Effect of Washes and Centrifugation on the Efficacy of Lipofilling With or Without Local Anesthetic

Abstract

Background:Among the different parameters that influence fat graft survival and lipofilling success, the use of local anesthetic and the way to process the fat before injection have often been pointed out. Likewise, we evaluated different techniques for processing adipose tissue before its injection and analyzed the quality of the grafts.Methods:Adipose tissue from the same patient was gently harvested from one side of the abdomen after infiltration of a tumescent solution without lidocaine and from the other side of the abdomen using a tumescent solution containing lidocaine 2%. Harvested tissue was prepared with different protocols, from simple decantation to advanced protocols including single or multiple washes and centrifugations. Each type of processed adipose tissue was then injected subcutaneously into immunodeficient mice. Adipose grafts were collected after 1 month and analyzed by histology with a detailed scoring method.Results:After lidocaine use, decantation protocol led to adipose grafts of poor quality with high resorption rate and oil vacuole formation. Larger grafts were obtained after centrifugation, but centrifugation alone resulted in increased fibrosis and necrosis, with or without the use of lidocaine. Finally, multiple washes and centrifugations greatly improved the quality of the lipografts.Conclusions:Centrifugation alone is not sufficient and must be associated with multiple washes to improve graft quality. This article aims to provide further evidence of lidocaine and washing/centrifugation effects in fat grafting to provide easy tips aimed at ensuring graft efficiency with a long-term clinical outcome.

Evaluation of a Single Intra-Articular Injection of Autologous Adipose Tissue for the Treatment of Osteoarthritis: A Prospective Clinical Study in Dogs

“…After removing the subnatant liquid, 25 mL of harvested tissue was transferred into a 50-mL tube, rinsed with 25 mL of Ringer lactate, then centrifuged (100 g for 1 second); this step was repeated twice, followed by a final wash and a soft centrifugation (400 g for 1 minute). 11 After each step, the oil supernatant and the lower liquid phase were discarded and ultimately only the intermediate layer, which potentially contained both adipose-derived stem cells and adipose tissue-derived stromal vascular fraction, 8 was transferred into 2-mL syringes. Aspiration of joint fluid from the elected joint confirmed proper needle placement (21-gauge needle).…”

Comparative technical analysis of lipoaspirate mechanical processing devices

“…But even if only mechanical treatments are considered, the various processing methods have a different impact on the integrity of the tissue, both in terms of cellular content and viability before and after processing. There are numerous papers in the literature that compare different processing techniques (Ansorge et al, 2014;Botti, Pascali, Botti, Bodog, & Cervelli, 2011;Butterwick, 2002;Canizares et al, 2017;Condé-Green, de Amorim, & Pitanguy, 2010;Condé-Green et al, 2013;Fisher et al, 2013;Girard et al, 2015;Hivernaud et al, 2017;Hoareau et al, 2013;Khater, Atanassova, Anastassov, Pellerin, & Martinot-Duquennoy, 2009;Mashiko et al, 2017;Minn, Min, Chang, Kim, & Heo, 2010;Palumbo et al, 2015;Pfaff, Wu, Zellner, & Steinbacher, 2014;Ramon et al, 2005;Rohrich, Sorokin, & Brown, 2004;Rose et al, 2006;Salinas et al, 2014;Smith et al, 2006;Zhu et al, 2013), but we have not found feedback for the mincing and pureeing procedures. It should be added that the same methods can be different according to the way they are used by the operators and/or implemented in the processing devices.…”

“…Coleman technique remains the gold standard for liposuction and lipofilling, but several studies have investigated the possibility to modify centrifugation parameters, in particular, reducing speed, because even the centrifuging technique is not always considered a minimal tissue manipulation technique. In fact, an excessive magnitude of centrifugal force can cause the rupture of the superficial fragile adipocytes and a loss of viability of ASCs (Bellini et al, 2017;Canizares et al, 2017;Coleman & Katzel, 2015;Galiè, Pignatti, Scambi, Sbarbati, & Rigotti, 2008;Girard et al, 2015;Palumbo et al, 2015;Strong et al, 2015).…”

“…Various processing techniques have been designed as an alternative to centrifugation (Brzezienski & Jarrell, 2016;Canizares et al, 2017;Cleveland et al, 2015;Gabriel et al, 2017;Gal et al, 2019;Hivernaud et al, 2015;Tremolada et al, 2016). Others have been conceptualized as complementary to a reduced speed centrifugation (Boureaux et al, 2016;Cleveland et al, 2015;De Francesco et al, 2018;El-Sabbagh, 2017;Girard et al, 2015;Hanson et al, 2019;Hivernaud et al, 2015;Osinga et al, 2015;Strong et al, 2015). Numerous devices have been produced and marketed, each implementing one or more processing methods.…”

“…Numerous studies have been carried out to compare various devices (Aronowitz et al, 2015;Cleveland et al, 2015;De Francesco et al, 2018;Domenis et al, 2015;Gal et al, 2019;Gentile et al, 2015;Hivernaud et al, 2015;Hivernaud, Lefourn, Robard, Guicheux, & Weiss, 2017;Osinga et al, 2015;Tremolada et al, 2016) and various processing techniques (Aronowitz et al, 2015;Boureaux et al, 2016;Canizares et al, 2017;Cleveland et al, 2015;El-Sabbagh, 2017;Gabriel et al, 2017;Gal et al, 2019;Gentile et al, 2015;Girard et al, 2015;Gupta et al, 2015;Hivernaud et al, 2017;Mashiko et al, 2017;Osinga et al, 2015;Palumbo et al, 2015;Simonacci et al, 2017;Strong et al, 2015;Zielins et al, 2016). These studies are not exhaustive because they compare a limited number of devices and/or different methods from a biological and/or clinical point of view, but often with nonuniform or standard evaluation parameters.…”