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Daoud RM, Alelyani AA, Bakhamees BH, Almutairi RF, AlSufyani N, Ayoub AY, Alshehri AM, Alali HA, Basri BW, Alhazmi RM, Aldoughan A, Alghofaili J, Alhayyan EM, Awaji BH. Thin Skin in Rhinoplasty: Considerations for Camouflaging Dorsal Nasal Irregularities. Cureus 2024; 16:e66595. [PMID: 39258084 PMCID: PMC11383643 DOI: 10.7759/cureus.66595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/12/2024] Open
Abstract
Thin skin presents a challenge for achieving optimal aesthetic outcomes and minimizing complications. The review analyzes various materials and techniques employed to achieve this goal. A comprehensive electronic search was conducted across various medical databases, retrieved 965 studies, from which 15 studies were eligible for inclusion in this review with a total number of 679 patients with thin nasal skin. Techniques that promote graft integration, minimize resorption, and provide a smooth dorsal contour are crucial for thin-skinned patients. Diced cartilage with PRP, fascia lata grafts, and laser-assisted rhinoplasty appear to be particularly effective based on the available evidence. Platelet-rich fibrin (PRF) appears to play a role in some techniques by enhancing healing and tissue regeneration. Natural materials, like fascia lata and ligamentous grafts, offer potential benefits but require further exploration. Fat grafting techniques show promise but necessitate more research. This review provides a comprehensive overview of various techniques for addressing dorsal irregularities in rhinoplasty for patients with thin skin. Surgeons can utilize this information to select the most appropriate approach for achieving optimal aesthetic outcomes while minimizing complications.
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Affiliation(s)
- Reda M Daoud
- Otolaryngology (ENT), King Salman Armed Forces Hospital in Nortwestren Region, Tabuk, SAU
| | | | | | | | | | | | | | | | - Bayan W Basri
- Hospital Medicine, Manchester Royal Infirmary, Manchester, GBR
| | - Rema M Alhazmi
- Otorhinolaryngology, Taibah University, AlMadinah AlMunawwarah, SAU
| | | | | | | | - Bassam H Awaji
- Otolaryngology (ENT), King Fahad Specialist Hospital, Riyadh, SAU
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Knox J, Hoffman WY. Facial Gender-Affirming Surgery: Pitfalls, Complications, and How to Avoid Them. Oral Maxillofac Surg Clin North Am 2024; 36:237-245. [PMID: 38402140 DOI: 10.1016/j.coms.2024.01.004] [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] [Indexed: 02/26/2024]
Abstract
Facial feminization is a complex undertaking requiring skill in both craniofacial and aesthetic plastic surgery. As in aesthetic procedures, understanding the patient's goals and setting realistic expectations in light of an individual's anatomy is critical. Both soft tissue and bone must be addressed to adequately soften masculine facial features. This article delves into specific anatomic areas and delineates some of the pathways to successful outcomes.
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Affiliation(s)
- Jacquelyn Knox
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, 505 Parnassus, Suite M-593, San Francisco, CA 94143-0932, USA
| | - William Y Hoffman
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, 505 Parnassus, Suite M-593, San Francisco, CA 94143-0932, USA.
