Fat Graft Survival Research Articles

Cold-Induced Browning: A Novel Method to Improve the Retention Rate of Fat Graft.

Autologous fat grafting is frequently used to heal soft-tissue defects. The key restriction that must be addressed is the poor transplant retention rate. Growing evidence has demonstrated that the browning of white adipose tissue enhances the survival of fat grafts. We hypothesized that cold-induced browning before transplantation may be a novel method to improve fat graft survival. Mice were kept in the 4 °C environment for 1 week, 2 weeks, and 3 weeks separately to detect whether different times of cold exposure could induce different numbers of beige adipocytes. Then, inguinal fat (roughly 150 mg) was collected and transferred. After post-graft weeks 4 and 12, the grafts were collected. The graft retention rate, histological morphology, vascularization, and browning were all assessed. Mice inguinal fat showed enhanced beige adipose regeneration as the cold exposure (4 °C) time increased. Cold-induced browning resulted in greater retention, reduced fibrosis and necrosis, and improved angiogenesis at post-graft weeks 4 and 12. Simultaneously, few beige adipocytes were seen in grafts at post-graft weeks 4 and 12. Cold-induced browning showed increased retention by promoting angiogenesis in a paracrine manner. Cold exposure of subcutaneous fat before transplantation may be a novel method to improve fat graft retention rate and retention quality. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dexmedetomidine regulates the anti-oxidation and autophagy of adipose-derived stromal cells under H2O2-induced oxidative stress through Nrf2/p62 pathway and improves the retention rate of autologous fat transplantation.

To investigate the protective mechanism of dexmedetomidine (DEX) on adipose-derived stromal cells (ADSCs) under oxidative stress model and its promotion effect on the retention rate of adipose granule transplantation by in vitro and in vivo experiments. The experiment was divided into control group, model group (ADSCs + H2O2+normal serum), DEX group (ADSCs + H202+DEX drug-containing serum), autophagy agonist group (ADSCs + H2O2+rapamycin (RAP)+normal serum), RAP + DEX group (ADSCs + H2O2+normal serum), RAP + DEX drug-containing serum), autophagy inhibitor group (ADSCs + H2O2+chloroquine (CQ)+normal serum), CQ + DEX group (ADSCs + H2O2+CQ + DEX drug-containing serum). HO-1, GSH-PX, SOD and CAT in ADSCs under oxidative stress model were measured. ROS fluorescence intensity and apoptosis ratio were detected. Expression of Nrf2, LC3-II/LC3-I and p62 were detected. In vivo, fat mixed with ADSCs or DEX -pretreated ADSCs was implanted subcutaneously in the lower back region of nude mice. Fat grafts were collected and analyzed at 2-, 4-, 6-, and 8-weeks post-transplantation. DEX pretreatment could reduce the expression of p62 to enhance the autophagy level of ADSCs under oxidative stress model. Additionally, cotransplantation of DEX-pretreated ADSCs with fat improved the long-term texture of fat grafts. DEX increased the fat graft survival and angiogenesis.

Tranexamic Acid in Liposuction: A Systematic Review of Literature and Meta-Analysis.

