Liporecycling: A Technique for Facial Rejuvenation and Body Contouring

BACKGROUND: Soft tissue augmentation using autologous fat is a standard method in facial rejuvenation and in refinement of body contouring. Different procedures by different authors have been described, each with its specific advantages and disadvantages. OBJECTIVE: The purpose of this article is to describe a method of harvesting, processing, and reinjection of fat that provides new aspects and advantages compared to previously described procedures. METHODS: We report about a new method of autologous fat grafting. Fat is harvested during machine-assisted liposuction in tumescent local anesthesia with microcannulas, processed in a special open manner, and reinjected through a 24-gauge needle for intra- and subdermal augmentation. RESULTS: Short- and long-term results are equivalent to other methods of fat cell grafting. CONCLUSION: Advantages of the described method include easy harvesting during conventional machine-assisted liposuction, the possibility of removing undesired bands of fibrous tissue from the graft, and easy passage through a 24-gauge needle. Thus sub- and intradermal augmentation is possible with the same material and syringe.     

Cryopreservation of mature human adipocytes: in vitro measurement of viability

Cryopreservation of fat grafts for autologous fat transplantation renders repeated harvesting procedures unnecessary. Anecdotic reports have been published, yet data about adipocyte survival are sparse. The beneficial effect of added cryoprotective agents (CPA) is known from other tissues but has not been investigated in adipocytes. Fat cells were harvested using the Coleman method (n = 24). Tests were done after 0, 2, 7, 14, and 30 days of cooling to -20 degrees C and -80 degrees C and after addition of various CPA. Analysis included cell stains, measurement of metabolic activity by MTT and XTT tests, and measurement of cell stability by assessment of extracellular glycerol-3-phosphate-dehydrogenase enzyme. After freezing, up to 92.7% of metabolic activity was lost, but the addition of CPA led to preservation of up to 54% of baseline activity. Also, lower storage temperature showed more cell destruction but yielded higher viability of the surviving cells. Our results implicate that the widely used practice of simple storage in a freezer leads to reinjection of nonviable tissue. Cell survival can be improved by addition of CPA.     

The effect of different factors on the survival of transplanted adipocytes

Most authors supported the theory of adipocyte survival. The viability of these cells has been demonstrated by various experimental clinical, radiological and biochemical studies. After a review of the literature, the authors report the various factors, which influence the survival of the transplanted adipocytes. These factors are presented according to their chronology in the operative procedure. The techniques used are very diverse. The reference technique chosen is that described by Coleman (Lipostructure). The following factors are studied: type of anaesthesia, infiltration, donor site of adipose tissue, method of harvesting, method of refining adipose tissue, anabolic complements, receiving site, reinjection technique, number of grafting sessions, freezing of adipose tissue and complementary postoperative treatments. It seems imperative that each phase of the operative procedure should be carried out without damage to the adipocytes, in particular their harvesting, refining and reinjection. All the other factors studied require comparative analysis in order to demonstrate their true importance. This opens up various directions of research aiming to improve the survival of the transplanted adipocytes.     

新鲜分离的脂肪SVF细胞促进脂肪移植存活的实验研究

目的 探讨应用自脂肪组织新鲜分离的血管基质层细胞辅助脂肪移植,提高移植物存活率的可行性.方法 将0.5 ml待移植的脂肪颗粒分别与下列细胞混合:①DiI标记的新鲜分离的自体血管基质层细胞(A组);②DiI标记的培养至第4代自体脂肪来源干细胞(B组);③DMEM完全培养基(C组),随机注射移植于14只新西兰兔背部皮下.术后观察:①湿重;②切片HE染色计数血管密度;③方网测试系统"点计数"法检测存活脂肪细胞计数以及纤维组织计数;④荧光显微镜检测DiI标记的细胞在体内的分化转归.结果 ①湿重:A组(291.0±72.1)mg,B组(269.3±67.3)mg,C组(177.8±60.0)mg,A、B两组脂肪存活率均高于C组(P<0.05),两组之间比较差异无统计学意义(P>0.05);②血管密度:A、B两组血管密度均高于C组(P<0.05),两组之间比较差异无统计学意义(P>0.05).③点计数:A、B两组存活脂肪细胞计数均高于C组(P<0.05),纤维组织计数均低于C组(P<0.05),两组之间比较差异均无统计学意义(P>0.05);④荧光显微镜下观察发现自体血管基质层细胞与自体脂肪来源干细胞在体内均可向血管内皮细胞分化.结论 自体血管基质层细胞与培养的自体脂肪来源于细胞均可提高脂肪移植物存活率,但前者操作更方便,安全性更高,具有广阔的临床应用前景.     

