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Improved Long-Term Volume Retention of Stromal Vascular Fraction Gel Grafting with Enhanced Angiogenesis and Adipogenesis

Zhang, Yuteng, M.D.; Cai, Junrong, M.D.; Zhou, Tao, M.D.; Yao, Yao, M.D.; Dong, Ziqing, M.D.; Lu, Feng, M.D., Ph.D.

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 676e–686e
doi: 10.1097/PRS.0000000000004312
Experimental: Original Articles

Background: The apoptosis of mature adipocytes after fat grafting can result in chronic inflammation, absorption, and fibrosis, leading to unpredictable outcomes. Selective elimination of mature adipocytes may result in better outcomes and a different underlying retention mode. The authors previously developed a mature adipocyte–free product, stromal vascular fraction gel, derived from lipoaspirate, which eliminates adipocytes and preserves the stromal vascular fraction. This study investigated the retention and regeneration mode of stromal vascular fraction gel grafting.

Methods: Nude mice were grafted with human-derived stromal vascular fraction gel or Coleman fat. Detailed cellular events over 3 months were investigated histologically and immunohistochemically.

Results: The retention rate 90 days after grafting was significantly higher for stromal vascular fraction gel grafts than for standard Coleman fat (82 ± 15 percent versus 42 ± 9 percent; p < 0.05). Histologic analysis suggested that, unlike Coleman fat grafts, stromal vascular fraction gel grafts did not include significant necrotic areas. Moreover, although adipose tissue regeneration was found in grafts of both groups, rapid angiogenesis and macrophage infiltration were observed at a very early stage after stromal vascular fraction gel grafting. The presence of small preadipocytes with multiple intracellular lipid droplets in stromal vascular fraction gel grafts on day 3 also suggested very early adipogenesis. Although some of the cells in the stromal vascular fraction survived in stromal vascular fraction gel grafts, most of the newly formed adipose tissue was host-derived.

Conclusion: Stromal vascular fraction gel has a high long-term retention rate and a unique adipose regeneration mode, involving prompt inflammation and infiltration of immune cells, stimulating rapid angiogenesis and inducing host cell–mediated adipogenesis.

Guangzhou, Guangdong, People’s Republic of China

From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University.

Received for publication July 13, 2017; accepted December 4, 2017.

The first two authors contributed equally and should be considered co–first authors.

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

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Ziqing Dong, M.D., Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People’s Republic of China, doctordongziqing@hotmail.com, Feng Lu, M.D., Ph.D., Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, Guangdong, People’s Republic of China, doctorlufeng@hotmail.com

©2018American Society of Plastic Surgeons