Tranexamic acid (TXA) is increasingly employed in plastic surgery to reduce perioperative hemorrhage. This systematic review assesses TXA's impact on blood loss, bruising, and fat graft survival following liposuction. A PRISMA-compliant systematic review was conducted. PubMed, Google Scholar, and Cochrane Library were searched using relevant keywords. Adult liposuction patients, receiving "intravenous TXA", "topical TXA", or "placebo", were categorized into "treatment" or "control" groups. Randomized controlled trials, prospective or retrospective cohort studies, and case-control studies were included, while uncontrolled observational studies, systematic reviews, letters, animal studies, and conference abstracts were excluded. Data on blood loss and bruises severity were synthetized into Excel spreadsheets. Study quality was independently assessed by two reviewers. Statistical analysis was accomplished employing forest plots for Hedge's G effect sizes and standardized mean differences, I2 heterogeneity, and publication bias using Egger's regressions and trim-and-fill funnel plots. Seven studies encompassing 457 patients were analyzed. Findings suggest that intravenous and topical TXA may contribute to blood loss reduction and a potential decrease in bruises severity following liposuction. No thromboembolic or serious complications were reported, suggesting a favorable safety profile for its routine use. TXA's impact on fat graft survival remains unknown. This meta-analysis suggests that TXA might be beneficial in reducing blood loss and bruising after liposuction, but the results are not definitive due to study limitations. Larger randomized controlled trials with standardized protocols of TXA administration, and better-designed measurement instruments are needed to confirm these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Early activation of macrophage-2 with IL-4 in stromal vascular fraction increases VEGF levels and adipocyte count and maintains volume of fat graft in Wistar rats (Rattus norvegicus)

Several previous studies have demonstrated the benefits of early macrophage 2 activation fat grafts supplemented with macrophage culture. However, this approach is considered impractical in clinical settings because of intraperitoneal induction use. The aim of this study was to investigate the effect of early stromal vascular fraction (SVF) macrophage-2 activation with IL-4 on fat graft survival compared to SVF alone using an animal model for better fat graft viability. This experimental study included inguinal fat harvesting, isolated with collagenases to retrieve the SVF, and then injected with a combination of fat graft and SVF (0.3 mL) into the scalp region. The intervention group received an IL-4 intralesional injection on the third day, and the fat grafts were biopsied on days 7, 14, and 30. The primary outcomes were the final volume of the fat graft, vascular endothelial growth factor (VEGF) expression, and the adipocyte cell count using perilipin staining on immunohistochemistry examination. The group receiving IL-4 exhibited significantly higher VEGF on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Similarly, the IL-4 treatment significantly increased the perilipin concentration on days 7, 14, and 30 (p=0.008, 0.008, and 0.029, respectively). In this group, VEGF concentration was significantly increased on day 14 as compared to day 7 (p=0.009), while no significant difference was observed in the control group (p=0.090). Additionally, the IL-4 group displayed significantly less reduction of fat graft volume than the control group, as observed on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Overall, the study underscores the potential benefits of early M2 polarization in fat grafting, as well as providing practical advantages for improving fat graft volume retention.

The effect of exogenous mitochondria in enhancing the survival and volume retention of transplanted fat tissue in a nude mice model

BackgroundDespite the pivotal role of fat grafting in plastic, reconstructive, and aesthetic surgery, inconsistent survival rates of transplanted adipose tissue, primarily due to early ischemic and hypoxic insults, remain a significant challenge. The infusion of healthy mitochondria has emerged as a promising intervention to support tissue recovery from ischemic, hypoxic, and other types of damages across various organ systems.ObjectivesThis study aims to evaluate the impact of supplementing human adipose tissue grafts with healthy exogenous mitochondria on their volume and mass retention rates when transplanted into the subcutaneous layers of nude mice. This approach seeks to improve and optimize fat grafting techniques.MethodsHuman adipose tissues were preconditioned with exogenous mitochondria (10 µg/mL), a combination of exogenous mitochondria and the inhibitor Dyngo-4a, Dyngo-4a alone, or PBS, and then transplanted into the subcutaneous tissue of 24 nude mice. Samples were harvested at 1 and 3 months post-transplantation for analysis of mass and volume retention. The structural morphology and integrity of the adipose tissues were assessed using Hematoxylin and Eosin (H&E) staining.ResultsMitochondrial preconditioning significantly enhanced the retention of mass and volume in fat grafts, demonstrating superior structural morphology and integrity compared to the control group.ConclusionsThis study highlights the potential of exogenous mitochondrial augmentation in fat transplantation to significantly improve fat graft survival, thereby optimizing the success of fat grafting procedures.

The Effect of Botulinum Toxin Type A in the Autologous Fat Grafting: A Review.

