April 2020 HSC Section 4 - Plastic and Reconstructive Problems

The Journal of Craniofacial Surgery

Volume 30, Number 3, May 2019

Brooker et al

TABLE 2. Human Studies of Fat Grafting Augmented with Stromal Vascular Fraction (SVF), Ex vivo Expanded Adipose Stem Cells (ASCs), Platelet-rich Plasma (PRP) and Nanofat Grafting in Ochre Study Cohort numbers Assessment methods Outcomes Reference Bourne et al, 2018 12 patients with at least 2 areas of craniofacial volume loss reviving SVF-enriched adipose graft or graft alone. All patients underwent SVF- enriched graft to one malar region and grafting alone to the other malar region CT volumetric analysis, SVF cell population calculation by flow cytometry 9-month follow-up found no significant advantage of SVF- enrichment by volumetric analysis. No correlation of volume retention with SVF cell number or viability Gontijo-de-Amorim et al, 2017 30 patients divided into 2 groups: autologous fat only (control), autologous fat plus centrifuged lipoaspirate containing SVF Independent clinician and photographic assessment. Subgroup of 5 patients in each group underwent CT Significantly better volume retention in SVF group by CT and higher aesthetic rating by clinicians Schendel, 2015 Single cohort of 10 patients all receiving SVF- enriched fat 3D photographic scanning allowed volume changes to be calculated Volume retention was positively correlated with the number of cells within the SVF Charles-de-Sa´ et al, 2015 Six patients receiving either SVF-enriched fat (right preauricular area) or ASC expanded in culture and suspended in saline (left preauricular area) Optical and electron microscopy of skin fragments, histologic analysis Decreased elastosis, increased dermal vascularity and increased elastic fibers in papillary dermis in both treatments Li et al, 2013 26 patients receiving SVF-enriched facial fat graft or fat graft alone (n ¼ 12) CT volumetric analysis Increased volume retention in SVF-enriched group 51 Chang et al, 2013 20 patients with Parry-Romberg. 10 receiving SVF- enriched fat and 10 receiving fat grafting alone CT volumetric analysis Increased volume retention at 6 months postoperatively in the SVF-enriched cohort 52 Lee et al, 2012 Nine patients all receiving SVF-enriched facial grafts on left versus nonenriched graft on the right Photography assessment by independent clinicians and patient questionnaire Subjective surgeon and patient assessment showed superior results for SVF-enriched graft 56 Kølle et al, 2013 10 patients receiving both ASC-enriched graft and graft alone. NB recipient site was arm not face MRI at time of graft and on postoperative day 121 ASC-enriched graft showed 4–5 times the volume retention of control graft 53 Koh et al, 2012 5 patients with Parry Romberg receiving ASC- enriched graft, 5 receiving graft alone 3D photography plus CT ASC enriched graft showed greater volume retention up to 18 months 55 Bashir et al, 2018 25 patient series, one of whom received ex vivo expanded ASC-enriched graft Subjective patient and physician satisfaction assessment at 6 months Patient with ASC enriched graft reported high degree of satisfaction after single graft 56 Sasaki et al, 2015 106 patients injected with fat þ PRP. 92 patients injected with fat alone (control). 9 patients injected with fat þ SVF, 29 patients injected with fat þ PRP þ SVF 3D photographic volume analysis up to 12 months postoperatively PRP and SVF significantly improved volume retention compared to fat alone. No significant difference between PRP and SVF enrichment effect. Addition of SVF to PRP/fat mixture did not augment retention 57 Rigotti et al, 2016 13 patients undergoing fat grafting with/without PRP in each preauricular area Optical and electron microscopy PRP did not improve skin rejuvenation compared to SVF- enriched fat or expanded ASC 58 Willemsen et al, 2014 9 patients receiving facial lipofilling alone and 10 receiving PRP-enriched lipofilling Preoperative and 3 month postoperative photographic assessment by panel of 10 independent facial aesthetic surgeons Addition of PRP significantly improved volume retention but not for signs of ageing 59 Gentille et al, 2014 10 patients with facial scars recieivng PRP- enriched fat grating, fat grafting along (10) or SVF-enriched fat grafting (10) Team and patient evaluation. MRI and ultrasound volumetric analysis PRP and SVF both led to significant improvement in volume retention of facial graft 60 Cervelli et al, 2009 19 patients receiving facial grafts enriched with PRP, 6 patients receiving facial fat grafting alone (control) Subjective evaluation of volume retention using pre and postoperative photographs by operator and patient PRP significantly augmented volume retention in fat graft compared to fat graft alone at 1 yr 61 Tonnard et al, 2013 67 patients all receiving nanofat injections for a range of skin rejuvenation purposes Cells were cultured in adipogenic medium to confirm their stem-cell quality Skin in recipient sites showed improvement in quality with visible blemishes, pigmentation and wrinkles decreased 28 Gu et al, 2018 20 patients with 25 atrophic scars treated with condensed nanofat combined with fat grafting Patient and observer questionnaire. Immunohistochemistry of punch biopsy 62 Liang et al, 2018 103 patients receiving nanofat plus platelet rich fibrin. 128 patients receiving hyaluronic acid injections 63 29 49 37 50 38

Both patient and observer ratings showed significant improvement in scar aesthetics and histology showed enhancement of staining in melanin and basal cell layer Higher patient satisfaction and improved skin quality in experimental group

Improvement in scar, discoloration and wrinkle appearance based on observer panel findings and patient assessment

Quantitative measurements using skin image analysis software up to 24 months postoperatively Patient satisfaction canvassed. Panel of three independent clinicians judged photographic outcomes

Uyulmaz et al, 2018 52 patients receiving nanofat injections for scar (40) wrinkles (6) and discoloration (6)

# 2019 Mutaz B. Habal, MD

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