are still strategies to improve further. However, there is still a lack of standardised techniques and training. More research is needed in the areas of fat processing and the use of additives to the fat graft. More clinical research is needed in the fat placement technique, which has very little published evidence and current techniques are mostly anecdotal by cosmetic surgeons.