Improved Adipocyte Viability in Autologous Fat Grafting With Ascorbic Acid–Supplemented Tumescent Solution

Abstract

Introduction In reconstructive surgery, fat volume augmentation is often necessary for esthetic or functional reasons. As an alternative to synthetic and xenogeneic materials, autologous fat grafting (AFG) based on liposuction is gaining popularity, yet successful transplantation and long-term volume maintenance are difficult. Standard tumescent solution formulations neglect adipocyte and stromal vascular fraction (SVF) cell survival during extraction, as well as SVF differentiation into adipocytes thereafter, all of which are crucial for the success of AFG. Here we hypothesized that addition of ascorbic acid (AA) to the tumescent solution could prevent liposuction-induced cell damage. Materials and Methods The effect of 0.1 mmol/L AA in tumescent solution was investigated in a previously described ex vivo model of AFG. Briefly, excision fat was infiltrated with tumescent solution, with or without AA, and incubated for 20 minutes at 37°C. Hand-assisted liposuction was then performed with a blunt cannula. Total cell viability, clonogenicity, and differentiation capacity of the SVF cells were assessed. Results With AA, 10.3% more cells and in particular 14.9% more adipocytes survived liposuction. Clonogenicity, adipocyte and osteoblast differentiation by SVF cells remained unchanged. Conclusions Addition of AA successfully improved survival of adipocytes during liposuction without affecting SVF growth and differentiation. This study therefore identified a useful supplement to the tumescent solution which may lead to improving AFG success.

Increased Total Antioxidant Capacity Value Improves Survival of Fat Grafts in Rat Model

“…34–38 Vitamin C was found to increase survival of adipocytes but not stromal vascular fraction cells, whereas vitamin E improved radiation-induced fibrosis and remaining fat graft volumes. 39,40 Melatonin has been shown to have antioxidant properties in several studies, and local use of melatonin in lipoaspirate has been demonstrated to increase fat graft volume by reducing inflammation. 10,14,41,42 The effects of zinc on fat graft survival are currently unknown, as studies have focused on its effects on flap viability.…”

Experimental study: effects of folic acid, vitamin C, and vitamin E on fat graft survival

“…2 Similarly, the antioxidative properties of Vitamin C (ascorbic acid), coupled with its participation in collagen synthesis, likely played a pivotal role in tissue repair, attenuating oxidative stress, and consequently supporting graft viability. 3 In a comparable vein, the pronounced antioxidative capacity of vitamin E (α-tocopherol) appeared to confer a protective shield against oxidative damage and inflammation, both recognized factors with the potential to curtail graft longevity. 4 This present study embarked on the task of unraveling the potential benefits offered by folic acid, ascorbic acid, and α-tocopherol in enhancing the survival and viability of fat grafts.…”

“…By mitigating oxidative stress and supporting tissue repair mechanisms, vitamin C could contribute to graft integrity and function preservation. 3 Similarly, vitamin E, another potent antioxidant, may offer protection against oxidative damage and inflammation, potentially safeguarding grafted adipose tissue from early resorption. 4 With these promising attributes, this study delves into the existing literature regarding the effects of folic acid, ascorbic acid, and α-tocopherol on fat graft survival, aiming to bridge the gap between theoretical advantages and practical clinical application.…”

Analysis of Fat Graft Survival and Platelet-Rich Plasma Effects: The Transcriptomic Differences

“…Fat graft loss after transplantation is a significant concern. It varies between 30% and 70% in different studies [ 1 - 3 ]. Only studies with trial-and-error methods have been employed to match the reason for fat graft loss.…”

“…Only studies with trial-and-error methods have been employed to match the reason for fat graft loss. To address the fat graft survival problem, studies that try different tumescent solution ingredients or that use various additives, cannulas, purification methods, or enrichment with stem cells have been published and declared to have varying success rates [ 1 - 3 ]. However, a clear etiology remains a mystery.…”