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Antiaging Treatment of the Facial Skin by Fat Graft and Adipose-Derived Stem Cells

Charles-de-Sá, Luiz M.D.; Gontijo-de-Amorim, Natale Ferreira M.D.; Maeda Takiya, Christina Ph.D.; Borojevic, Radovan Ph.D.; Benati, Donatella Ph.D.; Bernardi, Paolo Ph.D.; Sbarbati, Andrea Ph.D.; Rigotti, Gino M.D.

Plastic and Reconstructive Surgery: April 2015 - Volume 135 - Issue 4 - p 999–1009
doi: 10.1097/PRS.0000000000001123
Cosmetic: Original Articles
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Background: The regenerative property of fat grafting has been described. However, it is not clear whether the clinical results are attributable to the stem cells or are linked to other components of the adipose tissue. This work is aimed at analysis of the histologic and ultrastructural changes of aged facial skin after injection of fat graft in addition to its stromal vascular fraction, obtained by centrifugation, and to compare the results with those obtained by the injection of expanded adipose-derived mesenchymal stem cells.

Methods: This study was performed in six consecutive patients who were candidates for face lift and whose ages ranged between 45 and 65 years. The patients underwent sampling of fat by liposuction from the abdominal region. The injection of fat and its stromal vascular fraction or expanded mesenchymal stem cells was performed in the preauricular areas. Fragments of skin were removed before and 3 months after each treatment and analyzed by optical and electron microscopy.

Results: After treatment with the autologous lipidic component and stromal vascular fraction, the skin showed a decrease in elastic fiber network (elastosis) and the appearance of new oxytalan elastic fibers in papillary dermis. The ultrastructural examination showed a modified tridimensional architecture of the reticular dermis and the presence of a richer microvascular bed. Similar results following treatment with expanded mesenchymal stem cells were observed.

Conclusion: This study demonstrates that treatment with either fat and stromal vascular fraction or expanded mesenchymal stem cells modifies the pattern of the dermis, representing a skin rejuvenation effect.

Video Discussion by Michael T. Longaker, M.D., M.B.A., is available online for this article.

Verona, Italy; and Rio de Janeiro, Brazil

From the Department of Neurological and Motor Science, Section of Anatomy and Histology, University of Verona; the Unità di Chirurgia Rigenerativa, Clinica San Francesco; and the Postgraduate Program in Surgical Science, Federal University of Rio de Janeiro.

Received for publication February 2, 2014; accepted July 11, 2014.

The first two authors contributed equally to this article.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

A Video Discussion by Michael T. Longaker, M.D., M.B.A., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

Gino Rigotti, M.D., Clinica San Francesco, Via Monte Ortigara 21/B37127 Verona, Italy,,

©2015American Society of Plastic Surgeons