This review gives a basic overview of the current state of fat transplantation in view of adipose-derived stem cells. Current technologies regarding facial rejuvenation are presented, with a brief review of the procedures.
Adipose-Derived Stem Cells (ADSCs) do 4 basic things:
- •
ADSCs differentiate into adipocytes and contribute to the regeneration of fat.
- •
ADSCs differentiate into endothelial cells and possibly vascular mural cells for possible graft survival and angiogenesis.
- •
ADSCs release hormones and growth factors in response to conditions in which they are communicating with the cells around them in a new environment.
- •
Some ADSCs do not change but may help survival of the graft.
Fat transplantation procedures
Lipostructure
Sydney Coleman pioneered and trademarked Lipostructure. He has summarized the steps he uses for successfully transplanting fat, the basics of which are:
- 1.
Harvesting fat is to be done under low negative pressures to ensure the viability of the adipocytes.
- 2.
Purifying the harvested fat with centrifuge allows the old ruptured cells on the top to be decanted; this leaves the heavier cells or the portion with preadipocytes.
- 3.
Placement should use multiple passes in small 1-mL syringes, staying deep to orbicularis in periorbital areas, and tunneling techniques to maximize contact with the surrounding tissues and optimize survival rate.
In the past decade facial fat injections have been popularized and are now commonplace. Fat injections have been used with other facial procedures and for both functional and cosmetic effects.
Cell-Assisted Lipotransfer
In 2007, cell-assisted lipotransfer (CAL) was introduced by Kotaro Yoshimura. This technique involves the use of ADSCs that are isolated from liposuction aspirates. The processed cells are added to additional aspirated fat and then injected into tissue.
The CAL procedure is slightly different from lipostructure in that the lipoaspirate is processed in the same way but uses collagenase to break up the clumps of adipocytes, allowing the heavy cells or the preadipocytes to drop to the bottom of the lipoaspirate. This process takes approximately 2 hours, then there is a 30-minute incubation time with the collagenase, after which 2 washings of the fat are done with glucose. Yoshimuri has shown a single treatment to increase breast volume by 120 to 160 mL.
The LipoKit
A system commonly used to procure a high volume of ADSCs is the LipoKit (Medi-Khan, Los Angeles, CA, USA), a device approved by the Food and Drug Administration ( Fig. 1 ). LipoKit is an all-in-one closed device for condensed autologous fat transfer. Liposuction and fat aspiration is done within the same 50-mL fat-processing unit (FPU) syringe. The squeezing and centrifugation is also done using the same 50-mL FPU syringe containing lipoaspirates. Separating the impurities and free oils and harvesting of the condensed fat tissue is done in the same 50-mL FPU syringe.
Fat stays within the same 50-mL syringe throughout the fat-grafting procedure. The average number of ADSCs from 1 mL at the end of procedure is 1 million. From 50 mL of aspirated fat the stromal vascular fraction where the concentrated cells are located is about 3 to 4 mL or approximately 3 million ADSCs, which is mixed with lipoaspirate for a concentrated volume, or not if it is to be used for scarring or functional defects.
Fat transplantation procedures
Lipostructure
Sydney Coleman pioneered and trademarked Lipostructure. He has summarized the steps he uses for successfully transplanting fat, the basics of which are:
- 1.
Harvesting fat is to be done under low negative pressures to ensure the viability of the adipocytes.
- 2.
Purifying the harvested fat with centrifuge allows the old ruptured cells on the top to be decanted; this leaves the heavier cells or the portion with preadipocytes.
- 3.
Placement should use multiple passes in small 1-mL syringes, staying deep to orbicularis in periorbital areas, and tunneling techniques to maximize contact with the surrounding tissues and optimize survival rate.
In the past decade facial fat injections have been popularized and are now commonplace. Fat injections have been used with other facial procedures and for both functional and cosmetic effects.
Cell-Assisted Lipotransfer
In 2007, cell-assisted lipotransfer (CAL) was introduced by Kotaro Yoshimura. This technique involves the use of ADSCs that are isolated from liposuction aspirates. The processed cells are added to additional aspirated fat and then injected into tissue.
The CAL procedure is slightly different from lipostructure in that the lipoaspirate is processed in the same way but uses collagenase to break up the clumps of adipocytes, allowing the heavy cells or the preadipocytes to drop to the bottom of the lipoaspirate. This process takes approximately 2 hours, then there is a 30-minute incubation time with the collagenase, after which 2 washings of the fat are done with glucose. Yoshimuri has shown a single treatment to increase breast volume by 120 to 160 mL.
The LipoKit
A system commonly used to procure a high volume of ADSCs is the LipoKit (Medi-Khan, Los Angeles, CA, USA), a device approved by the Food and Drug Administration ( Fig. 1 ). LipoKit is an all-in-one closed device for condensed autologous fat transfer. Liposuction and fat aspiration is done within the same 50-mL fat-processing unit (FPU) syringe. The squeezing and centrifugation is also done using the same 50-mL FPU syringe containing lipoaspirates. Separating the impurities and free oils and harvesting of the condensed fat tissue is done in the same 50-mL FPU syringe.
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