Autologous fat grafting is a widely used technique in plastic and reconstructive surgery for soft tissue augmentation. Despite its advantages, the primary limitation is the unpredictable retention rate of transplanted fat. Recent studies suggest that botulinum toxin type A (BTX-A) can enhance fat graft survival by promoting angiogenesis and muscle paralysis. This review explores the potential of BTX-A as an adjuvant in autologous fat grafting, providing insights into its mechanisms, benefits, and the need for further clinical validation. A literature review was conducted using PubMed, Web of Science, MEDLINE, and Embase. Keywords related to BTX-A, fat grafting, fat graft survival, and angiogenesis were used. Comparative studies reporting histological changes following BTX-A application in fat grafting were included. Exclusion criteria involved case reports with fewer than three animals, reviews, and letters. The initial search yielded 108 articles, with seven experimental studies meeting the criteria. These studies demonstrated that BTX-A enhances fat graft retention by promoting vascularization and adipose-derived stem cell differentiation. However, these results are mainly based on small animal models. While BTX-A shows promise in improving autologous fat grafting outcomes, its efficacy and safety in humans need validation through large-scale clinical trials. Translating these preclinical findings into human trials is crucial to establish standardized protocols and optimize clinical outcomes. Future research should focus on optimizing dosage and injection sites, conducting long-term follow-up studies, and performing multicenter trials to verify the findings.

Lymphatic Vessel-Mediated Attenuation of Persistent Macrophage Infiltration Improves Fat Grafting Outcomes in Mice Models.

Persistent macrophage infiltration may lead to adverse consequences, such as calcifications and nodules in fat grafts. Lymphatic vessels, which transport inflammatory cells, are involved in regulating inflammatory responses. Less is known, however, about lymphatic vessels after fat grafting. The aim of this study was to explore the regulation of fat graft survival by lymphatic vessels. A common adipose graft model was constructed to assess the processes responsible for changes in the number of lymphatic vessels in grafts. Adipose tissue samples from C57/BL6 mice and green fluorescent protein-expressing mice were cross-grafted to determine the source of lymphatic vessels. The number of lymphatic vessels in the grafts was increased by treatment with vascular endothelial growth factor C, and the effects of this increase on fat grafting were evaluated. The number of lymphatic vessels was greater in postgrafted fat than in inguinal fat before transplantation, with lymphatic vessels in these grafts gradually transitioning from donor to recipient sources. Lymphatic vessels grew more slowly than blood vessels during early stages of grafting; during later stages, however, the number of blood vessels declined markedly, with more lymphatic vessels than blood vessels being observed 60 days after grafting. Vascular endothelial growth factor C treatment increased graft lymphatics and distant volume retention, while reducing fibrosis and oil sacs. Lymphatic vessels acted as drainage channels for macrophages, with the degree of sustained macrophage infiltration decreasing with increases in the number of lymphatic vessels. Increasing the number of lymphatic vessels is beneficial for fat graft survival, which may be related to a reduction in prolonged macrophage infiltration.

Oral Administration of Lutein Improves Fat Graft Survival by Alleviating Oxidative Stress in Mice.

Oxidative stress induced by ischemia and hypoxia in fat transplantation is a major obstacle to graft retention. Previous studies have shown that lutein has excellent adipose tissue affinity and antioxidative stress ability, however, the effects of oral lutein on fat transplantation have not yet been studied. We aimed to investigate whether oral lutein could improve fat transplantation retention by regulating oxidative stress, apoptosis, and inflammatory cytokine levels in graft tissues. Nude mice were assigned to the control group (normal saline), low-dose lutein group (10 mg/kg/day), and high-dose lutein group (20 mg/kg/day) randomly. All mice received treatment by gavage 1 week before fat grafting and continued for 2 weeks. The grafts were collected 1, 2, and 12 weeks after treatment. By conducting histological analyses, Western blotting, quantitative polymerase chain reaction and cell metabolic function detection, the regulatory effects of lutein on apoptosis and oxidative stress in grafts were demonstrated. Additionally, RNA sequencing was conducted to further clarify the efficacy of lutein on fat grafting. Lutein induced superior graft retention, histological structures, and more viable adipocytes than the control group. It relieved tissue oxidative stress and lipid oxidative damage by decreasing reactive oxygen species and significantly reduced inflammation and apoptosis of grafts. RNA sequencing analysis confirmed that lutein could downregulate the gene expression of oxidative stress and related inflammation and apoptosis. Our study suggests that oral administration of lutein can improve fat graft survival by reducing the levels of oxidative stress, inflammation, and apoptosis in grafted fat.