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Murta F, Guevara GF, Hyer JN, Ezra DG. Quantitative Assessment of Periocular Autologous Fat Transfer Survival Using 3D Stereophotogrammetric Imaging. Ophthalmic Plast Reconstr Surg 2024; 40:55-60. [PMID: 38241618 DOI: 10.1097/iop.0000000000002504] [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: 01/21/2024]
Abstract
PURPOSE To assess periocular autologous fat transfer (AFT) survival by assessment of volume change with sequential 3D VECTRA imaging. OBJECTIVE Little is known about the patterns of graft survival of AFT in the periorbital region, especially in cases involving prior radiotherapy or trauma. The aim of this pilot study was to characterize fat survival following AFT in patients with a broad range of clinical indications, with and without a history of prior radiotherapy, for both periocular and orbital AFT, and in a subgroup of patients with an anophthalmic socket. METHOD A single-institution, prospective cohort study involving 18 applications of AFT for volume augmentation in the periocular and orbital area. All patients had sequential 3D VECTRA photographs following a validated standardized protocol. Patient demographics, including gender, age, ethnicity, underlying diagnosis, and volume of fat injected, were also collected. RESULTS In total 13 patients were enrolled, 9 female (69.2%) and 4 male (31.0%). Mean age at the time of surgery was 47.8 years. Patients had volume deficiency secondary to a variety of causes; the most common cause was postenucleation socket syndrome following trauma in 6 patients (46.2%). The mean fat survival volume at the 1-month postoperative point was 70% and 55% by 6 months. AFT conducted with a multiport cannula for fat harvesting use had an initial higher rate of fat reabsorption with ANOVA p = 0.002, however, this was not observed at the later follow-up periods. There was no statistically significant difference in fat survival between abdominal or thigh donor fat sites. There was no statistically significant difference in residual injected volume at the early follow-up period between patients who had prior radiotherapy and those who did not p = 0.8496. CONCLUSION AFT is an effective treatment for periorbital volume compromise with an acceptable survival rate in all categories of patients. Complex etiologies such as radiotherapy-related orbital and midface dysgenesis should not be a contraindication for AFT, with no difference in outcomes.
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Affiliation(s)
- Fabiola Murta
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Demichelis MDRE, Barrera A, Campero A, Sufianov A, Ramírez MDJE, Nurmukhametov R, Montemurro N, Castillo-Rangel C, Rosario AR, Baldoncini M. Lipotranferences in post neurosurgical esthetic defects. Surg Neurol Int 2023; 14:443. [PMID: 38213453 PMCID: PMC10783699 DOI: 10.25259/sni_783_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Background There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. The objective of our work is to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post-neurosurgical patients, analyzing its results. Methods During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 were male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results The procedure was performed on an outpatient basis, with local anesthesia, and in an average time of 30-40 min. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injecting it into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion Fat transfer is a minimally invasive, effective, and cost-effective technique that plastic surgery offers us to implement in post-neurosurgical patients, as it achieves natural results that stand the test of time.
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Affiliation(s)
| | - Augusto Barrera
- Plastic Surgery Service, Churruca-Visca Medical Complex, Buenos Aires, Argentina
| | - Alvaro Campero
- Neurosurgery Service, Padilla Hospital, Faculty of Medicine, National University of Tucumán, Tucuman, Argentina
| | - Albert Sufianov
- Department of Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Renat Nurmukhametov
- Department of Neurosurgery, Russian People’s Friendship University, Ulitsa Miklukho-Maklaya, Moscow, Russian Federation
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Carlos Castillo-Rangel
- Neurosurgery Service, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Regional Hospital October 1, Mexico City, Mexico
| | | | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, San Fernando, Argentina
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Niu X, Zhang Y, Lai Z, Huang X, Gao J, Lu F, Chang Q, Yuan Y. Preoperative Short-Term High Carbohydrate Diet Provides More High-Quality Transplantable Fat and Improves the Outcome of Fat Grafts in Mice. Aesthet Surg J 2022; 42:NP531-NP545. [PMID: 35460566 DOI: 10.1093/asj/sjac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with a low body mass index may have inadequate high-quality adipose tissue for transplantation. The influence of high-energy diets on adipose tissue and graft retention remains unknown. OBJECTIVES We explored inguinal fat pad alternation in mice fed on a short-time high-fat diet (HFD) or a high-carbohydrate diet (HCD) preoperatively and the morphological and histological differences after transplantation. METHODS Mice were fed HFD (60% kilocalories from fat, 20% from carbohydrate), HCD (9.3% kilocalories from fat, 80.1% from carbohydrate), or normal (12% kilocalories from fat, 67% kilocalories from carbohydrate) diets for 2 or 4 weeks. Histological analyses were carried out following hematoxylin and eosin staining, and CD34 and proliferating cell nuclear antigen immunostaining. The uncoupling protein-1 (UCP-1) expression was determined by western blotting. Fat pads from each group were grafted into the dorsal region of the recipient mice and morphological and histological changes were determined 4, 8, and 12 weeks post-transplantation. Vascular endothelial growth factor α and platelet-derived growth factor α expression were determined using quantitative polymerase chain reaction. RESULTS The inguinal fat pad volume increased in the HFD and HCD groups. The presence of multilocular adipocytes in inguinal fat of HCD-fed mice, combined with the increased UCP-1 content, suggested adipocyte browning. HCD grafts showed higher volume retention and reduced oil cyst formation, possibly attributed to better angiogenesis and adipogenesis. CONCLUSIONS HCD enlarged adipose tissue and improved grafts survival rates, which may be due to the browning of fat before grafting and enhanced angiogenesis after grafting.
