The October 2017 Aesthetic Surgery Journal is full of stuff for us cosmetic plastic surgeons. As you know, I love fat grafting. But when you do fat transfer, not all of the fat survives, and survival can vary a lot between people. We are always trying to find ways to optimize.
This was a study with Dr. Rigotti (a heavy hitter in the field of fat transfer) entitled “Mechanical Supplementation With the Stromal Vascular Fraction Yields Improved Volume Retention in Facial Lipotransfer: A 1 Year Comparative Study.” So in English, what is that?
Background: Unpredictable volume survival is limitation in autologous fat grafting
Objective: Find out if enrichment of fat with stromal vascular fraction helps. *NOTE: Stromal vascular fraction is the small plug of cells at the bottom of a test tube after you centrifuge fat. You do this at 3000 rpm for 3 minutes. When you have centrifuged, you get 4 layers: an oily layer, a middle layer of firm compacted yellow tissue with less blood than If you separate by gravity, a lower layer of blood and fluid, and a bottom pellet. The bottom pellet is the stromal vascular fraction. You can also isolate the stromal vascular fraction by enzymatic methods, but they prefer centrifuge as it does not hurt cell viability and is inexpensive.
What is stromal vascular fraction (SVF)? It is regenerative cells, growth factors, and cytokines.
When they “enrich” the fat, the use the pellet from 1 centrifuged sample to a 10cc of fat to transfer.
Results:
- The SVF increases the helper factors by 1600 cells per ml
- Significant better volume retention, less volume loss (9.6% volume loss vs. 24 percent loss in the control)
- Aesthetic outcomes were viewed as better in enriched group (82% vs. 48% for control group)
My thoughts?
I like this study. We have known that adding the stromal cells improves fat survival, but past techniques used expensive machines and needed a large quantity of fat for a small pellet of usable cells. As many of my patients don’t have tons of extra fat (it is a curse of the athletic thin Bay Area woman), it wasn’t a good option given cost and lack of fat. This study shows a simple addition of 10cc of fat can give enough SVF to make a meaningful difference in fat survival. As I already centrifuge, this would be a simple small additional step. I look forward to trying it. There are limitations to the study like the size of the study, but again, it is a cheap and easy addition with what looks like real improvements in fat survival.