Investigation of the Effect of Mobile and Immobile Regions on Fat Graft Viability: An Experimental Study in a New Model.

Fat grafts are widely used in plastic, aesthetic and reconstructive surgery. Their unpredictable resorption is their main disadvantage. A review of the literature shows that there is a lack of research on the effect of mobile and immobile regions on fat graft survival in fat graft applications. Our aim was to investigate the relationship of fat graft survival with mobile and immobile region in a new experimental model. Twenty-four male Wistar albino rats were randomly divided into two groups (n=12). Fat grafts were harvested from the right inguinal region of the rat. In Group 1, the fat graft was placed in the subcutaneous pouch formed in the scalp region of the rat. In Group 2, fat grafts were placed in the pouch formed in the posterior cervical region of the rat. At the end of 6weeks, the weights and histopathology of the fat grafts were evaluated. Histopathological examinations were performed in a blinded fashion. The weights of the fat grafts were found to be higher in Group 1. At the same time, histopathological examinations showed that vascular density was higher in Group 1. There was no statistically significant difference in other histopathological examinations. The mobile and immobile areas may have different effects on the survival of transplanted fat grafts. Sliding movement between muscle and skin in the mobile zone puts stress on the fat graft. In our study, the mobile site was shown to have a negative effect on the vascularity of the fat graft. It was observed that the vascular density was higher in the fat graft placed in the immobilised area. Further studies on the increase in vascularity can be carried out using the new experimental model we have created. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modulating endothelial cell dynamics in fat grafting: the impact of DLL4 siRNA via adipose stem cell extracellular vesicles.

In the context of improving the efficacy of autologous fat grafts (AFGs) in reconstructive surgery, this study delineates the novel use of adipose-derived mesenchymal stem cells (ADSCs) and their extracellular vesicles (EVs) as vehicles for delivering delta-like ligand 4 (DLL4) siRNA. The aim was to inhibit DLL4, a gene identified through transcriptome analysis as a critical player in the vascular endothelial cells of AFG tissues, thereby negatively affecting endothelial cell functions and graft survival through the Notch signaling pathway. By engineering ADSC EVs to carry DLL4 siRNA (ADSC EVs-siDLL4), the research demonstrated a marked improvement in endothelial cell proliferation, migration, and lumen formation, and enhanced angiogenesis in vivo, leading to a significant increase in the survival rate of AFGs. This approach presents a significant advancement in the field of tissue engineering and regenerative medicine, offering a potential method to overcome the limitations of current fat grafting techniques.NEW & NOTEWORTHY This study introduces a groundbreaking method for enhancing autologous fat graft survival using adipose-derived stem cell extracellular vesicles (ADSC EVs) to deliver DLL4 siRNA. By targeting the delta-like ligand 4 (DLL4) gene, crucial in endothelial cell dynamics, this innovative approach significantly improves endothelial cell functions and angiogenesis, marking a substantial advancement in tissue engineering and regenerative medicine.

