Fat Transfer & Adipose Derived Stem Cells
(ADSCs) Enriched Fat Transfer for
Facial Rejuvenation

About Facial Rejuvenation

For ages, the face has been considered the most prominent feature of the human being, and the motivation to alter its appearance for cosmetic purposes is as old target as history of plastic surgery.

Facial Rejuvenation is not about suspension of sagginess but, it is all about augmentation to restore harmony to the face as the atrophy is the defining feature of aging.     

Augmentation is representing the past and the future of rejuvenation. For this reason, over the past decades, fuelled by western media adjusting to the growing older population, there has been an increasing demand for minimally invasive cosmetic procedures that enhance or maintain the youthful-looking appearance of the face. The 17 % decrease of major facial surgical cosmetic procedures since 2000 combined with the 6.5 % increase of facial fillers, globally in 2015. Unlike other fillers, fat augmentation is the permanent filler that will deliver a smooth, fresh, rejuvenated look that can last for a very long time with you.

Facial Fat Transfer (Micro-Lipofilling)

A youthful face is accentuated by convexities and an aging by concavities. The aging never known to be kind to human face. Indeed, nothing can display aging more than a bony appearance in the cheeks. Though the great cheekbones and jawline remain, the soft, fatty cushion of youth seems to melt away leaving a severe, masculine look to a now elongated, rectangular face. Fat transfer is an excellent solution to reverse this unwanted aging changes.

Indications for facial fat transfer are;

  1. To correct the volume deficiency of the face due to atrophic aging changes of fat, muscle and bony tissue.
  1. To give more noticeable & attractive facial contouring. The trend in our time for men & women is to have  more sculptured fashioned looking & this very helpful for patients having thin or skinny face or long face.
  2. To restore facial volume after weight loss.
  3. To correct facial asymmetry due to congenital defect or after trauma defect or post-surgery defect like excision of facial tumour.
  4. To treat deep lines as permanent fillers.
  5. To treat facial scars or acne scar.

With aging fat loss manifests around the mandible and throughout the forehead and scalp. The most common areas of the face which are treated with autologous fat grafts include the hollowness under eyes, nasolabial groove (smile lines), marionette lines, midface, & lips.

Autologous fat performs best in the midface area considering the longevity compared to other more mobile areas such as the lips & marionette grooves.

Potential areas for facial fat grafting;

Although fat transfer can be used to augment any depressed area on face, the most commonly addressed areas are the following:

  1. Nasolabial folds marionette lines
  2. Cheeks and infraorbital regions
  3. Tear trough area
  4. Chin
  5. Glabellar area, temple, forehead
  6. Inferior orbital rim
  7. Neck
  8. Lips

These areas can be addressed individually or sometimes together to achieve the desired result.

Fat transfer has three effects in the face;

First, to smooth the deep wrinkles by filling it with fat in multiple layers &

Second, to contour the face by restoring the lost volume in tissue where fat has been shifted to lower level or diminished in amount,

Third advantage is the improvement in skin texture and appearance because the fat by itself is a rich source of stem cells & thereby restoring a healthy, youthful look.

The most appropriate Candidates for fat transfer to face;

  • Healthy patients
  • Not smoker
  • Have a realistic expectation of fat grafting can & cannot achieve. Fat transfer will produce beautiful and natural softening of the face & its associated age-related folds but, it cannot substitute for a facelift.
  • Ready for recovery period which may take 10-21 days.

What fat transfer cannot do?

  • Smooth & tighten skin which is excessively slack or loose, in such cases need fat transfer as supportive technique with face &/or neck lift. As the face lift will deal with major youth cues and the fat transfer to address the minor youth cues, together can create a more convincing portrait of youth.
  • Remove age spots
  • Eradicate fine lines often from sun damage and age, that may need laser resurfacing, chemical peeling or skin dermabrasion to even it out.

