Clinical Application of Stromal Vascular Fraction Gel in Temple Augmentation Using Deep Injection and Shallow Pave Filling

Temple Volumization With Autologous Fat: A Systematic Review of the Literature

BACKGROUND

Facial aging leads to cosmetically unappealing temporal volume loss.

OBJECTIVE

To systematically review the literature regarding temporal volumization with autologous fat.

METHODS

PubMed, Scopus, Embase, and Cochrane databases were queried with relevant terms for all articles describing temporal volumization with autologous fat. Studies unrelated to temporal volumization, using synthetic fillers, without novel clinical/patient data, or unavailable in English were excluded, as were published abstracts of already included studies or with insufficient detail. Included article reference lists were also reviewed.

RESULTS

Database query yielded 1,224 unique articles. After screening, evaluation for duplicates and inclusion/exclusion criteria, and reference review, 45 articles with 1,239 patients were included and analyzed. Significant improvements in subcutaneous fat thickness/augmentation and investigator-/subject-graded efficacy criteria were reported, with a mean volume retention rate of 42.11% ± 11.50% (32.6%-65.7%) at 12 months. Ecchymosis (43.68%, 114/261) was the most common posttreatment adverse event. No infections, nerve dysfunction, or fat necrosis were described. Two cases of cutaneous necrosis/scarring and 22 cases of embolic serious adverse events leading to ocular injury, neurologic impairment, and/or death were reviewed.

CONCLUSION

Temporal volume loss can be effectively improved with autologous fat. Although predominantly a safe procedure, rare yet serious adverse events due to distal embolization have been reported.

Mechanical Fractionation of Adipose Tissue-A Scoping Review of Procedures to Obtain Stromal Vascular Fraction

Clinical indications for adipose tissue therapy are expanding towards a regenerative-based approach. Adipose-derived stromal vascular fraction consists of extracellular matrix and all nonadipocyte cells such as connective tissue cells including fibroblasts, adipose-derived stromal cells (ASCs) and vascular cells. Tissue stromal vascular fraction (tSVF) is obtained by mechanical fractionation, forcing adipose tissue through a device with one or more small hole(s) or cutting blades between syringes. The aim of this scoping review was to assess the efficacy of mechanical fractionation procedures to obtain tSVF. In addition, we provide an overview of the clinical, that is, therapeutic, efficacy of tSVF isolated by mechanical fraction on skin rejuvenation, wound healing and osteoarthritis. Procedures to obtain tissue stromal vascular fraction using mechanical fractionation and their associated validation data were included for comparison. For clinical outcome comparison, both animal and human studies that reported results after tSVF injection were included. We categorized mechanical fractionation procedures into filtration (n = 4), centrifugation (n = 8), both filtration and centrifugation (n = 3) and other methods (n = 3). In total, 1465 patients and 410 animals were described in the included clinical studies. tSVF seems to have a more positive clinical outcome in diseases with a high proinflammatory character such as osteoarthritis or (disturbed) wound healing, in comparison with skin rejuvenation of aging skin. Isolation of tSVF is obtained by disruption of adipocytes and therefore volume is reduced. Procedures consisting of centrifugation prior to mechanical fractionation seem to be most effective in volume reduction and thus isolation of tSVF. tSVF injection seems to be especially beneficial in clinical applications such as osteoarthritis or wound healing. Clinical application of tSVF appeared to be independent of the preparation procedure, which indicates that current methods are highly versatile.