Poloxamer 188 washing of lipoaspirate improves fat graft survival: A comparative study in nude mice

BackgroundAutologous fat transplantation is limited by the uncertainty of grafting retention, impeding its application. Among current strategies of processing lipoaspirates, high-density fat (HDF) due to its enrichment of stem cells and washing before cotton concentration for the simplicity of operation are recommended. Poloxamer 188 (P188) washing has been shown to repair the membranes of damaged cells. This study aimed to investigate the effect of P188-washing on fat graft survival and to identify the best processing technique. MethodsLipoaspirates were prepared by centrifuging to obtain HDF, and by washing with saline or P188 followed by cotton concentration. Tissue integrity, adipocytic activity and viability of SVF in samples from three groups were assessed. Samples were sequenced in vitro by high-throughput RNA-Seq, and differentially expressed genes (DEGs) were validated through qPCR and WB. After transplantation under the dorsum of nude mice for 8 weeks, the grafts were extracted and examined in residual volume, histologic characteristics and vascularization. ResultsHDF and P188 groups showed higher survival rate of SVF, more Ki67-positive cells, intact tissue structure, and less fibrosis. There were no significant differences in the density of SVF and residual volume of grafts. HDF showed significantly improved vascularization during 8 weeks. Through RNA-Seq and bioinformatic analysis, there were noteworthy changes of several related genes after transplantation. ConclusionsP188 treatment can prevent cell from apoptosis and preserve tissue viability, thereby improving graft quality. High-density fat contains large amount of SVF and can be regarded as an excellent grafting material.

Comparison of stromal vascular fraction cell composition between Coleman fat and extracellular matrix/stromal vascular fraction gel

ABSTRACT As a mechanically condensed product of Coleman fat, extracellular matrix/stromal vascular fraction gel (ECM/SVF-gel) eliminates adipocytes, concentrates SVF cells, and improves fat graft retention. This study aims to compare SVF cell composition between Coleman fat and ECM/SVF-gel. Matched Coleman fat and ECM/SVF-gel of 28 healthy women were subjected to RNA-seq, followed by functional enrichment and cell-type-specific enrichment analyses, and deconvolution of SVF cell subsets, reconstructing SVF cell composition in the transcriptome level. ECM/SVF-gels had 9 upregulated and 73 downregulated differentially expressed genes (DEGs). Downregulated DEGs were mainly associated with inflammatory and immune responses, and enriched in fat macrophages. M2 macrophages, resting CD4+ memory T cells, M1 macrophages, resting mast cells, and M0 macrophages ranked in the top five most prevalent immune cells in the two groups. The proportions of the principal non-immune cells (e.g., adipose-derived stem cells, pericytes, preadipocytes, microvascular endothelial cells) had no statistical differences between the two groups. Our findings reveal ECM/SVF-gels share the same dominant immune cells beneficial to fat graft survival with Coleman fat, but exhibiting obvious losses of immune cells (especially macrophages), while non-immune cells necessary for adipose regeneration might have no significant loss in ECM/SVF-gels and their biological effects could be markedly enhanced by the ECM/SVF-gel’s condensed nature.

Advancing Standardization in Fat Graft Survival Studies: Assessing the Superiority of Paraepididymal Fat Graft as a Donor Site.

There is currently no standardization in the field of research on fat grafts in rats, which is one of the most popular topics in plastic surgery. The aim of our study was to demonstrate the effects of selecting paraepididymal fat grafts as the donor area on enhancing the reliability of fat graft studies. In this study, 12 male Sprague-Dawley rats were used to obtain adipose grafts from both inguinal and paraepididymal regions. After measuring the graft weights, they were subjected to histological examination using hematoxylin-eosin staining, as well as immunohistochemical staining with antiperilipin antibody. Purity of the samples, viability of adipose cells, and the presence of lymph nodes within the grafts were analyzed. The purity of adipose cells in graft samples obtained from the paraepididymal region was found to be 98.1% compared with the total sample. In contrast, the purity of adipose cells in graft samples obtained from the inguinal region was 58.37%. Hematoxylin-eosin staining revealed significantly higher adipocyte viability and vascularity in the paraepididymal region compared with the inguinal region (P = 0.0134). Conversely, lymphatic tissue content in samples obtained from the inguinal region was significantly higher compared with paraepididymal adipose tissue samples (P < 0.0001). Immunohistochemical staining with antiperilipin antibody showed a denser and more uniform staining pattern in paraepididymal adipose grafts (P < 0.0001). Using paraepididymal fat, devoid of lymphatic tissue, naturally eliminates 2 critical biases (estrogen and lymphatic tissue), enhancing the standardization and reliability of fat graft survival studies.

