What is new with Fat grafting to the face and hands at the Aesthetic Laser Cen-ter?

What is new is called autologous lipocyte micronized injections. This is a fancy term that describes what we do to the fat after it is harvested before I graft it to the face, hands or scalp for hair restoration.

Previously, I harvested the fat from patients and centrifuged the fat to further purify it and remove the excess oil and fluid. What was left was mature fat cells and a small im-portant portion called Stromal Vascular Fraction or SVF.The SVF contains fibroblast, endothelial cells, pre-adipoctyes (cells that will turn into adipocytes or fat cells), smooth muscle cells, lymphocytes, macrophages and adipose derived stem cells.There have been numerous studies in the literature documenting the use of SVF to be effective in regenerative medicine. The problem with SVF is that it is expensive to obtain and it needs to be enzymatically prepared.

The fat after it is harvested can be mechanically micronized and placed through a filter that removes the adult fat cells. What is left, contains most of the cells in the Stromal Vascular Fraction or SVF. This is also called autologous cellular matrix or ACM and it is very watery compared to the fat that I used to graft. What is nice is that it can be in-jected with a small needle or 25 gauge cannula that I use to inject fillers.

Extrinsic photo-aging and chronological intrinsic aging occurs in our skin. UV exposure causes changes of epidermal thinning along with decreased fibroblast activity and irreg-ularly arranged elastin fibers. The results are wrinkles, dryness, laxity due to decrease elasticity, and irregular pigmentation. Studies have shown an increase in collagen pro-duction in the dermis along with increased vascularity when SVF is injected into the skin.

A study by Amirkhani, et al 1 showed that after the skin was injected with SVF, it caused the dermis to be thicker and there was more vessels produced which caused a rejuve-nation of the skin. They also observed that water evaporation of the skin was also de-creased which made the skin look plumper and less dry.

I like to treat the epidermis also when I inject the micronized fat. I will usually do a Dermapen on the patient at the same time. I like to glide the Dermapen with the mi-cronized fat, which produces channels in the skin and thus introduces the material that has the stem cells and other cells needed for rejuvenation into the dermis. This has the effect of thickening the epidermis which does not occur when you inject the micronized

fat in the dermis or subcutaneous tissue. Patients also get nice skin tightening when a Dermapen is performed at the same time.The injected material has a volumizing effect and rejuvenating effect just like when I used to inject fat. What I have noticed is that there is much less swelling probably be-cause the injected adult fat cells would die within 72 hrs. and would have to be naturally removed by the body’s own immune mechanisms.

A study by Rigotti, et al 2 showed that adding PRP did not improve the skin over using adipose-derived stem cells or SVF-enriched fat. The PRP produced a greater vascular reactivity which was not needed for simple rejuvenation of the skin. It might be more useful in regenerative medicine where more new and existing blood vessel formation if needed such as in healing chronic ulcer wounds.

Before and after micronized injections to the face along with a Dermapen treatment. Injections to tear troughs, temporals, lips.

Before and after micronized injections into hands along with a Dermapen treatment.

The following are examples of patients that had micronized fat injections using a 25g cannula or 27g needle and a Dermapen at the same time.

Before and after micronized injections into the Tear Troughs, Temporals along with Dermapen treatment of face and neck. Notice the skin tightening in neck.

References:1. Amirkhani, et al. Rejuvenation of facial skin and improvement in the dermal ar-

chitecture by transplantation of autologous stromal vascular fraction in a clinical study. Bioimpacts. 2016, 6(3): 149-154.

2. Ribotti, G., et al. Expanded Stem Cells, Stromal-Vascular Fraction, and Platelet-Rich Plasma Enriched Fat: Comparing Results of Different Facial Rejuvenation Ap-proaches in a Clinical Trial. Aesthetic Surg. J. 2016 Mar;36(3):261-70.