Regenerative Cells For Facial Surgery: Biofilling and Biocontouring

Abstract

Zuk et al in 2001 identified stem and regenerative cells within the stromal vascular fraction of fat. In preclinical studies, these cells appeared to stimulate angiogenesis and reduce inflammation, and soon thereafter, clinical use of stromal vascular fraction (SVF) evolved as researchers such as Rigotti, Coleman, Mojallal, our group, and others demonstrated that fat can be used for both therapeutic and aesthetic indications. The regenerative effects of fat and its contents on facial aesthetics have been shown at the histologic and cellular level. Regeneration of elastin and collagen fibers as well as improvement in capillary density and reduction of inflammation have been reported. We review our current approach to the use of regenerative cells and different types of fat grafts in facial surgery. The fat graft is classified, both from a regenerative point of view as well as a tissue product that can be modified into different tissue characteristics, depending on the area and condition treated. Clinical use of SVF enriched fat, millifat, microfat, and nanofat grafts as well as composite fat grafts are reviewed. Based on clinical experience and evidence to date, it appears that the regenerative effects seen with the use of SVF in aesthetic surgery are modest, but there appear to be definite histologic findings of regeneration. These improvements may not be clinically apparent to a patient when cell enriched fat grafts are compared to fat grafts alone. However, the subtle changes seen in histology may be cumulative over time. Three types of fat grafts are defined: millifat (parcel size 2.4<), microfat (1.2<), and nanofat (400-600 μm). Each are characterized by their injectability ratings and emulsification parcel size as well as amount of sSVF cells. Newer concepts of periosteal fat grafting, buccal fat pad grafting, pyriform aperture fat grafting, intraorbital fat grafting, and nanofat grafting are discussed. Composite fat grafts are presented as a new concept as is biofilling and biocontouring. The use of regenerative cells in facial surgery is evolving rapidly. Our understanding of the anatomic changes that occur with aging has become more precise and our ability to target histologic changes seen with aging has become more effective. Deep fat compartment grafting, superficial fat grafting, nanofat, and SVF are becoming important components of contemporary facial rejuvenation. The use of regenerative approaches in facial rejuvenation is a logical step in changing the paradigm from surgical treatment of aging to a more proactive prevention and maintenance approach that keeps up with changes in the tissues as they age.

Facial aesthetic fat graft retention rates after filtration, centrifugation, or sedimentation processing techniques measured using three-dimensional surface imaging devices

“…In recent years, adipocyte-derived stem cells, platelet-rich plasma (PRP), and stromal vascular fraction (SVF) have been widely used for both therapeutic and esthetic indications because of their capacity for angiogenesis and wound healing. [39] Many studies have investigated the effects of cell-assisted fat grafting on increasing fat survival. Sasaki et al [21] reported a prospective study of 236 patients in 4 groups using conventional fat grafting, PRP-assisted fat grafting, SVF-assisted fat grafting, and PRP/SVF-assisted fat grafting.…”

Intraoperative Strategies for Minimal Manipulation of Autologous Adipose Tissue for Cell- and Tissue-Based Therapies: Concise Review

“…The technique referred as “Injectable Tissue Replacement and Regeneration—ITR 2 ” is designed to replace and regenerate losses in deep and superficial fat compartments, bone, skin as well as in capillary density, elastin, and collagen tissues . Candidates for the procedure are patients having different types of facelifts who have associated volume loss and patients having laser therapies, where skin damage with thinning of the dermis and epithelium, fat, and bone loss has occurred.…”

Review of Plastic Surgery Biomaterials and Current Progress in Their 3D Manufacturing Technology

“…For the problem of self-absorption, it may be necessary to perform another operation [ 81 ]. The clinical application of autologous fat is not only used for routine cosmetic treatment, such as wrinkle removal but also widely used for congenital defects, trauma, or reconstruction of surgically removed tissues, such as breast collapse after breast tumor surgery [ 82 ] and soft tissue deficiency after maxillofacial surgery [ 83 ].…”