Background: The ageing process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss and tissue descent, wrinkles deepen, and loss of skin structure and quality. Recently, several studies proved the efficacy of therapies based on the autologous adipose tissue grafting that leverages the properties of stromal vascular fraction (SVF) and adipose derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aimed to verify the ability of the guided Superficial Enhanced Fluid Fat Injection (SEFFI) in the facial area to correct volume loss and skin aging and proved the very low rate of complications of this standardized procedure . Methods: we retrospectively collected data from 2,365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. Results: SEFFI was used alone in more than 60% of the patients, and in all face areas. In about one tenth of patients SEFFI was combined with botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent event, and yet observed in only 14.2% and 38.6% of patients, respectively. Conclusions: The SEFFI technique is standardized and minimally invasive, leading to very few complications. It can be a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

Background: The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. Methods: We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. Results: guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively. Conclusions: The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

Therapies based on the autologous grafting of adult mesenchymal stem cells (MSC) are known to effectively accelerate the skin's healing and the regenerative processes of mesenchymal tissues. [1][2][3] Regenerative medicine mostly uses adipose-derived stem cells (ADSC), which are pluripotent adult progenitor cells derived from embryonic connective tissue. 3,4 Adipose tissue is found throughout the adult human body in bone marrow, adipose tissue, muscle, and dermis. 3,4 ADSC share similar characteristics with bone marrow mesenchymal cells. Still, they have some advantages, including their easy availability and harvesting through a less invasive surgical procedure. 3,[5][6][7] Compared with the bone marrow, the adipose tissue is richer in adult MSCs and stromal components (the stromal vascular fraction [SVF]). 6,7 ADSC have the potential to differentiate into mesodermal cells (e.g. adipocytes, cartilage, bone, and skeletal muscle) and cells of non-mesodermal lineage (e.g. neurons, cardiomyocytes, and vascular endothelial cells). 3,6,7 Moreover, ADSC can release trophic and soluble factors with anti-fibrotic, anti-apoptotic, and pro-angiogenic properties that provide ADSC with regenerative and immune-modulatory activities. 3,7 The ADSCs regenerative and anti-inflammatory properties currently find therapeutic applications in various medical fields including, but not limited to, reconstructive and esthetic surgery