Searching for the Favorable Donor Site for Fat Injection: In Vivo Study Using the Nude Mice Model

BACKGROUND: The use of suctioned fat grafts for correction of soft tissue defects is a widespread procedure in esthetic and reconstructive surgery. The main disadvantage of this simple and sensible procedure is the unpredictable absorption rate of the fat graft. A lot of research has been performed aiming for enhancement of the take of the fat grafts. OBJECTIVE: Our study was performed to find if there is any favorable donor site for fat harvesting. METHODS: This in vivo experiment using the nude mice model enables the study of the long-term survival of human fat in an animal model. The fat was harvested from three donor areas: the thigh, abdomen, and breast of a 48-year-old woman who came for an elective esthetic procedure. After centrifugation, 1 cc of fat was injected subcutaneously into the scalp of the nude mouse. There were 15 mice in each of the three groups, according to the selected donor sites. The animals were sacrificed 16 weeks after the procedure. The extracted fat was evaluated in terms of weight, volume, and six histologic parameters: integrity, vascularization, cyst formation, fibrosis, necrosis, and inflammation. RESULTS: This study could not find any statistically significant differences between the three investigated donor sites in the evaluated parameters. CONCLUSION: On the basis of this study, there is no favorable area for harvesting fat grafts. The donor site can be chosen according to the preference of the surgeon and the patient.     

The Effect of Epidermal Growth Factor on Autogenous Fat Graft

Autogenous fat grafting is widely used for the correction of soft tissue contour deformity. However, the high absorption rate results in the need for overcorrection, and graft longevity is unpredictable. The authors hypothesized that epidermal growth factor (EGF), a potent stimulator of neovascularization, would improve fat graft survival. The experiment used two groups of New Zealand White Rabbit ear. Inguinal fat was harvested and injected with EGF or saline (n = 24, each group). The 48 cases of fat grafting were managed for observation of volume and morphologic change. The fat was harvested 3 months after the autogenous graft. The survival rate and the degree of neovascularization were measured. The grafts in the EGF group had a significantly higher survival rate than those in the control group. Histologic examination of the grafts demonstrated an increase in neovascularization and maintenance of fat cell morphology. These findings show that EGF can enhance fat graft survival and degree of neovascularization. Further well-controlled studies are required before EGF is used for clinical purposes.     

Fat injection: a 20-year revision

In the last 20 years, several different techniques of lipoinjection have been developed. Nevertheless, a standard procedure has not been adopted by all practitioners. There is no agreement as to the best way of processing the fat to ensure maximal take and viability of the graft. Other controversial issues include the ideal cannula for harvesting and reinjection, the presence of blood in the transplanted fat, trauma, air exposure, contamination of the graft, durability, and fat cell survival. Newly emerging approaches to fat tissue engineering with the use of cultured autologous preadipocytes may improve the technique of fat injection and transplant.     

Fat Transfer Techniques: The Effect of Harvest and Transfer Methods on Adipocyte Viability and Review of the Literature

