Abstract
Background
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.
Objectives
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.
Methods
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.
Results
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.
Conclusions
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
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Pessa JE (2000) An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show and the lateral suborbital trough deformity. Plast Reconstr Surg 106(2):479–488
Camp M, Filip ZA, Wong W et al (2009) A novel three-dimensional analysis of periorbital facial aging. Plast Reconstr Surg 124(4S):41–42
Rohrich RJ, Arbique GM, Wong C et al (2009) The anatomy of sub-orbicularis oculi fat: implications for periorbital rejuvenation. Plast Reconstr Surg. 124:946–951
Rohrich RJ, Ghavami A, Constantine FC et al (2014) Lift-and-fill: integrating the fat compartments. Plast Reconstr Surg 133:756e–767e
Kaufman MR, Miller TA, Huang C et al (2007) Autologous fat transfer for facial contouring: is there science behind the art? Plast Reconstr Surg 119:2287–2297
Kaufman MR, Bradley JP, Dickinson B et al (2007) Autologous fat transfer national consensus survey: trends in techniques for harvest, preparation, and application, and perception of short-and long-term results. Plast Reconstr Surg 119:323–331
Gir P, Brown SA, Oni G et al (2012) Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg 130:249–258
Zuk PA, Zhu M, Mizuno H et al (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7:211–228
Daher SR, Johnstone BH, Phinney DG et al (2008) Adipose stromal/stem cells: basic and translational advances: the IFATS collection. Stem Cells 26:2664–2665
Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for facial lipoatrophy: efficacy of clinical use of adipose-derived stem cells. Dermatol Surg 34:1178–1185
Chang Q, Li J, Dong Z et al (2013) Quantitative volumetric analysis of progressive hemifacial atrophy corrected using stromal vascular fraction—supplemented autologous fat grafts. Dermatol Surg. 39:1465–1473
Li J, Gao J, Cha P et al (2013) Supplementing fat grafts with adipose stromal cells for cosmetic facial contouring. Dermatol Surg 39:449–456
Peltoniemi HH, Salmi A, Miettinen S et al (2013) Stem cell enrichment does not warrant a higher graft survival in lipofilling of the breast: a prospective comparative study. J Plast Reconstr Aesthet Surg 66:1494–1503
Sterodemas A, de Faria J, Nicaretta B et al (2011) Autologous fat transplantation versus adipose-derived stem cell-enriched lipografts: a study. Aesthet Surg J 31(6):682–693
Llull R (2005) Cited as Personal Communication in manuscript by Moseley TA, Zhu M, Hedrick MH (2006) Adipose-derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg 118 (Suppl.):121S
Cohen SR, Mailey B (2012) Adipocyte-derived stem and regenerative cells in facial rejuvenation. Clin Plastic Surg 39:453–464
Tiryaki T, Findikli Tiryaki D (2011) Staged stem cell-enriched tissue (SET) injections for soft tissue augmentation in hostile recipient areas: A preliminary report. Aesth Plast Surg 35:965–971
Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer (CAL) for cosmetic breast augmentation—supportive use of adipose-derived stem/stromal cells. Aesthet Plast Surg. 32(1):48–55
Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496
Sanchez AR, Sheridan PJ, Kupp LI (2003) Is platelet-rich plasma the perfect enhancement factor? A current review. Int J Oral Maxillofac Implants 18:93–103
Sterodimas A, de Faria J, Nicaretta B et al (2010) Tissue engineering with adipose-derived stem cells (ADSCs): current and future applications. J Plast Reconstr Aesthet Surg 63:1886–1892
Choi J, Minn KW, Chang H (2012) The efficacy and safety of platelet-rich plasma and adipose-derived stem cells: an update. Arch Plast Surg 39:585–592
Sadati KS, Corrado AC, Alexander RW (2006) Platelet-rich plasma (PRP) utilized to promote greater graft volume retention in autologous fat grafting. Am J Cosmet Surg 23:203–211
Cervilli V, Gentile P, Scioli MG et al (2009) Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation. Tissue Eng Part C Methods 15:625–634
Baker DC (2001) Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: evolution and application. Aesthet Surg J. 21(1):14–26
Coleman SR (2006) Facial augmentation with structural fat grafting. Clin Plast Surg 33:567–577
Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119:2219–2227