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Affiliation(s)
- Xingtang Niu
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Yuchen Zhang
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Zhuhao Lai
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Xiaoqi Huang
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Jianhua Gao
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Feng Lu
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Qiang Chang
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Yi Yuan
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
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Novel Approach for Midface Depression. Plast Reconstr Surg Glob Open 2022; 10:e4242. [PMID: 35425689 PMCID: PMC9000050 DOI: 10.1097/gox.0000000000004242] [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: 12/19/2021] [Accepted: 02/08/2022] [Indexed: 12/03/2022]
Abstract
Background: Although Le Fort type II, prosthesis detainment, and orthodontic treatment are considered for the management of midface retraction, they may be limited by their high cost, infection risk, and excessive amount of tooth movement. Therefore, the Point A-Koji method was devised as a novel treatment in patients with midface retraction. Methods: This is a case report of a 26-year-old woman who presented with a feeling of depressed midface and protrusion of the mouth. Preoperatively, the position of the lip and line connecting the nasal apex and mental muscles (E-line) were normal, but the subnasale was located posteriorly. The patient had a narrow nasolabial angle of 74 degrees and the subnasale-Pog’ to the upper lip of 6.5 mm. After insertion of a metallic-plate implant under the periosteum, the plate was screwed and fixed to the bone. The Point A-Koji method was used for treatment in this patient. This is characterized by the A-point anterior migration technique in which the periosteum of hard tissue A-point circumferential attachment was shifted anteriorly, thereby preventing the return of soft tissue. Results: The following changes with respect to preoperative findings were noted 5 months postsurgery: facial convexity from 3.3 degrees to 7.6 degrees; nasolabial angle from 74 degrees to 90.2 degrees; true horizontal line from 50 degrees to 73 degrees; and subnasale-Pog’ to the upper lip from 6.5 mm to 4.7 mm. This resulted in an improved midface retraction. Conclusion: The Point A-Koji method may be an ideal method to improve the midface retraction in patients.
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Breast Reconstruction by Exclusive Lipofilling after Total Mastectomy for Breast Cancer: Description of the Technique and Evaluation of Quality of Life. J Pers Med 2022; 12:jpm12020153. [PMID: 35207642 PMCID: PMC8876120 DOI: 10.3390/jpm12020153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
Background: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject. Methods: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q. Results: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien–Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort. Conclusions: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.
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Keyhan SO, Ramezanzade S, Bohluli B, Fallahi HR, Mirzahoseini S, Nahai F. Autologous Fat Injection for Augmentation Rhinoplasty: A Systematic Review. Aesthet Surg J Open Forum 2021; 3:ojab010. [PMID: 33987531 PMCID: PMC8092143 DOI: 10.1093/asjof/ojab010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. OBJECTIVES This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. METHODS The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet. RESULTS The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. CONCLUSIONS Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Seied Omid Keyhan
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Shaqayeq Ramezanzade
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Behnam Bohluli
- Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Reza Fallahi
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Sanaz Mirzahoseini
- Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
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Kovacevic M, Kosins AM, Göksel A, Riedel F, Bran G, Veit JA. Optimization of the Soft Tissue Envelope of the Nose in Rhinoplasty Utilizing Fat Transfer Combined with Platelet-Rich Fibrin. Facial Plast Surg 2021; 37:590-598. [PMID: 33636740 DOI: 10.1055/s-0041-1723785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.
