Preenrichment with Adipose Tissue-Derived Stem Cells Improves Fat Graft Retention in Patients with Contour Deformities of the Face

Abstract

Quick absorption of adipose tissue grafts makes the outcomes less satisfactory for clinical applications. In the current study, adipose tissue grafts were mixed with adipose tissue-derived stem cells (ASCs) to improve retention of adipose tissue grafts and to make the clinical outcomes of fat grafting more reliable. Adipose tissue was either injected alone (conventional group) or mixed with ASCs (stem cell group) before injection. In both groups, adipose tissue was injected at the site of contour throughout layers of tissues till visual clinical symmetry with the opposite side was achieved. The volume of injected fat graft was measured after 72 hours and 6 months using a B-mode ultrasound device connected with a 12 MH frequency probe. The percentage reduction in the volume of injected fat, physician satisfaction scores (Ph-SCs), and patient satisfaction scores (P-SCs) were also recorded. After 6 months, there was significantly lower fat absorption in the stem cell group as compared to the conventional group. Mean physician and patient satisfaction scores were significantly improved in the stem cell group. No significant adverse effects were noted in any patient. Significantly lower absorption of graft due to the use of ASCs improves the clinical outcomes of conventional fat grafting for contour deformities of the face. The current preenrichment strategy is noninvasive, safe and can be applied to other diseases that require major tissue augmentation such as breast surgery. This trial is registered with NCT02494752.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2019 Muhammad M. Bashir et al.

Figures

Figure 1

Flow chart showing the management plan of patients with contour deformities of the face.

Figure 2

(a) Syringes standing vertically to allow gravity sedimentation. (b) The filtration of fat through the common strainer to concentrate the fat and to separate it from oil and debris. (c) The transfer of fat from 10 cc syringes to 1 cc syringes for transplantation.

Figure 3

Representative ultrasonic measurement of soft tissue thickness (a) after 72 hours and (b) 6 months after transplantation. (c) Comparison of mean percentage reduction of fat absorption in both groups six months after the 1st fat graft session.

Figure 4

Comparison of mean (a) physician 1 and (b) physician 2 satisfaction score in both groups six months after the 1st fat graft session. (c) Comparison of mean of patient satisfaction score in both groups six months after the 1st fat graft session.

Figure 5

Representative picture showing preoperative and postoperative view of patients in (a–d) the conventional group and (e–h) the stem cell group. (a, c) Preoperative view of patient 1 (with facial contour deformity involving bilateral cheeks) and patient 2 (with facial contour deformity involving right mandibular area), respectively. (b, d) Fat absorption six months after the 1st session of conventional lipofilling. (e, g) Preoperative view and (f, h) postoperative view of patients in the stem cell group. (e) exhibits preoperative view of a patient with contour deformity of the right mandibular area, and (f) shows postoperative view six months after a single session of ex vivo expanded ASC-enriched lipofilling. (g) represents preoperative view of a patient with contour deformity of the face near the eye, and (f) shows postoperative view six months after a single session of ex vivo expanded ASC-enriched lipofilling in some patients.