Strategic Sequences in Fat Graft Survival

Abstract

Although lipotransfer, or fat grafting, is a commonly used procedure in aesthetic and reconstructive surgery, there is still variability in graft survival and neoadipogenesis from one procedure to the next. A better understanding of the sequential molecular events occurring with grafting would allow us to strategize methods to improve the regenerative potency of the grafted tissue. These steps begin with an autophagic process, followed by the inclusion of stromal vascular fraction and matrix components. By tailoring and modifying each of these steps for a particular type of aesthetic or reconstructive procedure, strategic sequencing represents a dynamic approach to lipotransfer with the aim of maximizing adipocyte viability and growth. In the implementation of the strategic sequence, it remains important to consider the clinical viability of each step and its compliance with the US Food and Drug Administration regulations. This review highlights the basic science behind clinically translatable approaches to supplementing various fat grafting procedures.

Phenotypic Analysis of Stromal Vascular Fraction after Mechanical Shear Reveals Stress-Induced Progenitor Populations

“…23 Our unique combination of phenotypic markers for the identification of ADSCs, EPCs, pre-adipocytes and pericytes (Table 1) is based on the findings of Zimmerlin et al 25 and those most commonly cited in the literature. 11,12 Currently, we are exploring various potential mechanisms of regenerative action including the contributions that autophagy, 26 microparticles and extracellular matrix play in the induction of these progenitor populations. Ultimately, we will assess whether siSVF leads to improved fat graft retention in an animal model of cell-assisted lipotransfer.…”

Self‐synthesized extracellular matrix contributes to mature adipose tissue regeneration in a tissue engineering chamber

“…Adipose tissue flaps with independent vascular pedicles placed in chambers were implanted into rabbits. Adipose volume increased significantly during the observation period (week 1,2,3,4,16). Histomorphometry revealed mature adipose tissue with signs of adipose tissue remolding.…”

“…It can also be used for achieving aesthetic treatment goals such as rejuvenation, and for treating other conditions. [3][4][5] Autologous fat is considered ideal for soft tissue augmentation because it is biocompatible, versatile, naturallooking, nonimmunogenic, inexpensive, and readily obtainable with low donor site morbidity. 6,7 However, the graft survival rate remains unpredictable and often low, with resorption rates ranging from 25% to 80%.…”

“…Lipotransfer is used in breast reconstruction after cancer treatment, and is also used to treat burn scars, congenital malformations, and posttraumatic malformations. It can also be used for achieving aesthetic treatment goals such as rejuvenation, and for treating other conditions …”

Nanofat-derived stem cells with platelet-rich fibrin improve facial contour remodeling and skin rejuvenation after autologous structural fat transplantation

“…Immediate access to the blood supply is crucial for transplant survival in the early stages of recovery. Studies show that an abundance of adipose-derived stem cells (ASCs) in the stromal vascular fraction (SVF) of liposuction aspirates can enhance survival rates by increasing blood supply in fat transplants [ 11 – 13 ]. The clinical success of nanofat in skin rejuvenation procedures, which was first reported in 2013, may also depend on the presence of stem cells [ 14 ].…”