Autologous fat graft assisted by stromal vascular fraction improves facial skin quality: A randomized controlled trial

Background: Cell-assisted lipotransfer (CAL) promotes the survival of fat grafts with high vascular density and improves skin quality by increasing collagen content. However, no study has quantified the changes on the skin surface, and rigorous methodological evaluations are still lacking. Design: Fifty patients were recruited and randomly divided into two groups: an experimental group (n=25) that underwent a stromal vascular fraction (SVF)-assisted fat graft and a control group (n=25) that underwent fat graft only. Methods: The SVF cells were counted, tested in terms of viability, and characterized. The volumes of whole faces were determined by using a 3D scanner and Geomagic software preoperation, immediately after surgery, and 6 months postoperation. Facial skin qualities, including spots, wrinkles, texture, pores, UV spots, brown spots, red areas, and porphyrins, were detected by a VISIA skin detector preoperation and 6 months postoperation. A visual analog scale was used for clinical evaluation. Results: The cell pellet contained 1-3 x 10(7)/mL of fresh SVF cells. The cell viability exceeded 98%. The immunophenotyping characteristics and stemness were consistent with the features of adipose- derived stem cells (ADSCs). The survival rate of SVF-enriched fat grafts was significantly higher than that of control grafts: 77.6%+/- 11.6% versus 56.2%+/- 9.5% (p<0.001). The VISIA values of wrinkles (19.3 +/- 6.6 versus 10.9 +/- 5.5, p<0.001) and texture (15.8 +/- 7.0 versus 10.3 +/- 5.0, p<0.01) were significantly higher in SVF-enriched group than in control group at 6 months postoperation. During long-term follow-up, the majority of patients in both groups were satisfied with the final facial esthetic results. Conclusions: Our results demonstrated the positive outcomes of autologous SVF-assisted fat graft in improving facial skin quality and its promising application potential in clinical settings. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd.