High-Density Fat Grafting Assisted Stromal Vascular Fraction Gel in Facial Deformities

Zhe Cao, Hui Li, Zhen Hua Wang, Xiao-Qin Liang, Zhe Cao, Hui Li, Zhen Hua Wang, Xiao-Qin Liang

Abstract

Autologous fat grafting is commonly used for soft tissue augmentation and reconstruction, this technique is limited by a high rate of graft absorption. The stromal vascular fraction gel (SVF-gel) grafting for facial volume augmentation can exert a positive effect on skin rejuvenation, but its major limitation is the low rate of conversion of Coleman fat. The purpose of our study was to investigate a novel surgery using performing high-density fat in combination with SVF-gel in the treatment of hemifacial atrophy, or Romberg diseases. From October 2017 to October 2019, 13 patients with hemifacial atrophy underwent high-density fat transfer with SVF-gel injection. The outcome was determined by the difference in presurgery and postsurgery FACE-Q modules (FACE-Q conceptual framework: 1, Satisfaction with Facial Appearance; 2, Health-Related Quality of Life; 3, Negative Sequelae; 4, Satisfaction with Process of Care), which were designed as patient-reported outcome instrument to evaluate the unique outcomes of patients undergoing facial cosmetic procedures.The excellent cosmetic results were observed during follow-up periods, with no adverse events was seen in the treatment group. All patients showed improvements in facial augmentation and contour. In patients with facial volume loss, high-density fat transfer with SVF-gel facial injection resulted in significantly higher improvement scores and better patient satisfaction. The patient-reported FACE-Q modules presurgery and postsurgery results showed statistically significant improvement (P < 0.05). This high-density fat in combination with SVF-gel is an effective method of correcting the facial volume loss that leave no complications during follow-up, having a satisfactory volumization effect. This could largely facilitate the clinical utilization of fat.

Conflict of interest statement

The authors report no conflicts of interest.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.

Figures

FIGURE 1
FIGURE 1
Procedure for processing high-density fat and SVF-gel. (A) Sediment fat. (B) Coleman fat. (C) SVF-gel. (D) High-density fat. HF, high-density fat; LF, low-density fat. Li, liquid; Oi, oil; SVF-gel, stromal vascular fraction gel.
FIGURE 2
FIGURE 2
A woman patient with hemifacial atrophy underwent high-density fat grafting procedure with SVF-gel technique. (A-C) Front view, oblique view of preoperative face. (B-D) Front view, oblique view of the face 10 months after the surgery. The patient was without a second fat graft. SVF-gel, stromal vascular fraction gel.
FIGURE 3
FIGURE 3
Patient with hemifacial atrophy had high-density fat in combination with SVF-gel for the cheek filling. (A) Front view of preoperative face. (B) Front view of the face 14 months after the surgery. The patient was without a second fat graft. SVF-gel, stromal vascular fraction gel.
FIGURE 4
FIGURE 4
Patient with mild hemifacial atrophy had high-density fat in combination with SVF-gel for the fullface filling. (A) Front view of preoperative face. (B) Front view of the face 12 months after the surgery. The patient was without a second fat graft. SVF-gel, stromal vascular fraction gel.
FIGURE 5
FIGURE 5
The result of FACE-Q scores comparing preoperative and postoperative psychological function, facial appearance and social function (P < 0.05). Data represent group means with minimum and maximum scores.