BACKGROUND: Autologous fat transplantation is an excellent tool for filling defects and augmenting tissue. The literature provides a variety of reports with varying degrees of success or failure. The procedure is operator dependent and relies on the techniques of harvesting, cleansing, and reinjection. OBJECTIVE: To evaluate various retrieval and reinjection techniques to see their effect on the viability of the fat cells. METHODS: Fat was removed from five patients utilizing various cannulas, needles, suction pressures, and centrifugation for collection and reinjection. Preoperative external ultrasound and massage were evaluated as well as the use of the ratchet gun for injection. The fat was routinely cleansed of blood and tumescent solution products by means of washing with normal saline and then decanting repeatedly until the infranatant solution was clear. RESULTS: Histologic examination of the fat cells showed the central core of fat and edges of the core had 98-100% intact cells (presumably viable) in every specimen except when -700 mmHg vacuum was used for fat collection where cell damage was greater than 10% and when preoperative massage was performed where cell damage was 30%. Preoperative external ultrasound did not appear to damage the fat cell but did disrupt some of the fibrous tissue holding the fat cells in large bundles. CONCLUSION: The variety of techniques used to collect, clean, and reinject fat do not damage the fat cells except for the collection of fat at -700 mmHg vacuum. External ultrasound, preoperatively, does not destroy fat cells but produces smaller bundles of fat. The ratchet gun does not result in increased fat cell loss. Preoperative massage causes 30% cell loss and deformation of 80% of the remaining cells.     

A novel and innovative technique of using a disposable syringe and mesh for harvesting fat for structural fat grafting

Background:Successful restoration of structure and function using autologous free fat grafts has remained elusive. Review of literature shows that various harvesting and preparation techniques have been suggested. The goal of these techniques is to obtain greater adipocyte cell survival and consequently more reliable clinical results.Results:By using a polypropylene mesh in our technique, we can separate the transfusate from the harvested fat graft during harvesting itself. The fat graft thus obtained is dense and concentrated, with fewer impurities.Conclusion:Hence, we recommend our technique as a reliable method for extracting sterile emulsified fat in an economical way.KEY WORDS: Centrifugation, emulsified fat, fat grafting, liposuction aspiration, mesh     

Permanent lip augmentation with serial fat grafting

A simple technique for lip augmentation with autologous fat is presented. Local anesthesia is injected into those areas used for fat harvesting and the perioral areas that are to receive the grafts. The fat is taken with a large needle and syringe, washed over meshed gauze, placed into the syringe, and injected into the lip tissue. Multiple passes with a small needle deposit the strained fat in horizontal tunnels within the lips. Subsequent injections are performed at a minimum of 3 months. Lip swelling is short lived and permanent lip augmentation occurs when patients undergo two to three grafting procedures.     

Fat Grafting Versus Adipose-Derived Stem Cell Therapy: Distinguishing Indications, Techniques, and Outcomes

With adipose-derived stem cells (ASCs) at the forefront of research and potential clinical applications, it is important that clinicians be able to distinguish them from the fat grafting currently used clinically and to understand how the two approaches relate to one another. At times, there has been confusion in clinically considering the two therapies to be the same. This report is aimed at distinguishing clearly between fat grafting and ASC therapy with regard to the indications, harvesting, processing, application techniques, outcomes, and complications. Findings have shown that autologous fat transfer, a widely used procedure for soft tissue augmentation, is beneficial for reconstructive and cosmetic procedures used to treat patients with volume loss due to disease, trauma, congenital defects, or the natural process of aging. On the other hand, ASCs have been identified as an ideal source of cells for regenerative medicine, with the potential to serve as soft tissue therapy for irradiated, scarred, or chronic wounds. Recent advances in tissue engineering suggest that the supplementation of fat grafts with ASCs isolated in the stromal vascular fraction may increase the longevity and quality of the fat graft. Research suggests that ASC supplementation may be a great clinical tool in the future, but more data should be acquired before clinical applications.     

Autologous fat transplantation employing liposuction techniques

Patients with minor to extensive contour defects continue to present a challenge to plastic surgeons. Surgical techniques that were previously used are often associated with a high degree of morbidity and complications. Past experience with fat transplantation has been combined with the latest advances in fat harvesting methods. The patient described in this article had a breast augmentation for symmetry and soft-tissue correction after breast reconstruction following mastectomy. Using fat removed by liposuction, autologous tissue was transplanted by transcutaneous injection. To date, our follow-up on this patient is almost 3 years. Excellent aesthetic results and volume augmentation have been maintained.     

