These preliminary results suggest that SET is safe and may provide superior results compared to traditional fat grafting. By performing the procedure in a staged approach, operating room expenses are minimized, which ultimately decreases the cost of the procedure. Adipose-derived regenerative cells may mitigate early ischemia by increasing angiogenesis, decreasing apoptosis, and modulating the local inflammatory response. This technique may be of particular value to the surgeon when grafting high volumes of fat or when faced with hostile recipient area conditions, including fibrosis and post radiation.

Background: Adipose stromal vascular fraction (SVF) isolation with enzymatic digestion is the gold standard, but is expensive, having practical and legal concerns. The alternative mechanical SVF isolation methods provide lower cell yields as they employ either centrifugation, emulsification, or digestion steps alone. We combined mechanical processing with buffer incubation and centrifugation steps into an isolation method called “mechanical digestion” and compared the cell yields with that of enzymatic digestion. Methods: A total of 40-mL lipoaspirate was harvested from 35 women undergoing liposuction and was submitted to conventional enzymatic digestion for SVF isolation or mechanical digestion using a closed unit harnessing 3 ports with blades, followed by buffer incubation and centrifugation. Culture of the SVFs and flow cytometry were performed. Results: The SVF cell yield obtained by enzymatic digestion was significantly higher 3.38 × 106/mL (±3.63; n = 35) than that obtained by mechanical digestion 1.34 × 106/mL (±1.69; n = 35), P = 0.015. The average cell viability was 82.86% ± 10.68 after enzymatic digestion versus 85.86% ± 5.74 after mechanical digestion, which was not significant. Mechanical digested SVF expressed 2-fold higher stem cell surface markers compared with enzymatically digested SVF. Mechanical digestion was less time consuming, cost effective, and did not require a specific laboratory environment. Conclusions: Mechanically digested SVF was comparable to enzymatically digested SVF in terms of stromal cell composition and viability. With mechanical digestion, we can isolate 30%–50% SVF cells of that isolated with enzymatic digestion. Further studies are warranted to determine the clinical outcomes.

Background Nanofat was introduced by Tonnard and Verpaele in 2013. Their initial observations in intradermal applications showed improvement in the appearance of the skin. Since then, a number of Nanofat devices have been introduced. The cellular content in the processing of Nanofat is not the same in every device, yet the cellular composition is responsible for the biologic action of Nanofat. The authors sought to find a different means to produce a matrix rich Nanofat to optimize the cellular content. Objectives The primary objective of this study was to compare cell counts, cultures, and cell viabilities produced by LipocubeNano (Lipocube, Inc., London, UK) in comparison to Tulip’s NanoTransfer (Tulip Medical, San Diego, CA) processing methods. Methods Twenty milliliters of fat were harvested from 10 patients in order to test two methods of Nanofat production. Ten milliliters of fat were used to assess each method and, after the final product was obtained, enzymatic digestion for stromal vascular fraction (SVF) isolation was performed. A Muse Flow-cytometer was used to measure cell counts and cell viabilities, cell cultures were performed, and cell images were taken with a florescent microscope. Results The LipocubeNano was shown to be superior to Tulip’s NanoTransfer system of progressive downsizing with final filtering, which appeared to trap more fibrous tissue leading to lower amounts of SVF. LipocubeNano resulted in higher cell counts (2.24 × 106/cc), whereas Tulip’s NanoTransfer method resulted in a lower cell count at 1.44 × 106/cc. Cell viability was the same (96.05%) in both groups. Conclusions Nanofat from LipocubeNano has a higher regenerative cell count and more SVF cells than the other common mechanical method of Nanofat processing. This new means of mechanical processing preserves more matrix, optimizing the cellular content of the Nanofat, thus having potentially a higher regenerative effect. Level of Evidence: 5

Background Liposuction and lipoabdominoplasty procedures frequently involve the treatment of the superficial and deep fatty layers of the abdomen. Objectives The aim of the present investigation was to provide comprehensive data on the thickness of the abdominal fatty layers in relation to age, gender, and body mass index (BMI). Methods The study investigated 150 Caucasian individuals; there was an equal distribution of males and females (each n = 75) and a balanced distribution of age (n = 30 per decade: 20–29, 30–39, 40–49, 50–59, and 60–69 years) and BMI (n = 50 per group: BMI ≤24.9, 25.0–29.9, and ≥30 kg/m2). Ultrasound-based measurements of the superficial and deep abdominal fatty layers were performed. Results An increase in BMI was associated with an increase in total abdominal wall fat thickness. The measured increase was related more to the thickness of the deep fatty layer than to the thickness of the superficial fatty layer (Z = 1.80, P = 0.036). An increase in age was associated with a decrease in thickness of the superficial fatty layer (rp = –0.104, P = 0.071) but with an increase in thickness of the deep fatty layer (rp = 0.197, P = 0.001). Conclusions Age and BMI can change the thickness of both the superficial and deep fatty layers of the anterior abdominal wall, thus influencing the plan and conduct of cosmetic surgical procedures. Knowledge of the layered anatomy of the anterior abdominal wall, as well as its associated blood supply, is important for surgeons performing procedures in this area.

We propose that bilateral chemodenervation of the primary depressors and elevators of the eyebrows can result in a symmetrical standstill of the eyebrows in the neutral position. The treatment is easy to administer and involves few complications.

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Cultured human dermal fibroblasts combined with hyaluronic acid can provide a suitable, biocompatible, and long-lasting material and should be regarded as a new method in dermal renovation even beyond their temporary filling effect.

Background: Enzymatic digestion of extracellular matrix (ECM) from lipoaspirate is the conventional form of harvesting stromal vascular fraction (SVF) called enzymatically digested SVF (E-SVF). Mechanical SVF (M-SVF) isolation has emerged as an alternative method, but it has also some limitations in terms of lower cell viability and diminished cell counts. To enhance the SVF qualitatively and quantitatively, we propose a novel concept called "hybrid-SVF,” in which we combine M-SVF with the concentrated parts of adipose tissue after centrifugation, which is called stromal vascular matrix (SVM). Methods: Hybrid-SVF injection was applied as an adjunctive therapy to fat grafting in 88 patients and 11 samples were evaluated in the laboratory for cell count, viability and cell activity. Results: Experimental results determined that SVM part showed higher cellular activity. SVM and M-SVF showed higher cellular potency than E-SVF. Clinically, none of the patients required an additional session for fat grafting since there was no significant graft resorption. However, seven patients asked for further volume augmentation due to their individual preferences. No major complication was encountered. Conclusions: The usage of hybrid-SVF has a very high regenerative potential due to the ECM support and exceptionally high cell yield in addition to preserved cell potency. Although there are ongoing studies focusing on optimizing cell counts and further clinical applications, we believe that our preliminary results might create a paradigm shift in the area of regenerative fat grafting.