Breast Lipofilling: Is the Bra Really Full? Clinical Bra Pressure Measurement and In Vitro Testing of Processed and Unprocessed Fat Cells.

Breast lipofilling, a popular cosmetic and reconstructive procedure, involves the transplantation of autologous fat to enhance breast volume and contour. Despite its widespread use, cell processing and the aftertreatment remain controversial. This study investigates the pressure applied by a compression bra and reports in vitro stress tests of processed and unprocessed fat cells. Clinical bra pressure measurements were conducted on a cohort of 45 patients following lipofilling, reduction mammoplasties and DIEP flaps. Laboratory analysis included cell vitality testing using Resazurin assays of processed and unprocessed fat cells after exposure to mechanical or hyperbaric pressure. Our findings show a mean overall pressure value of the compression bra for all patients of 6.7 ± 5.7 mmHg (range 0-35). Cell processing is superior to sedimentation only regarding fat cell vitality. However, neither mechanical pressure within the specified range nor hyperbaric oxygen exposure significantly affected fat graft survival as measured by Resazurin assays. The in vitro measurements showed that it was impossible to harm fat cells with external pressure during lipofilling procedures, regardless of their processing. In the clinical context, the compression bra applied pressure values deceeding the perfusion pressure and may therefore not diminish oxygen supply nor harm the transplanted cells. Therefore, we recommend the use of a compression bra for all lipofilling procedures around the breast. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Establishment of Early Blood Perfusion Promotes CXCL12 Expression and Recruits Monocytes/Macrophages in Damaged Adipose Tissue in Mice Model.

Blood perfusion in the recipient site is important for adipose tissue repair after fat grafting. It delivers host-derived macrophages derived from monocytes in bone marrow to initiate inflammatory reactions and regenerative responses. According to the ability of CXCL12, a stromal cell-derived factor, to recruit monocytes/macrophages, we studied its effect on adipose tissue repair and regeneration under ischemic and normal conditions. Each inguinal fat pad was crushed for 30 seconds with a clamp in mice (n = 35). The left inguinal vessels were divided and cut off (ischemic group), while the right inguinal vessels were kept patent (control group). Seven animals were sacrificed at 1, 3, 7, 14, and 30 days after surgery, and macrophages (Mac2 and CD206) and adipocytes (perilipin) were assessed. Levels of inflammatory factors (interleukin (IL)-1β, IL-6, and tumor necrosis factor-α) and CXCL12 were measured by quantitative PCR. The number of macrophages was higher in the control group than in the ischemic group at day 3 (10.33 ± 2.40 vs. 1.33 ± 0.33, p = 0.021). The percentage of M2 macrophages was higher in the control group than in the ischemic group at day 7 (p<0.05). The levels of inflammatory factors and CXCL12 were higher in the control group than in the ischemic group at the early stage (p = 0.038). Established blood perfusion leads to up-regulation of CXCL12 during adipose tissue repair and regeneration, which may increase recruitment of monocytes to damaged adipose tissue. These findings increase understanding of the cellular events involved in fat graft survival after grafting. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The role of platelet rich plasma enriched fat graft for correction of deformities after conservative breast surgery.

