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Perioral Rejuvenation
The perioral region is second to the periorbital area in making a person appear tired, sad, happy, or healthy. Although a lot of emphasis has been...
Recently there has been a lot of interest and attention given to the rejuvenation of the face utilizing autologous fat. Much of this interest stems from the understanding of the aging process on facial fat volume, bone density, and muscle thickness. Even in your 30s, volume deficit begins to show as undereye circles and the cheeks take on a submalar hollow, which continues to progress with time.
Charles-de-Sá et al (Plast Reconstr Surg. 2015;135:999-1009) looked at the direct antiaging effects that autologous fat grafting has on skin. The authors observed 6 consecutive patients (5 women and 1 man; mixed ethnic backgrounds; aged 45–65 years; nonsmokers) who presented for face-lifts. A small skin and fat biopsy from the preauricular area on each patient was taken for baseline histologic analysis.
The patients had abdominal fat harvested and processed in 2 manners. One portion was centrifuged at 3000 rpm for 3 minutes. The pellet at the base of the syringe (stromal vascular fraction) was then taken and mixed with 1 mL of adipose tissue and injected into the right preauricular skin in a subdermal fanning technique using a small cannula (1.5 mm) on a 3-mL syringe. The second portion of the fat was sent for stem cell expansion (2×106 mesenchymal cells). Five weeks later, the solution of stem cells (0.4 mL) was diluted with normal saline to a volume of 1 mL and injected in the left preauricular area, also 2 cm in front of the tragus.
Three months after the injections, repeat biopsies in the grafted areas were taken and sent for hematoxylin and eosin stain and electron microscopy. Results showed that at baseline on hematoxylin and eosin, the skin showed evidence of mild solar elastosis. However, after both methods of fat processing, the treated areas showed a reduction in solar elastosis, increased elastin fibers in the papillary dermis, and increased vasculature in the reticular dermis (near the subcutaneous fat). The results were similar in both types of fat processing; there was no statistically significant difference between modalities.
What’s the issue?
Those of us who have performed autologous fat grafting on patients have remarked for years on the improved appearance of the skin and the slowing down of the aging process that is not accounted for by volume replacement alone. This study has shown that fat grafting or stem cell injection in the subcutaneous layer has a beneficial effect on the overlying skin. The fact that both techniques showed similar results is helpful because it demonstrates that improvement can be achieved without having to expand the cells in vitro, thus eliminating all the regulatory issues that accompany cell cultures. A larger study would be extremely beneficial at this point. How does this procedure compare to platelet-rich plasma injections that are also the big fad for skin rejuvenation?
