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Introducción: El envejecimiento periorbitario se considera un proceso complejo y multifactorial que se relaciona con procesos intrínsecos y extrínsecos tales como los cambios degenerativos en la piel, la aparición de líneas finas, la pérdida de volumen, el descenso de tejidos, la piel flácida y el exceso de depósito de grasa. Objetivo: Evaluar los resultados de la corrección de las ojeras y del surco nasoyugal con Nanofat. Métodos: Se realizó un estudio longitudinal prospectivo en el Servicio de Cirugía Plástica y Caumatología del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" desde agosto de 2019 a mayo de 2021. La muestra la constituyeron 37 pacientes. Los datos se resumieron en frecuencias absolutas y relativas. Resultados: La edad promedio fue 47,2 ± 10,7 años. El 89,2 por ciento de los pacientes eran mujeres. La media del tejido emulsionado infiltrado por cada lado fue de 1,40 ± 0,4 ml, con un volumen mínimo de 1 ml y un máximo de 2 ml. En el 83,8 por ciento de los casos se constató una disminución del surco nasoyugal y en el 16,2 por ciento se evidenció una gran mejoría. En el 100 por ciento de los pacientes hubo avance de la hiperpigmentación y mejoría de la calidad de la piel. Dentro de las complicaciones solo un paciente (2,7 por ciento) presentó nódulos por calcificación en la zona receptora. El resto de los pacientes en estudio no presentó eventos adversos. El grado de satisfacción postratamiento con Nanofat fue de 100 por ciento. Conclusiones: Los resultados de la corrección de las ojeras y del surco nasoyugal con Nanofat son muy buenos(AU)
Introduction: Periorbital aging is considered a complex and multifactorial process that is related to intrinsic and extrinsic processes such as degenerative changes in the skin, appearance of fine lines, volume loss, tissue descent, sagging skin, and excess fat deposition. Objetive: To evaluate the results of correction of dark circles under the eyes and the nasojugal sulcus with Nanofat. Methods: A prospective longitudinal study was performed in the Plastic Surgery and Caumatology Service of the Clinical Surgical Hospital "Hermanos Ameijeiras" from August 2019 to May 2021. The sample consisted of 37 patients. The data were summarized in absolute and relative frequencies. Results: The mean age was 47.2±10.7 years. The 89.2 percent of the patients were women. The mean emulsified tissue infiltrated per side was 1.40±0.4 ml, with a minimum volume of 1 ml and a maximum of 2 ml. In 83.8 percent of the cases there was a decrease in the nasojugal sulcus and in 16.2 percent there was a great improvement. In 100 percent of the patients there was improvement of hyperpigmentation and great improvement of skin quality. Among the complications only one patient (2.7 percent) presented nodules due to calcification in the recipient area. The rest of the patients in the study did not present adverse events. The degree of post-treatment satisfaction with Nanofat was 100 percent. Conclusions: The results of correction of dark circles and nasojugal sulcus with Nanofat are very good(AU)
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Humans , Female , Middle Aged , Aging , Prospective StudiesABSTRACT
Objective:To evaluate the clinical effect of autologous nanofat combined with pearl fat transplantation in comprehensive improvement of lacrimal groove depression.Methods:Seventy-eight patients (age ranges from 28 to 56 years, with average 38 years) who desired for lacrimal groove improvement were involved in this study from Jan. 2019 to Jun. 2020 in the Department of Plastic Surgery in Peking Union Medical College Hospital. Primary fat tissue was obtained and purified by liposuction. Nanofat and pearl fat were prepared and injected into lacrimal groove area in different layers and multiple points evenly to ameliorate depression. Visual analogue scoring (VAS) was used for evaluating injection pain. Dark eye circles, faint lines on lower eyelid, color spots and lacrimal groove depression between pre-operation pictures and post-operation pictures of 1 year follow-up were evaluated by patients＇ satisfaction scores.Results:All 78 patients revealed mild swelling and disappeared in 3 to 4 days. Injection areas were stable in 3 months. All patients appeared no complications such as infection, hematoma, fat liquefaction, local induration and so on. Among 78 patients, 2 patients showed ecchymosis after surgery which disappeared in 10 days, and 1 patient showed uneven appearance which disappeared after timely treatment. After 1 year of follow-up, the average satisfaction score of improvement was 8.9±0.5, which showed satisfied post-operative effect.Conclusions:Autologous nanofat combined with pearl fat transplantation has high feasibility, short operation time, which could achieve good effect of facial rejuvenation with high patients＇ satisfaction. In this case, this technique is worthy of clinical promotion.
