The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging
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Numerous methodologies and algorithms have been suggested to enhance fat graft survival, including the usage of stromal vascular fraction (SVF) and platelet-rich plasma (PRP), but no long-term studies are available.
This single-center prospective, case-controlled study investigated the safety and efficacy of combining a modified Baker-designed lateral SMASectomy or plication face lift with simultaneous anterior mid-face grafting into site-specific compartments by (1) conventional Coleman’s technique or (2) Yoshimura’s cell-assisted lipografting technique.
On the voluntary principle, candidates selected one of four techniques for volumization of their mid-face: conventional fat grafting; PRP-assisted fat grafting; SVF-assisted fat grafting; and PRP/SVF- assisted fat grafting. For comparison data, comparable fat volumes, SVF volumes and nucleated cells, and PRP volumes and platelet concentrations were injected into each designated group. Indirect volume retentions were determined by standardized Vectra 3D analyses up to 1 year.
PRP, SVF, and PRP/SVF cell supplementation of processed fat resulted in statistically significant percent mean graft retention over their baseline control at 12 months (p < 0.01). The use of either PRP or SVF alone resulted in almost equal outcomes. Combining cell populations provided no additional advantage over single cellular therapy. Complications were negligible.
Autologous fat grafting continues to be a viable adjunct in facial aesthetic surgery. With refinements in the entire grafting process and the potential benefits of autologous cell approaches with SVF and PRP, future evidence-based controlled studies under regulatory approval may improve graft survival in a safe and effective manner.
Level of Evidence III
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KeywordsAutologous fat transfer Stromal vascular fraction Adipose-derived stem cells Platelet-rich plasma
The author thanks LVN Brigette Ibarra and RN Cathy Miller, for technical assistance in SVF/ PRP isolation and cell counting procedures, CST Chelsea Knutson and CST Sharon Cuellar for surgical assistance, and Margaret Gaston for creating the art work and providing the statistical and photographic assistance. The author is an unpaid consultant to Harvest Technologies Corp. and MicroAire Surgical Instruments and declares no conflicts of interests with respect to the authorship and publication of this article. The author has neither financial nor investigational interests with Cytori Therapeutics, Inc. The author received no financial or equipment support from any of the device companies in this study. No financial support was provided for the writing of the article.
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