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Affiliation(s)
| | - Aaron M Kosins
- Department of Plastic Surgery, University of California, Irvine School of Medicine, Irvine, California
| | | | | | | | - Johannes A Veit
- HNO-Zentrum Rhein-Neckar, Mannheim, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
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Karwowska NN, Turner MD. Step by Step: Autologous Fat Transfer in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2021; 79:e4-e7. [PMID: 33386087 DOI: 10.1016/j.joms.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- N Nina Karwowska
- Resident Physician, Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY
| | - Michael D Turner
- Chief, Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY.
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Development and Validation of a Fully GMP-Compliant Process for Manufacturing Stromal Vascular Fraction: A Cost-Effective Alternative to Automated Methods. Cells 2020; 9:cells9102158. [PMID: 32987708 PMCID: PMC7598595 DOI: 10.3390/cells9102158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
The therapeutic use of adipose-derived stromal vascular fraction (SVF) is expanding in multiple pathologies. Various processes have been proposed for manufacturing SVF but they must be revisited based on advanced therapy medicinal product (ATMP) regulations. We report here the development and validation of a fully good manufacturing practices (GMP)-compliant protocol for the isolation of SVF. Adipose tissue was collected from healthy volunteers undergoing lipoaspiration. The optimal conditions of collagenase digestion and washing were determined based on measurements of SVF cell viability, yield recovery, and cell subset distribution. Comparability of the SVF obtained using the newly developed manufacturing process (n = 6) and the Celution-based automated method (n = 33), used as a reference, was established using inter-donor analyses. Characteristics of SVF (n = 5) generated using both manufacturing protocols were analyzed for an intra-donor comparison. In addition, these comparisons also included the determination of colony-forming unit fibroblast frequency, in vitro angiogenic activity, and in vivo regenerative effects in a mouse ischemic cutaneous wound model. We successfully developed a process for the generation of SVF presenting higher cell viability and yield recovery compared to the Celution device-based protocol. Characteristics of the SVF including phenotype, capacity for angiogenesis, and wound-healing promotion attested to the comparability of the two manufacturing processes. We validated an optimized non-automated process that should allow for a GMP-compliant, more affordable, and reduced-cost strategy to exploit the potential of SVF-based regenerative therapies.
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Autologous Facial Fat Transfer: Soft Tissue Augmentation and Regnenerative Therapy. J Craniofac Surg 2020; 31:1879-1882. [PMID: 32796302 DOI: 10.1097/scs.0000000000006731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Soft-tissue contour deficiencies depend on various origins including esthetics, congenital and post trauma asymmetries, post tumor defects, and chronic wound sequelae. Reconstructions or repairs are still a challenge today. Fat grafting is an old reconstructive technique dating back to 1893, but it has only recently become popular, especially among plastic surgeons. Being generally disregarded by medical practitioners for many years, adipose tissue has come into the spotlight because it is omnipresent and easily obtainable in substantial quantities with little patient discomfort and no relevant donor-site morbidity. Particularly, adipose tissue contains more multipotent cells per cc than bone marrow does. For example, 1 g of adipose tissue yields ∼5 × 10 stem cells, that is, 100-fold higher than the number of mesenchymal stem cells in 1 g of bone marrow. In reconstructive surgery, both adipose tissue aspiration and fat transfer have become typical surgical procedures. It is quite easy to harvest an abundant volume of tissue, obtaining a large amount of isolated stem and therapeutically active cells without needing cell expansion in tissue culture facilities. This procedure will likely mark the beginning of a new era in both regenerative medicine and facial-craniofacial reconstructions.
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