Comparisons between fresh and cryopreserved fat injections in facial lipofilling

Complications Associated with Facial Autologous Fat Grafting for Aesthetic Purposes: A Systematic Review of the Literature

Background

With the increasing demand for aesthetic procedures, autologous fat grafting (AFG) seems to be an attractive option for facial volumization and rejuvenation. The aim of this study was to assess the type and severity of associated complications after facial AFG for aesthetic purposes.

Methods

The entire PubMed/Medline and Cochrane databases were screened to identify studies describing complications that occurred after the injection of autologous fat into the face. These complications have been reviewed and analyzed according to their occurrence and severity in the different anatomical regions of the face.

Results

Twenty-two articles including 38 patients reported on a total of 58 complications. Thirty-two complications have been classified as severe or permanent, including hemiplegia (n = 11), loss of vision (n = 7), or skin necrosis (n = 3). The other 26 complications were classified as mild or transient, such as lipogranuloma (n = 12) or mycobacterial abscess (n = 2). The majority of complications were reported after injection to the forehead (n = 26) and the temporal region (n = 21). Interestingly, this location seems to be the area at risk because 53% of all severe complications occurred in this anatomical region.

Conclusions

AFG to the face is associated with a low incidence of complications, but if they occur, they can be dramatic, particularly in the forehead and temporal region. Nevertheless, AFG can be used to correct age-related changes of the face and volume loss and may represent an alternative to synthetic fillers. Therefore, AFG to the face should be performed by qualified doctors under careful consideration of risks and facial anatomy.

The Effect of Various Temperatures on the Inflammatory Profile of Fat Graft Storage: An Experimental Study

Fat tissue has been widely used as a filler material during plastic surgery, but unpredictable fat retention remains a significant concern. Fat tissue is vulnerable to ischemia and hypoxia, but it always has waiting time before injection in the operation theater. Apart from transferring fat tissue as quickly as possible after harvesting, washing the aspirate with cool normal saline is often used. However, the mechanisms of cool temperature acting on adipose tissue have yet to be fully elucidated. Herein, this study aims to explore the effect of preservation at different temperatures on the inflammatory profile of adipose tissue. Inguinal adipose tissue of rats was collected and cultured in vitro under 4°C, 10°C, and room temperature for 2 hours. The proportion of damaged adipocytes and an array of cytokines were determined. We observed that the damage rate of the adipocyte membrane was slightly higher at room temperature, but there was no significant difference, while we noticed increased IL-6 and MCP-1 levels in adipose tissue at room temperature ( P ＜0.01). The 4°C and 10°C cool temperatures may offer protection against proinflammatory states during the adipose tissue preserved in vitro.

SVF-GEL Cryopreserved for Different Times Exhibits Varied Preservation and Regeneration Potential After Transplantation in a Mouse Model

BACKGROUND

Matrix vascular component (SVF) gels derived from fat preserve tissue integrity and cell viability under cryopreserved conditions, making them easy to inject again for later use. Here, we compared the preservation power and regeneration potential of SVF-gel under different cryopreservation times.

METHODS

The SVF-gel stored under - 20 °C, without cryoprotectant cryopreservation for 5, 15, and 45 days, with fresh SVF-gel as control. We evaluated the rate of volume retention after thawing the SVF-gel and the apoptosis rate of adipose-derived stem cells. Next, we analyzed retention rated, adipogenesis, angiogenesis, and connective tissue hyperplasia of the grafts, one month after subcutaneously transplanting the specimen into immunodeficient mice.

RESULTS

SVF-gel cryopreserved for 5 and 15 days exhibited no significant different in apoptosis rates relative to the control group. Extending the cryopreservation time to 45 days resulted in significantly increased and decreased apoptosis and volume retention rates of SVF-gel, respectively. SVF-gel grafts cryopreserved for 5 and 15 days exhibited no significant differences from those in the control group, although their weights and volumes still fluctuated. Extending the cryopreservation time to 45 days resulted in significantly decreased retention rates of the grafts. Histologically, extending freezing time resulted in a gradual decline in the graft's health adipose tissue, as well as decreased angiogenesis, and connective tissue hyperplasia.

CONCLUSION

Simple freezing of SVF-gel at - 20 °C conferred them with sufficient cell viability. Notably, short-term cryopreservation did not significantly increase the apoptosis rate, and it still had a certain regeneration after transplantation. However, prolonging freezing time to 45 days resulted in increased apoptosis rate and worsened transplantation effect.

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Evaluation and management of facial granuloma caused by various injection materials

BACKGROUND

Various substances are currently being used for cosmetic or postsurgical reconstruction reasons. Injecting of various materials into the face may provoke inflammatory or granulomatous reactions, infection and tissue necrosis. Among these reactions are foreign body granulomas. This study aims to describe the clinical characteristics of and therapeutic approaches used in patients with facial foreign body granulomas caused by the injection of various substances.

METHODS

From 2007 to 2020, a total of 64 patients visited our hospital due to inflammatory signs, palpable masses or surface irregularities. We reviewed patient characteristics, type of injected material, medical history and treatment outcomes. The treatment results were scored with patient satisfaction and statistical analysis of the treatment period was performed.

RESULTS

Most patients underwent conservative treatment followed by surgical treatment because of persistent symptoms; one patient did not require surgery. All patients reported good treatment results and satisfaction. The earlier the surgical treatment was performed, the shorter the treatment period and the higher patient satisfaction scoring.

CONCLUSION

Granulomatous changes to the face are an emerging concern in various cosmetic procedures and surgeries, including fillers, silicone implants and autologous fat injections. Our findings strongly suggest that patient symptoms require accurate diagnosis and surgical treatment.