Ex vivo fat graft preservation: effects and implications of cryopreservation

There are a variety of recommended methods for harvesting, treating, and utilizing autologous fat grafts. Previous work with the MTT assay illustrated that various preimplantation handling techniques had minimal effect on the viability of fat samples. This assay was used to test the viability of harvested fat samples after being stored for up to 8 days in a variety of conditions. Surprisingly, freezing the fat before assaying also had no measurable detrimental effect, which led us to study this phenomenon in greater detail. The results demonstrated that fat stored at subzero temperatures showed remarkable maintenance of their mitochondrial metabolic activity as compared with fat stored in a 32 degrees C incubator. These data suggest exciting possibilities for storage and banking of human adipose tissue, which would reduce patient cost, discomfort, and time associated with multiple grafting procedures.     

Comparison of AlloDerm, fat, fascia, cartilage, and dermal grafts in rabbits

OBJECTIVE: To compare various graft materials in the rabbit model, including autologous cartilage, dermal tissue, fat, and AlloDerm (a cadaver-derived material). METHODS: Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts. RESULTS: The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption. CONCLUSIONS: The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.     

Bone harvesting from the iliac crest

BACKGROUND: Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation. Although an autologous bone transplant does improve the local bone healing potency, significant donor site morbidity must be considered. METHODS: In this study we elucidate special bone harvesting techniques from the iliac crest and review the literature related to clinical significance of donor site morbidity. Furthermore, our own experiences are compared and discussed critically with relevant data of other investigators. RESULTS: The increasing number of scientific publications which focus on bone harvesting techniques and related complications in recent years indicate the high interest and relevance of this issue. There is a tendency to alternatives such as biomaterials as bone substitutes, whereas the role of growth factors and cell therapeutics in the treatment of bony defects are still being evaluated in clinical studies. CONCLUSION: Although autologous, heterotopic bone transplantation is still the gold standard in the treatment of bony defects, there is a tendency towards the application of biomaterials, stem cells, and growth factors. Conscientious observation of relevant anatomic considerations during bone harvesting procedures may help to avoid complications.     

The Role of Frozen Storage in Preserving Adipose Tissue Obtained by Suction-Assisted Lipectomy for Repeated Fat Injection Procedures

BACKGROUND: The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures. OBJECTIVE: To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures. METHODS: Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at -18 degrees C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection. RESULTS: Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined. CONCLUSION: Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.     

Successful Correction of Depressed Scars of the Forehead Secondary to Trauma and Morphea en coup de sabre by en bloc Autologous Dermal Fat Graft

BACKGROUND: Atrophic scars of the forehead can result from various pathologic processes including morphea en coup de sabre as well as trauma. A variety of surgical techniques can be used to correct these atrophic scars. OBJECTIVE: Soft tissue augmentation for correction of atrophic scars of the forehead using en bloc autologous dermal fat graft. METHODS: Use of en bloc autologous dermal fat graft harvested from the hip and inserted into a pocket created under the atrophic scar in two patients with depressed scars of the forehead. RESULTS: Overcorrection of the scars with en bloc autologous dermal fat grafts resulted in the treated areas becoming level with the adjacent skin within 3 months. Follow-up for a period of 12 months showed a perfectly level and stable graft with no further resorption. CONCLUSION: En bloc autologous dermal fat grafting appears to be a safe technique that provides excellent cosmetic results for the correction of small to medium depressed scars of the forehead.     

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells

Background Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. Methods To overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. Results Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. Conclusions The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further. Partially presented at the 3rd annual meeting of the International Fat Applied Technology Society (IFATS), Charlottesville, Virginia, 11 September 2005, and the 8th annual meeting of Tissue Engineering Society International (TESI), Shanghai, China, 23 October 2005.     

Fat injection

The results of grafts of fat obtained through liposuction are presented. They are the outcome of the current revitalization of the old technique of fat extraction and transplant. Both doctor and patient should be aware that a successful treatment is achieved through continuity. Fat grafts evolve with respect to time and permanence with reabsorption a part of the normal evolutionary process. Fat reinjection is a consequence of tissue reabsorption or a complement of the preceding injection. There is no complication associated with repeated reinjection. All cases reported here include patients with two or more reinjections, depending on their pathology and evolution.