Fat transfer has been widely used after breast conservative surgery (BCS) where it aims to recover shapes as a simple, inexpensive, biocompatible method but the technique is not without complications. Platelet Rich Plasma (PRP) is a promising approach to enhance fat graft survival and subsequently improve the outcome. The aim of this study was to evaluate the effect of enriching fat graft with PRP for delayed correction of deformities after conservative surgery for breast cancer regarding esthetic outcome and incidence of complications. The current study included 50 female patients who were scheduled for delayed lipofilling for correction of deformities after conservative surgery for breast cancer. The studied patients were randomly allocated into 2 groups: Group I (G I) included 25 patients scheduled for PRP enriched lipoinjection and Group II (G II) included 25 patients scheduled for lipoinjection without PRP as a control group. Number of sessions of lipoinjection was significantly less in G I in comparison to G II (P =0.024). During the 2nd session; the amounts of fat injected and harvested were significantly less in G I in comparison to G II (P =0.049 and 0.001 respectively). Recipient site complications were significantly more evident in G II in comparison to G I (P =0.01). Surgeon and patient satisfactions were significantly more evident in GI in comparison to G II (P =0.005 and 0.029 respectively). The addition of PRP to fat grafts is a simple, cost-effective and safe method to improve esthetic outcome and decrease complications.

Adenosine washing improves the retention rate of fat grafts under conditions of obesity

Background Fat grafting is a commonly employed aesthetic procedure for contour enhancement. However, outcome prediction is challenging due to the complex regeneration and remodeling processes involved. We investigated whether adenosine improves engraftment and fat graft survival under conditions of obesity.Methods Fat was harvested from mice fed a high-fat diet. This fat was washed with either Krebs-Ringer bicarbonate HEPES buffer (the vehicle group) or a buffer containing 500 nM adenosine (the adenosine wash group). Subsequently, the fat was transplanted into normal mice at 0.2 mL per mouse. In both groups, 50% of the mice were sacrificed at 1 week and the remainder at 4 weeks post-transplantation. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis was conducted during week 1. In week 4, micro-computed tomography, immunofluorescence staining, and RT-qPCR were performed. A sample of the initially harvested fat was set aside for lipolysis assay.Results Adenosine washing improved fat graft retention volumes by up to 50%. One week post-transplantation, the expression of adipogenic and angiogenic genes was found to be upregulated in the adenosine wash group. After 4 weeks, immunofluorescence staining revealed greater adipocyte integrity and an increased number of vessels. Furthermore, adenosine appeared to modulate inflammation by stabilizing the lipolysis rate.Conclusions Adenosine washing increased the fat graft survival rate under conditions of obesity. Clinically, this suggests a simple, cost-effective adjuvant method for improving fat graft survival in individuals with obesity. Further research is warranted to elucidate the underlying mechanisms and explore the applicability of this technique for autologous transplantation.

Disulfiram Improves Fat Graft Retention by Modulating Macrophage Polarization With Inhibition of NLRP3 Inflammasome-Mediated Pyroptosis.

Macrophage-mediated inflammatory response in the early post-grafting period restricts fat graft retention. Pyroptosis is a novel type of programmed cell death that extensively participates in inflammatory pathologies. This study sought to determine whether macrophage pyroptosis was activated during the inflammatory phase after fat grafting and to investigate the efficacy of a pyroptosis inhibitor, disulfiram (DSF), in fat graft retention. We established a C57BL/6 mice fat grafting model and then analyzed macrophage pyroptosis. DSF (50 mg/kg, every other day) was intraperitoneally injected starting 1 hour before fat grafting and continued for 14 days. An in vitro co-culture system was established in which mouse RAW264.7 macrophages were co-cultured with apoptotic adipocytes to further validate the findings of the in vivo studies and to explore the underlying mechanisms. Here we reported that macrophage pyroptosis was activated in both fat grafts and in vitro co-culture models. DSF was found to be a potent pyroptosis inhibitor, promoting M2 macrophage polarization. In addition, DSF was demonstrated to enhance vascularization and graft retention. Our results suggested that pyroptosis plays a crucial role in the inflammatory cascade within fat grafts. DSF, being a clinically available drug, could be translated into a clinically effective drug for improving fat graft survival by inhibiting macrophage pyroptosis, therefore inducing M2 macrophage polarization and promoting neovascularization.

