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International Journal of Aesthetic and Anti-Ageing Medicine Informa Healthcare, 119 Farringdon Road, London, EC1R 3DA, UK www.informahealthcare.com


Managing Editor Rosalind Hill rosalind.hill@informa.com


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A


UTOLOGOUS FAT GRAFTING HAS BEEN USED FOR MORE THAN A CENTURY TO FILL defects and restore volume. Since its first description by Neuber (1893), the technique has been gradually perfected: atraumatic harvesting by a mild negative pressure in the syringe, gentle processing with less aggressive centrifugation, gentle deposit of micro aliquots of fat using micro-cannulae, and multi-directional, multi-tunnel pattern. All current procedures derive from the lipostructure technique developed by Coleman (1994).


In 2001, Zuk et al published the first article noting the presence of multi-potent stem cells in fatty tissue.


Since then, adipose-derived stem cells (ADSCs) have been at the forefront of medical research. Meanwhile, ‘stem cells’ became trendy and many physicians are marketing ‘stem cell rejuvenation therapy’ or ‘stem cell lift’, when actually they are performing a fat graft. As it is considered minimally invasive, autologous fat grafting is primarily used for volume enhancement in reconstructive and cosmetic surgery, while stem cells are indicated for wound healing, tissue engineering and more recently, the enhancement of fat grafting. To separate ADSCs from fatty tissue, the harvested fat must be extensively washed with phosphate


buffered saline (PBS) and digested with 0.2% collagenase at 37°C for 1 hour. Collagenase is then inactivated and the digest centrifuged for 5 minutes. The supernatant is eliminated and the resulting stromal vascular fraction (SVF) containing ADSCs must be re-suspended in 10% foetal bovine serum (FBS). Clearly, these are not conditions present in daily practice; let us call to mind that a minimum of 250 cc of harvested fat is necessary to obtain 107


ADSCs. It is remarkable that many of those marketing ‘stem cell rejuvenation’ suddenly become world experts in


stem cell rejuvenation therapy. My own lectures focus on the sole effect I can observe and measure: the volume enhancement aspect of fat grafting, ignoring the stem cell effect. During a meeting about stem cells in Milan last September, I concluded my lecture about my complete ignorance of the subject of stem cells, although I have one of the most stable rates of fat grafting in the literature for the periorbital area. To date, there are no evidence-based clinical trials proving the efficacy of stem cells for facial rejuvenation.


The only accepted effect is volume restoration and enhancement by fat grafting, leading to facial rejuvenation. A recent study on mice showed that fat grafting supplemented with ADSCs had a greater survival rate at 6 months. Again, no data supports this in humans. Micro-fat grafting, when properly done, leads to predictable and reproducible fat take in different areas of the face. I have been using micro-fat grafting since 2001 in the most difficult areas (i.e. the upper lid and retroseptal area). When this procedure is done cautiously, from harvesting to injection, and with the proper micro-instruments, the desired effect is obtained in 100% of cases. The important question should not be about the percentage of fat take, nor whether we need to add stem


cells to fat in order to improve fat take. The critical issue i should be: what is the optimal amount necessary to be injected in a given area in order to have the desired effect? We can rely on the best equipment to harvest fat and process the aspirate in order to make it richer in ADSCs; however, if the physician is not patient enough or does not have the skill to deposit micro aliquots of adipose tissue, fat take will not occur. Thus, we better remain what we are — doctors respecting medical ethics and giving the image of serious


professionals, rather than pseudo-wizards pretending fiction that science has not proven. Our acts and statements must be thoughtful as we set the example for the younger generation of plastic surgeons, dermatologists, and more generally, for the cosmetic medical profession.


Fahd Benslimane National Secretary of the International Society of Aesthetic Plastic Surgery, Casablanca


PRIME JOURNAL EDITORIAL BOARD BOARD MEMBER SPECIALISM


Dr Claude Dalle


Dr Wilmar Accursio Dr Pierre Andre Dr Ashraf Badawi


Anti-ageing & aesth. medicine France Endocrinologist Dermatology Dermatology


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Dr Janethy Balakrishnan Dermatology Dr Lakhdar Belhaouari Dr Philippe Berros Dr Dario Bertossi


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BOARD MEMBER SPECIALISM Dr Mario Krause


Dr David Lai


Dr Marina Landau Dr Jean-Luc Levy Dr Sohail Mansoor Prof Leonardo Marini Dr Georges Mouton Dr Ruben Muhlberger Prof Daniel Pella Dr Vincenzo Penna


Prof Ascanio Polimeni Dr Herve Raspaldo Dr Constantin Stan Dr Pakpilai Thavisin Dr Mario Trelles Dr Ines Verner Dr Octavio Viera


Prof Bernard Weber Prof Alfred Wolf Christophe Luino Catherine Decuyper Wendy Lewis


Anti-ageing medicine Anti-ageing medicine Dermatology Dermatology Dermatology Dermatology


Sports medicine


Anti-ageing medicine Cardiology


Dr Chariya Petchngaovilai Dermatology Dr Eric Plot


Plastic surgery Plastic surgery


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France


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Anti-ageing medicine; pediatry Spain Genetician


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Industry expert & consultant France Industry expert & consultant France Industry expert


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