Preenrichment with Adipose Tissue-Derived Stem Cells Improves Fat Graft Retention in Patients with Contour Deformities of the Face

Abstract

Quick absorption of adipose tissue grafts makes the outcomes less satisfactory for clinical applications. In the current study, adipose tissue grafts were mixed with adipose tissue-derived stem cells (ASCs) to improve retention of adipose tissue grafts and to make the clinical outcomes of fat grafting more reliable. Adipose tissue was either injected alone (conventional group) or mixed with ASCs (stem cell group) before injection. In both groups, adipose tissue was injected at the site of contour throughout layers of tissues till visual clinical symmetry with the opposite side was achieved. The volume of injected fat graft was measured after 72 hours and 6 months using a B-mode ultrasound device connected with a 12 MH frequency probe. The percentage reduction in the volume of injected fat, physician satisfaction scores (Ph-SCs), and patient satisfaction scores (P-SCs) were also recorded. After 6 months, there was significantly lower fat absorption in the stem cell group as compared to the conventional group. Mean physician and patient satisfaction scores were significantly improved in the stem cell group. No significant adverse effects were noted in any patient. Significantly lower absorption of graft due to the use of ASCs improves the clinical outcomes of conventional fat grafting for contour deformities of the face. The current preenrichment strategy is noninvasive, safe and can be applied to other diseases that require major tissue augmentation such as breast surgery. This trial is registered with NCT02494752.

Phenotypic and Cellular Characteristics of a Stromal Vascular Fraction/Extracellular Matrix Gel Prepared Using Mechanical Shear Force on Human Fat

“…Therefore, the key to fat regeneration is to increase the content of SVF cells and ASCs. At present, the cell-assisted fat transplantation technology Lipotransfer involves the addition of regenerated cells (ASCs or SVF cells), which has proven to significantly improve the retention rate of fat grafts in small-scale fat transplantation (Zhang et al, 2016;Zhou et al, 2016;Gontijode-Amorim et al, 2017;Li et al, 2017;Cai et al, 2018;Bashir et al, 2019;Hong et al, 2019;Kim et al, 2019). However, this technology is limited based on safety challenges such as enzyme digestion, contamination, and possible promotion of tumor recurrence in the process of regeneration related to the steps of cell separation; these have hindered its clinical use (Fraser et al, 2011;Krumboeck et al, 2013;Orbay et al, 2018;Gebremeskel et al, 2019).…”

Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence?

“…ASCs isolated from lipoaspirate are purified, concentrated, or expanded ex vivo, and then added to the fat graft tissue before injection. Pre-enriched fat graft with ex vivo expanded autologous ASCs has been demonstrated to reduce fat reabsorption in patients with contour deformities [ 94 ] and to improve breast volume in retention in patients undergoing surgery for breast augmentation [ 95 ]. Despite further additional studies and clinical trials being needed, available data seem to demonstrate the efficacy and safety of ASCs supplementation in order to obtain better results and improvements in FG.…”

Comparison of the Effect of Suction-Assisted Lipectomy Devices on Survival of Adipose Tissue Graft

“…A significant portion of grafted fat (up to 70%) is absorbed after transplantation, making the outcomes less satisfactory. 2 , 3 The unpredictable absorption of grafted fat has led to harvesting and processing procedures being revised to improve fat grafting outcomes. 4 Similarly, fat graft pre-enrichment strategies have been suggested to enhance the survival of grafted fat.…”

“…4 Similarly, fat graft pre-enrichment strategies have been suggested to enhance the survival of grafted fat. 3 The fat harvesting procedure, as the first step in fat grafting, is of prime importance, however, and requires careful evaluation.…”

“…Fat graft survival is usually assessed by measuring the percentage retention of grafted fat by magnetic resonance imaging (MRI) or B-mode ultrasound. 3-5 Hsiao et al, however, measured the final survival of grafted fat by sectioning implanted graft and excluding the area occupied by vacuoles. This may represent the survival of individual cells in a specific portion of graft but not survival of fat grafts as a whole.…”