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Objective To evaluate the clinical effect of nanofat on superficial rhytides of face and neck and dark lower eyelids.Methods From September 2014 to January 2017,a total of 86 cases were collected in our hospital for voluntary nanofat transplantation on superficial rhytides and dark lower eyelids.This was a retrospective study,which included 18 cases of eye wrinkles,14 cases of forehead wrinkles,neck wrinkles in 14 cases,and 22 cases of dark lower eyelids.First of all,we harvested mircofat through liposuction,and then transformed mircofat to nanofat.At last,nanofat was grafted into intradermal layer of the skin with sharp needles.We took the standard photographs of the patients.After six months follow-up,doctors and patients evaluated the short term and long-term postoperative effect.Results No serious complications occurred in all patients.Postoperative evaluation of facial and neck superficial wrinkles showed that the satisfactory rate of doctors and patients after one month,was 85.9％and 84.3％,and after 6 months 87.5％ and 84.3％,respectively.Postoperative evaluation of dark lower eyelids showed that the satisfactory rate of doctors and patients after one month was 45.5％ and 36.4％,and after 6 months 81.8％ and 86.4％,respectively.Conclusions Nanofat can rectify the superficial rhytides of face and neck and dark lower eyelids in some patients.However,for some patients the effect is not satisfied.
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Objective@#To study the effects of three different granular fats on proliferation, differentiation and migration of adipose-derived stem cells.@*Methods@#Ten patients were selected for lumbar liposuction. The adipose tissue was obtained with different sized side-hole fat aspiration devices: 10 ml of Macrofat (n=10), 10 ml of Microfat (n=10) and 10 ml of Nanofat (n=10). Enzyme digestion method was used to separate and extract adipose-derived stem cells(ADSCs). The differences of vascular matrix components in these 3 kinds of fat sources were analyzed. XTT assay was used to detect proliferation and growth ability. The migration ability of the cell injury model was observed in vitro, and the multi-directional differentiation ability was compared by the analysis of adipogenic and osteogenic induction. The experimental data were analyzed using SPSS 13.0 software. One-Way ANOVA was used to compare the difference of multiple groups. P<0.05 was considered as statistically significant.@*Results@#The detection of adipose-derived stem cells was by flow cytometry and it showed Macrofat, Microfat and Nanofat was(4.23±0.37)×105, (2.29±0.33)×105 and(1.56±0.16)×105. The content of fat-derived stem cells in Macrofat was the highest, followed by Microfat, and the content of Nanofat was the least (F=209.533, P<0.001). XTT assay showed that the proliferative ability of adipose-derived stem cells in the first two generations of Macrofat was the highest, followed by Microfat, while the proliferation of Nanofat was the lowest (the absorbance in 3 groups increased in a time-dependent manner). There was no significant difference in the proliferative capacity of the third generation of 3 groups (the absorbance of these 3 groups were compared at each time point). The cellular trauma model showed that the first generation of Macrofat-derived stem cells had the best migration ability, followed by Microfat, while the Nanofat had the weakest migration ability(Compared with the remaining area of wounds at 0 h, 12 h, 24 h point between the three groups, F=306.370, 1409.907, P<0.001). From the second generation, the migration ability of each group of ADSCs gradually self-repaired, and the migration ability at 12 h was similar to that of the first generation (F=11.410, P<0.001), but there was no significant difference in 24 h (F=0.070, P=0.933). Oil red O and alizarin red staining showed that the first generation of Macrofat and Microfat had better fat-forming and osteogenic differentiation ability than Nanofat(F=523.532, 620.022, P<0.001). However, there was no significant change after the second generation (F=2.144, 0.866, P=0.137, 0.432).@*Conclusions@#In the process of adipose tissue extraction of Nanofat, the production and activity of adipose-derived stem cells was impacted. However, in the process of culture and passage, the cell activity, proliferation ability, migration ability and differentiation ability can be achieved through self-repair, evenclose to the level of Macrofat or Microfat.
