Adipose-Derived Stem Cells for Facial Rejuvenation

The interest in regenerative medicine is increasing, and it is a dynamically developing branch of aesthetic surgery. Biocompatible and autologous-derived products such as platelet-rich plasma or adult mesenchymal stem cells are often used for aesthetic purposes. Their application originates from wound healing and orthopaedics. Adipose-derived stem cells are a powerful agent in skin rejuvenation. They secrete growth factors and anti-inflammatory cytokines, stimulate tissue regeneration by promoting the secretion of extracellular proteins and secrete antioxidants that neutralize free radicals. In an office procedure, without cell incubation and counting, the obtained product is stromal vascular fraction, which consists of not only stem cells but also other numerous active cells such as pericytes, preadipocytes, immune cells, and extra-cellular matrix. Adipose-derived stem cells, when injected into dermis, improved skin density and overall skin appearance, and increased skin hydration and number of capillary vessels. The main limitation of mesenchymal stem cell transfers is the survival of the graft. The final outcomes are dependent on many factors, including the age of the patient, technique of fat tissue harvesting, technique of lipoaspirate preparation, and technique of fat graft injection. It is very difficult to compare available studies because of the differences and multitude of techniques used. Fat harvesting is associated with potentially life-threatening complications, such as massive bleeding, embolism, or clots. However, most of the side effects are mild and transient: primarily hematomas, oedema, and mild pain. Mesenchymal stem cells that do not proliferate when injected into dermis promote neoangiogenesis, that is why respectful caution should be taken in the case of oncologic patients. A longer clinical observation on a higher number of participants should be performed to develop reliable indications and guidelines for transferring ADSCs.

Facial Fat Grafting in reconstructive maxillofacial surgery

Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FG was initially used as a technique to improve facial aesthetics. Over the years the technique has evolved into more complex reconstructive and regenerative procedures and new clinical applications. Methods: In the last two decades the indications of FG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects, aesthetics,congenital and other postsurgical volume deficits. Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate. Conclusion: FG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.

Atrophic Scars: Reinforcing the Flap Mattress Using Adipocyte Transfer in Paraplegic Patients at Risk of Pressure Ulcer Recurrence

Atrophic scars may be defined as depressive areas on the skin, due to a defect of fatty tissue under the skin. This situation may lead to adherence to the depth (fascia, bone, tendon) to be a source of functional impairment. Most of the atrophic scars are secondary to acne localized over the face. Multiple techniques were proposed to restore the volume and uniformize the surface, like laser, injection of fat, microneedling, microdermabrasion, dermal fillers, and surgical techniques such as subcision and platlet rich plasma (PRP). On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including edema and erythema (Goutos). Regenerative surgery, including fat harvesting, centrifugation, and isolation of adipocyte stem cells, has been promoted since years and should be repeated when injected fat progressive crush is observed. The clinical case presented here is a paraplegic patient presenting a pressure sore in the left ischiatic area. The flap was successful but the depth of the transplanted fatty tissue was decreasing after some years. A first fat injection was programmed.

Autologous Fat Grafting for Craniofacial Reconstruction in Oncologic Patients

Due to the anatomical and functional complexity of the region, craniofacial tumor removal requires some of the most challenging surgical approaches, often complemented with advanced chemo-radiotherapy techniques. However, these modern therapies often lead to sequelae that can drastically reduce the quality of life for the surviving patients. Recent advances in the field of regenerative medicine opened new avenues for craniofacial reconstruction following head and neck cancer treatment. One of the most promising recent strategies relies on the use of autologous fat transplant. In this mini review, we briefly present some of the fat’s biological properties that make it an ideal tissue for craniofacial reconstruction following cancer treatment. We then outline the recent advances that led to a better understanding of the detailed anatomy of the craniofacial fat depots. Furthermore, we provide a succinct review of the methods used for fat harvesting, processing and engrafting in the craniofacial area after head and neck tumor removal, discussing their main applications, advantages and limitations.