Rohrich RJ, Pessa JE, Ristow B (2008) The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 121(6):2107–2122
Billings E Jr, May JW Jr (1990) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 85:378–386
Ogawa R (2006) The importance of adipose-derived stem cells and vascularized tissue regeneration in the field of tissue transplantation. Curr Stem Cell Res Ther 1:13–20
Rendu F, Brohard-Bohn B (2001) The platelet release reaction: granules’ constituents, secretion and function. Platelets 12:261–273
Bir SC, Esaki J, Marui A et al (2009) Angiogenic properties of sustained release platelet-rich plasma: characterization in-vitro and in the ischemic hind limb of the mouse. J Vasc Surg 50(870–879):e2
Kakudo N, Minakata T, Mitsui T et al (2008) Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg 122(5):1352–1360
Cervelli V, Scioli MG, Gentile P et al (2012) Platelet-rich plasma greatly potentiates insulin-induced adipogenic differentiation of human adipose-derived stem cells through a serine/threonine kinase Akt-dependent mechanism and promotes clinical fat graft maintenance. Stem Cells Transl Med 1(3):206–220
Fukaya Y, Kuroda M, Aoyagi Y et al (2012) Platelet-rich plasma inhibits the apoptosis of highly adipogenic homogeneous preadipocytes in an in vitro culture system. Exp Mol Med 44(5):330–339
Giusti I, Rughetti A, D’Ascenzo S et al (2009) Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells. Transfusion 49:771–778
Freshwater MF (2013) The use of platelet-rich plasma in plastic surgery remains unproven. J Plast Reconstr Aesthet Surg 66(3):311
Sommeling CE, Heyneman A, Hoeksema H et al (2013) The use of platelet-rich plasma in plastic surgery: a systematic review. J Plast Reconstr Aesthet Surg 66:301–312
Jin R, Zhang L, Zhang Y-G (2013) Does platelet-rich plasma enhance the survival of grafted fat? An update review. Int J Clin Exp Med 6(4):252–258
Rehman J, Traktuev D, Li J et al (2004) Secretion of angiogenic and antiapoptotic factors by human adipose stromal cells. Circulation 109:1292–1298
Kilroy GE, Foster SJ, Wu X et al (2007) Cytokine profile of human adipose-derived stem cells: expression of angiogenic, hematopoietic, and pro-inflammatory factors. J Cell Physiol 212:702–709
Tholpady SS, Aojanepong C, Llull R et al (2005) The cellular plasticity of human adipocytes. Ann Plast Surg 54:651656
Thangarajah H, Vial IN, Chang E et al (2009) IFATS series: adipose stromal cells adopt a proangiogenic phenotype under the influence of hypoxia. Stem Cells. 27:266–274
Traktuev DO, Prater DN, Merfeld-Clauss S et al (2009) Robust functional vascular network formation in vivo by cooperation of adipose progenitor and endothelial cells. Circ Res 104:1410–1420
Merfeld-Clauss S, Gollahalli N, March KL et al (2010) Adipose tissue progenitor cells directly interact with endothelial cells to induce vascular network formation. Tissue Eng Part A 16:2953–2966
Song SY, Chung HM, Sung JH (2010) The pivotal role of VEGF in adipose-derived-stem cell-mediated regulation. Expert Opin Biol Ther 10(11):1529–1537
Kakudo N, Tanaka Y, Morimoto A et al (2013) Adipose-derived regenerative (ADRC)-enriched fat grafting” optimal cell concentration and effects on grafted fat characteristics. J Transl Med 11:254–262
Halme DG, Kessler DA (2006) FDA regulation of stem cell-based therapies. N Engl J Med 355:1730–1735
Yu JM, Jun ES, Bae YC et al (2008) Mesenchymal stem cells derived from human adipose tissues favor tumor cell growth in vivo. Stem Cells Dev 17:463–473
Muehlberg FL, Song YH, Krohn A et al (2009) Tissue-resident stem cells promote cancer growth and metastases. Carcinogenisis 30:589–597
Kuhbier JW, Bucan V, Reimers K et al (2014) Observed changes in the morphology and phenotype of breast cancer cells in direct co-culture with adipose-derived stem cells. Plast Reconstr Surg 134:414–423
Casiraghi F, Remuzzi G, Abbate M et al (2013) Multipotent mesenchymal stromal cell therapy and risk of malignancies. Stem Cell Rev 9:656–679
Centeno CJ, Fuerst M, Faulkner SJ et al (2011) Is cosmetic platelet-rick plasma a drug to be regulated by the food and drug administration? J Cosmet Dermatol 10:171–173
Acknowledgment
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sasaki, G.H. The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging. Aesth Plast Surg 39, 833–846 (2015). https://doi.org/10.1007/s00266-015-0533-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-015-0533-5