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Key Points
- Autologous fat transplantation, use of stem cells in various stages of development around the globe
- Cell-assisted lipotransfer helps to overcome some issues that may arise in lipoinjection, such as low graft survival rate
Autologous fat transplantation is an exciting treatment for facial rejuvenation, breast enhancement/reconstruction and general soft tissue augmentation, according to cosmetic surgeons who perform this treatment, because it accomplishes these deeds without incisional scars or the complications that are associated with injection of foreign materials.
The use of fat as a soft tissue filler has been a staple in the armamentarium of a handful of forward-thinking cosmetic surgeons for a couple of decades, but more recent refinements that concentrate on isolating and transplanting the powerful and abundant stem cells found in adipose tissue are adding depth and promise to the already versatile and burgeoning field of fillers.
CELL-ASSISTED LIPOTRANSFER While autologous fat transplantation and its use of stem cells are in various stages of clinical use and development around the world, Japanese cosmetic surgeons are making remarkable strides. Kotaro Yoshimura, M.D., associate professor, department of plastic surgery, University of Tokyo, is one of the leading investigators in stem cell research and usage for aesthetic applications. Along with his colleagues, Dr. Yoshimura has developed a novel strategy known as cell-assisted lipotransfer (CAL) to overcome problems that typically have been associated with lipoinjection, such as unpredictable results and a low rate of graft survival due to partial necrosis.
In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. Dr. Yoshimura has found that after nonvascularized transplantation of adipose tissue, adipocytes die and are replaced with a new generation derived from ASCs. He says this shows that the number of ASCs contained in the graft is a crucial factor determining final adipose volume. Dr. Yoshimura's experience and outcomes in more than 450 breast augmentation and reconstruction patients since 2003 suggest that CAL is safe and effective for soft tissue augmentation.
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Before (left) and nine months after stem cell fat grafting breast augmentation. Breast volume increase nine months post-operatively was +4.5 cm.
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CELL ISOLATION Extracting fat from a donor site, purifying it and injecting it elsewhere is a basic three-step process; the tricky part is isolating the stem cell fractions. Dr. Yoshimura uses manual isolation in a cell-processing room or the automated Tissue Genesis Cell Isolation System (Tissue Genesis) technology to extract the stem cells.
According to Dr. Yoshimura, supplementation with ASC-containing SVF may boost the efficacy and safety of conventional autologous micro-fat grafting. "ASCs are a promising tool in the initial stages of regenerative medicine. A substantial (therapeutic) amount of cells can be obtained without cell culture, and the anticipated therapeutic potential is similar to that of bone marrow-derived mesenchymal stem cells.
"Our results are pretty encouraging. We can use it for breast implant replacement as well as breast reconstruction. Facial reconstruction for inborn or acquired diseases are also good indications," Dr. Yoshimura says. The basis for stem cell transplant utilization and efficacy, he says, is, "We need stem cells to repair, renew and reconstruct our tissue. What is important is how to activate stem cells and control their behavior so that they behave in the right way."
Dr. Yoshimura stresses that confirming long-term safety and efficacy is important, and that several challenges remain. "We still see some challenges for thin patients (as far as insufficient donor site fat), as well as breast reconstruction with adhesive scar tissues and previous irradiation," he says.