References

    1. Pu LLQ. Fat grafting for facial rejuvenation and contouring: a rationalized approach. Ann Plast Surg 2018; 81: (6S Suppl 1): S102–S108.
    1. Ohashi M. Fat grafting for facial rejuvenation with cryopreserved fat grafts. Clin Plastic Surg 2020; 47:63–71.
    1. Yang X, Wu R, Bi H, et al. . Autologous fat grafting with combined three-dimensional and mirror-image analyses for progressive hemifacial atrophy. Ann Plast Surg 2016; 77:308–313.
    1. Ibrahiem SMS, Farouk A, Salem IM. Facial rejuvenation: serial fat graft transfer. Alexandria J Med 2016; 52:371–376.
    1. Ross RJ, Shayan R, Mutimer KL, et al. . Autologous fat grafting current state of the art and critical review. Ann Plast Surg 2014; 73:352–357.
    1. Rigotti G, Marchi A, Galie‘ M, et al. . Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose derived adult stem cells. Plast Reconstr Surg 2007; 119:1409–1422.
    1. Gir P, Oni G, Brown SA, et al. . Human adipose stem cells: current clinical applications. Plast Reconstr Surg 2012; 129:1277–1290.
    1. Cai W, Yu L, Tang X, et al. . The stromal vascular fraction improves maintenance of the fat graft volume: a systematic review. Ann Plast Surg 2018; 81:367–371.
    1. Xie Y, Li Q, Zheng D, et al. . Correction of hemifacial atrophy with autologous fat transplantation. Ann Plast Surg 2007; 59:645–653.
    1. Qiao J, Gui L, Fu X, et al. . A novel method of mild to moderate Parry-Romberg syndrome reconstruction: computer assisted surgery with mandibular outer cortex and fat grafting. J Craniofac Surg 2017; 28:359–365.
    1. Bucher F, Fricke J, Neugebauer A, et al. . Ophthalmological manifestations of Parry-Romberg syndrome. Surv Ophthalmol 2016; 61:693–701.
    1. Avelar RL, Göelzer JG, Azambuja FG, et al. . Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109:e20–e25.
    1. Guerrerosantos J, Guerrerosantos F, Orozco J. Classification and treatment of facial tissue atrophy in Parry-Romberg disease. Aesthetic Plast Surg 2007; 31:424–434.
    1. Olenczak JB, Seaman SA, Lin KY. Effects of collagenase digestion and stromal vascular fraction supplementation on volume retention of fat grafts. Ann Plast Surg 2017; 78: (6S Suppl 5): S335–S342.
    1. Bae YC, Song JS, Bae SH, et al. . Effects of human adipose-derived stem cells and stromal vascular fraction on cryopreserved fat transfer. Dermatol Surg 2015; 41:605–614.
    1. Shaoheng Xiong, Chenggang Yi, Lee L Q Pu. An overview of principles and new techniques for facial fat grafting. Clin Plastic Surg 2020; 47:7–17.
    1. Li W, Zhang Y, Chen C, et al. . Increased angiogenic and adipogenic differentiation potentials in adipose-derived stromal cells from thigh subcutaneous adipose depots compared with cells from the abdomen. Aesthet Surg J 2009; 39:NP140–NP149.
    1. Grasys J, Kim BS, Pallua N. Content of soluble factors and characteristics of stromal vascular fraction cells in lipoaspirates from different subcutaneous adipose tissue depots. Aesthet Surg J 2016; 36:831–841.
    1. Caggiati A, Germani A, Di Carlo A, et al. . Naturally adipose stromal cell-enriched fat graft: comparative polychromatic flow cytometry study of fat harvested by barbed or blunt multihole cannula. Aesthet Surg J 2017; 37:591–602.
    1. Aronowitz JA, Lockhart RA, Hakakian CS, et al. . Clinical safety of stromal vascular fraction separation at the point of care. Ann Plast Surg 2015; 75:666–671.
    1. Yao Y, Cai J, Zhang P, et al. . Adipose stromal vascular fraction gel grafting: a new method for tissue volumization and rejuvenation. Dermatol Surg 2018; 44:1278–1286.
    1. Allen RJ, Jr, Canizares O, Jr, Scharf C, et al. . Grading lipoaspirate: is there an optimal density for fat grafting. Plast Reconstr Surg 2013; 131:38–45.
    1. De Francesco F, Guastafifierro A, Nicoletti G, et al. . The selective centrifugation ensures a better in vitro isolation of ASCs and restores a soft tissue regeneration in vivo. Int J Mol Sci 2017; 18:1038.
    1. Chiu CH. Does stromal vascular fraction ensure a higher survival in autologous fat grafting for breast augmentation? A volumetric study using 3-dimensional laser scanning. Aesthet Surg J 2019; 39:41–52.
    1. Dong Z, Fu R, Liu L, et al. . Stromal vascularfraction (SVF) cells enhance long-term survival of autologous fat grafting through thefacilitation of M2 macrophages. Cell Biol Int 2013; 37:855–859.
    1. Zhang Y, Cai J, Zhou T, et al. . Improved long-term volume retention of SVF-gel grafting with enhanced angiogenesis and adipogenesis. Plast Reconstr Surg 2018; 141:676e–686e.
    1. Zhou S, Chiang C-A, Xie Y, et al. . In vivo bioimaging analysis of stromal vascular fraction-assisted fat grafting: the interaction and mutualism of cells and grafted fat. Transplantation 2014; 98:1048–1055.
    1. Gontijo-de-Amorim N-F, Charles-de-Sá L, Rigotti G. Fat grafting for facial contouring using mechanically stromal vascular fraction-enriched lipotransfer. Clin Plastic Surg 2020; 47:99–109.
    1. Sherman JE, Fanzio PM, White H, et al. . Blindness and necrotizing fasciitis after liposuction and fat transfer. Plast Reconstr Surg 2010; 126:1358–1363.
    1. Park SH, Sun HJ, Choi KS. Sudden unilateral visual loss after autologous fat injection into the nasolabial fold. Clin Ophthalmol 2008; 2:679–683.
    1. Szantyr A, Orski M, Marchewka I, et al. . Ocular complications following autologous fat injections into facial area: case report of a recovery from visual loss after ophthalmic artery occlusion and a review of the literature. Aesthetic Plast Surg 2017; 41:580–584.

Source: PubMed

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