Enhancing Fat Transplantation Efficiency in a Mouse Model through Pretreatment of Adipose-Derived Stem Cells with RIP3 Inhibitors.

Autologous fat transplantation, widely used in cosmetic and reparative surgery for volumetric enhancements, faces challenges with its inconsistent long-term survival rates. The technique's efficacy, crucial for its development, is hindered by unpredictable outcomes. Enriching fat grafts with adipose-derived stem cells (ADSCs) shows promise in improving survival efficiency. This study aimed to explore the potential of receptor-interacting protein kinase 3 (RIP3) kinase inhibitors as a pretreatment for ADSCs in enhancing autologous fat graft retention over a long term. ADSCs were isolated, cultured under normal or oxygen-glucose deprivation conditions, and mixed with particulate fat grafts to form distinct experimental groups in female nude mice. Fat graft mass and volume, along with underlying mechanisms, were evaluated using quantitative reverse transcription polymerase chain reaction (RT-qPCR), immunohistochemistry, and Western blot analysis. The experimental group, pretreated with RIP3 kinase inhibitors, had higher graft mass and volume, greater adipocyte integrity, and increased peroxisome proliferator-activated receptor gamma (PPARγ) mRNA levels than control groups. Furthermore, the experimental group demonstrated lower expression of necroptosis pathway proteins in the short term and an ameliorated inflammatory response as indicated by interleukin-1 beta (IL-1β), interleukin-10 (IL-10) mRNA levels, and histological analyses. Notably, enhanced neovascularization was evident in the experimental group. These findings suggest that RIP3 kinase inhibitor pretreatment of ADSCs can improve fat graft survival, promote adipocyte integrity, potentially decrease inflammation, and enhance neovascularization. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lipolysis inhibition improves the survival of fat grafts through ameliorating lipotoxicity and inflammation.

Fat grafting is a promising technique for correcting soft tissue abnormalities, but oil cyst formation and graft fibrosis frequently impede the therapeutic benefit of fat grafting. The lipolysis of released oil droplets after grafting may make the inflammation and fibrosis in the grafts worse; therefore, by regulating adipose triglyceride lipase (ATGL) via Atglistatin (ATG) and Forskolin (FSK), we investigated the impact of lipolysis on fat grafts in this study. After being removed from the mice and chopped into small pieces, the subcutaneous fat from wild-type C57BL/6J mice was placed in three different solutions for two hours: serum-free cell culture medium, culture medium+FSK (50 μM), and culture medium+ATG (100 μM). Following centrifugation to remove water and free oil droplets, 0.3 mL of the fat particles per mouse was subcutaneously injected into the back of mice. Additionally, the subcutaneous fat grafting area was immediately injected with PBS (control group), ATG (30 mg/kg), and FSK (15 mg/kg) following fat transplantation. Detailed cellular events after grafting were investigated by histological staining, real-time polymerase chain reaction, immunohistochemistry/immunofluorescent staining, and quantification. Two weeks after grafting, grafts treated with ATG showed lower expression of ATGL and decreased mRNA levels of TNFα and IL-6. In contrast, grafts treated with ATG showed elevated expression levels of IL-4 and IL-13 compared to the control grafts. In addition, fewer apoptotic cells and oil cysts were observed in ATG grafts. Meanwhile, a higher CD206+/CD68+ ratio of macrophages and more CD31+ vascular endothelial cells existed in the 2-month ATG grafts. In comparison to the control, ATG treatment improved the volume retention of grafts, and decreased graft fibrosis and oil cyst formation. By preventing oil droplet lipolysis, pharmacological suppression of ATGL shielded adipocytes from lipotoxicity following grafting. Additionally, ATG ameliorated the apoptosis and inflammation brought on by adipocyte death and oil droplet lipolysis in grafted fat. These all indicate that lipolysis inhibition improved transplanted fat survival and decreased the development of oil cysts and graft fibrosis, offering a potential postoperative pharmacological intervention for bettering fat grafting.