However, fat transfer involves a short procedure, need a precise & meticulous technique in fat aspiration, preparation and reinjection to the face & in multiple layers & in small tinny droplets with multi-small-holed cannula. (Micro lipofilling). There is associated swelling for a few weeks postoperatively. This is the price of permanency.

However, the swelling eventually wears away completely, a certain percentage of fat will vascularise and become permanent. It is a living graft and contrary to popular myth will not go away if properly performed. How much stays depends on the individual patient and sites, but anywhere between 20% to 80% will live indefinitely. Occasionally, repeated fat injections from 6 to 12 months apart may be required deliver optimal results over time. Liposculpture of the face (fat transfer to face) is currently the preferred substance to all high experience plastic surgeons to permanently add volume to the face. It is soft, natural and safe.  The results are not only permanent but natural and after a year or so, even skin texture and pigment irregularities can be improved. However, the reported rates of fat cell survival are very variable (10–90%), presumably due to different techniques of harvesting, processing and reinjecting of fat cells. Recently, the addition of ADSCs has been considered very effective to improve fat intake, and several studies have already demonstrated improvement of wound healing and fat grafting survival in both reconstructive and aesthetic cases by using fat grafting enriched with ADSCs.

Adipose Derived Stem Cells- ADSCs Enriched Fat Transfer to Face

Advantage of fat transfer;  

All studies has proven the following effect on skin quality are:

  • Improved skin texture and elasticity.
  • Softening of wrinkles.
  • Decreased pore size.
  • Enduring and appealing natural looking outcomes
  • Improved pigmentation during the first-year posttreatment.

In fact, analysis of clinical result following both reconstructive and aesthetic surgery reveals that after one or several repeated fat grafting procedures, the nutrient and quality of the recipient site are improved. These changes develop over several months following the fat grafting procedure, with an often-variable expression, as improvements in skin texture, skin suppleness, skin colour, and /or scar quality like acne scar.

Advantage of enriching fat transfer with stem cells;

Stem cells can turn into any type of cell if it is well stimulated. Adding stem cells to the prepared fat for reinjection into the face or the body has a proven data of the following advantage:

  1. These stem cells ensure the transplanted fat is healthy and increase its survival rate. This is because they promote new blood vessels (vascularization) for fat transfer & bring essential nutrients.
  2. Stem cells assist the fat cell to integrate with the injected area by preserving tissue volume that forms new fat cells and stimulates fibroblasts migration for increased collagen production.
  3. Stem cell enriched fat also reduces fat injection aggressive effects like fibrosis formation, calcification, and pseudo cyst.
  4. There is no chance of allergic reactions or infections to your own body fat cells.

The advent of fat grafting or lipofilling, and its new role as part of regenerative medicine. The large amount of stem cells in fat graft is play an important role in this regenerative of the tissue. They are usually implanted into the superficial layer just beneath the dermis to replace lost tissue volume while they simultaneously induce collagen production via stretching of dermal fibroblasts, ultimately improving skin texture and thickness. It can be injected also submuscular and sub periosteum in the significantly atrophic facial structure specially when combined with face lift (FAMI Procedure).

Forehead and Temples:  The, the forehead tends to flatten, losing the youthful convexity of youth. Concavity ensues resulting in a more pronounced ridge along the eyebrows. Additionally, the temples become hollow imparting an aged, bony appearance to the upper third of the face. Unfortunately, women seem to suffer from this pattern of aging more significantly then men. Fortunately, fat transfer is an excellent solution to restore lost volume in these regions. Not only does a patient look naturally refreshed but aesthetic focus is directed back towards the eyes while the face appears more diamond shaped and shorter.

Upper and Lower Eyelid Regions: These too, like the temples, lose vital fat leading to more progressive deepening of the eyes, dark circles and the appearance that the eyes are closer together than where they were in the 20’s. Restores fat to the upper eyelid to make the eyes more “open”, wider spaced and almond shaped. For the lower eyelid, needs fat transfers fat to the “tear troughs” or lower eyelid hollows to reduce the appearance of dark circles and in turn, create a smooth transition from the lower eyelid into the cheek itself. When combined with an endoscopic mid facelift to elevate the cheek back to the lower lid, results will be more magnificent.

