Nanofat has since its description in 2013 been extensively studied. This mechanical method for isolating the stromal vascular fraction from an adipose tissue aspirate is well reproducible and shows a number of advantages to enzymatic stromal vascular fraction isolation methods.3–10 The standard method for delivering nanofat to the skin is by means of very superficial injection through 27-gauge needles; however, this is technically demanding, and it is difficult to maintain a consistent level of injection.
Microneedling, also known as percutaneous collagen induction, is a well-established minimally invasive method of facial rejuvenation.11–14 Percutaneous collagen induction does not ablate the epidermis or create open wounds, and triggers the release of growth factors such as platelet-derived growth factor, fibroblast growth factor, and transforming growth factor-α and transforming growth factor-β, resulting in scarless healing, which is essential for a cosmetic procedure.11,14 Histologically, a significant increase in collagen deposition has been shown at 6 months, along with a 40 percent increase of the epidermal thickness and normal rete ridges at 1 year after treatment.11,15 The reason why microneedling is proposed as a method for delivering nanofat into the skin is its property to create microchannels of a controlled depth in the skin. These microchannels close within 5 to 30 minutes; however, during this time, topical substances, pigment particles, platelets, or even noncultured autologous skin cells can be delivered to and captured by the deeper layers of the skin.11,12,16
The device proposed simultaneously creates the necessary microchannels to open up the skin while delivering small amounts of nanofat liquid with each tapping motion. The area to be treated can easily be needled in a uniform fashion. Thus, nanofat needling may improve the reproducibility of an even injection level over the whole treated surface.
Whereas in most cosmetic applications, average needle lengths rarely reach 1.5 mm, this length is required to consistently reach the papillary dermis, which is reflected in the observation of punctate bleedings.11,12 Although clinical results are obvious (Figs. 3 and 4), they are not to be compared with traditional ablative methods such as dermabrasion or laser resurfacing, with the latter requiring a recovery of at least 1 week, usually followed by several weeks of erythema, compared with 48 hours for the nanofat needling technique. However, the neck and the décolletage area, which are not amenable to any aggressive resurfacing technique, are perfectly indicated for treatment with nanofat needling. No adverse effects other than limited petechiae have been observed to date. No yellow staining as is sometimes observed after nanofat injection1 has been observed. A long-term benefit is to be expected from the delivery of living stromal vascular fraction cells into the skin.
Microneedling as a standalone procedure needs to be repeated a few times to achieve the desired effect of skin rejuvenation.17 With the incorporation of nanofat to the microneedling procedure, the need for repeated procedures may be reduced and the effect may be longer lasting.18,19 As with nanofat and other regenerative treatments, final results should not be interpreted before 6 to 8 months after the procedure. Further research is needed to determine the amount of stromal vascular fraction penetrating through the microchannels, and to determine the individual contribution of the needling and the nanofat to this technique.
We have combined the regenerative capacities of microneedling with those of nanofat injection. The properties of the regenerative cells of nanofat can accelerate the effects of the microneedling and provide the effects in a more sustained and longer lasting manner. Nanofat needling can be used as a standalone technique or as a part of any other facial rejuvenation procedure. Although early clinical results are encouraging, this innovation needs longer follow-up and further research with biopsy specimens to substantiate its histologic effects.
Patient provided written consent for the use patient’s images.
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