Lips : This is one area where over correction is important to ensure a meaningful aesthetic result. With fat transfer alone to the lips, subtle shape changes such as an elevated corner or highlighted vermillion border or ‘white roll’ can be attained. It is important to have a deep appreciation of aesthetic proportion of the lips as it pertains to the size and shape of the upper to the lower. Fat can be successfully transferred into the vermillion border, upper and lower lip and also into the subtle irregularities that surround the pink lips themselves such as marionette folds, creases and the vertical wrinkles known as “smokers lines”.

For More Attractive Facial Looking

With wide spread of social media and selfie, become more common women and men requesting facial beautification. They do need first to quality of their underlying skull, specifically the strength and shape of their cheekbones, chin and jawline. Most patients think that artificial facial implants is their only option but fat transfer can be an amazing substitute for these implants. Not only is fat transfer natural but when implanted onto or near bone specially when it enriched with stem cells, it will feel just like that-bone. It not  as placing cheek implant, but, still fat transfer can provides remarkable results without complication of facial implants. It is possible also to  augmented chins and defined jaw lines, all with fat alone or for better and longer result enriched with adipose derived stem cells.

References:

  1. Alberto Di Giuseppe, Dennis Wolf. Breast Augmentation with Stem Cells Fat Transfer and VaserTM. In: Melvin A.Shiffman, Alberto Di Giuseppe, Franco Bassetto, editors, Stem Cells in Aesthetic Procedure: Art, Science, and Clinical Techniques. Springer-Verlag Berlin Heidelberg; 2014. P 529-56. 
  2. American Society of Plastic Surgeons. Report of the 2010 statistics: National Clearinghouse of Plastic Surgery Statistics. 2010, http://www.plasticsurgery.org/news-and-resources/statistics.html. Accessed June 5, 2017. Click Here for PDF
  3. Barret JP, Sarobe N, Grande N, Vila D, Palacin JM (2009) Maximizing results for lipofilling in facial reconstruction. Clin Plast Surg 36:487–492 
  4. Billings E Jr, May JW Jr (1990) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 85:378–386 Click Here for PDF
  5. Cervelli V, Palla L, Pascali M, De Angelis B, Curcio BC, Gentile P (2009) Autologous platelet-rich plasma mixed with purified fat graft in aesthetic plastic surgery. Aesthetic Plast Surg 33:716–721 Click Here for PDF
  6. Groen J-W, Krastev TK, Hommes J, Wilschut JA, Ritt MJPF, van der Hulst RRJW. Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction. Plastic and Reconstructive Surgery Global Open. 2017;5(12):e1606. 
  7. ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2015; 2015, https://www.isaps.org/Media/Default/global statistics/2016%20ISAPS%20Results.pdf. Accessed June 7, 2017. Click Here for PDF
  8. Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg. 2012;5:121–132. Click Here for PDF
  9. Ogawa R (2006) The importance of adipose-derived stem cells and vascularized tissue regeneration in the field of tissue transplantation. Curr Stem Cell Res Ther 1:13–20 Click Here for PDF
  10. Sasaki, G. H. (2015). “The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging.” Aesthetic Plast Surg 39(6): 833-846. Click Here for PDF
  11. Wang F, Garza LA, Kang S, Varani J, Orringer JS, Fisher GJ,Voorhees JJ (2007) In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 143:155–163 Click Here for PDF 
  12. Zhu M, Zhou Z, Chen Y, Schreiber R, Ransom JT, Fraser JK, Hedrick Mh, Pinkernell K, Kuo HC. Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg. 2010;64(“):267-71 Click Here for PDF
  13. Zins JE, Moreira-Gonzalez A. Cosmetic procedures for the aging face. Clin Geriatr Med. 2006;22:709–728. Click Here for PDF

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