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Objective@#To investigate the clinical effect of subcutaneous injection of nanofat combined with autologous fat into tear trough deformity to improve the mixed dark circle at lower eyelid, and the feasibility of using L*a*b* value to objectively evaluate the improvement of skin color at the lower eyelid with dark circle.@*Methods@#A total of 14 patients with the mixed dark circle at lower eyelid, admitted by Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from November 2017 to August 2018 were selected. They were all female, aged between 21 and 46 years old. Thigh or abdomen was selected as the fat donor area. Autologous fat was filled into the tear trough deformity. The prepared nanofat was injected into the subcutaneous layer of the lower eyelid with dark circle. Photoes were taken under the same condition and same room temperature for patients before operation and 6 months after operation. Photoshop, CS7 exposure correction, as well as 64 Image J software measurement were adopted to evaluate the skin L* a* b* value at dark circle of lower eyelid. SPSS 20.0 rows of data statistical analysis was applied with paired t test(P<0.05).@*Results@#All patients were followed up for 6 months after the operation, and a satisfactory effect was achieved after one injection, with an overall satisfaction rate of 78.6% (11/14). The color and skin fine wrinkles at the dark circle of the lower eyelid were improved in 14 patients, and the contour of the injection area was smooth without obvious complications. 6 months after the operation, the L* value of the skin at the lower eyelid with dark circle was 55.13±5.56, which was 7.74±2.39 higher than the preoperative value of 48.23±5.63, showing significant difference(t=12.089, P=0.00). Six months after surgery, the a* value was 14.68±2.84, which decreased by 0.11±0.60 compared with 14.79±3.04 before surgery, showing no statistically difference(t=-0.71, P=0.49). Six months after surgery, the b* value was 19.77±3.45, which increased by 0.27±1.03 compared with 19.50±3.45 before surgery, showing no statistical difference (t=0.98, P=0.35).@*Conclusions@#Subcutaneous injection of nanofat combined with autologous fat injection for tear trough deformity is effective in the treatment of lower eyelid with mixed dark circle. The L*a*b* value can objectively evaluate the improvement of skin color at the lower eyelid with dark circle.
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Autologous adipose tissue is the most common filling material for repairing soft tissue defects at present. There are many studies on the efficacy and safety of autologous fat transplantation, and the results highly varies. For helping the doctors select the best practices for patients and beauty-seekers, the following aspects of the research progress of autologous fat grafting in recent years are discussed: functional anatomy of the superficial fat compartments of the face, nano-fat injected in dermis by micro-needle, SVF-gel and matching the donor fat site and the recipient environment of autologous fat grafts for better postoperative outcomes and safety.
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Objective@#To study the clinical effect of nano-fat mixed granule fat transplantation in the treatment of cicatricial facial depression and atrophy, and to explore the related experimental mechanism.@*Methods@#(1) From January 2012 to April 2018, 105 patients conforming to the inclusion criteria, with cicatricial facial depression and atrophy deformity who needed facial fat transplantation, were admitted to our unit. Their medical records were analyzed retrospectively. According to the patients′ wishes, 54 patients (12 males and 42 females) aged 10-59 years received traditional transplantation of pure autologous granule fat collected from abdomen/thigh and were included in simple transplantation group, while the other 51 patients (14 males and 37 females) aged 7-63 years received transplantation of autologous nano-fat mixed granule fat collected from abdomen/thigh and were included in mixed transplantation group. The treatment satisfaction of patients 3 and 6 months after operation was assessed by the facial fullness, symmetry, scar, and complications using self-made scales and photo data before and after operation. Six months after operation, the patients were assessed whether they needed to undergo a second operation, and the rate of second operation was calculated. During the second operation, the fat of patients transplanted in the first operation was collected, and the morphology of adipocytes and microangiogenesis was observed under a scanning electron microscope. (2) Adipose-derived stem cells (ADSCs) were isolated and cultured from abdominal fat of a 4-week-old male Sprague-Dawley (SD) rat. The 5th passage of cells were selected to observe cell morphology after cultured for 14 days, observe expression of vimentin and cytokeratin-18 by immunofluorescence method, identify osteogenic and adipogenic differentiation, and detect rates of CD29 and CD44 positive cells by flow cytometer (n=3). Eighteen 4-week-old male SD rats were divided into ADSCs transplantation group, simple scar group, and blank control group according to the random number table, with 6 rats in each group. Rats in ADSCs transplantation group and simple scar group were subcutaneously injected with 1 mL bleomycin which was dissolved in phosphate buffered saline (PBS) with a mass concentration of 1 mg/mL at the back to establish scar models. After 3 hours, rats in ADSCs transplantation group were injected with 1×106 ADSCs suspended in 0.1 mL PBS at the same injection site, while rats in simple scar group were injected with 0.1 mL PBS. Rats in blank control group were injected with the same doses of PBS in the same place at the same two time points mentioned above. After continuous injection for 28 days in each group, the full-thickness skin tissue of the injected area of all rats was collected to observe the collagen fibers by Masson staining and expressions of α-smooth muscle actin (α-SMA) and transforming growth factor β1 (TGF-β1) by immunohistochemistry, and the positive cells were counted. Data were processed with Mann-Whitney U test, χ2 test, one-way analysis of variance, and least significant difference test.@*Results@#(1) Compared with the preoperative condition, the facial fullness and symmetry of patients in simple transplantation group were better in 3 months after operation, with scar color closer to the surrounding skin, and the filling volume of patients in this group decreased in 6 months after operation as compared with that in 3 months after operation. In mixed transplantation group, the facial fullness and symmetry of patients were better in 3 and 6 months after operation as compared with the preoperative condition, with scar color and texture closer to the surrounding skin, and the filling volume in 6 months after operation was not obviously reduced as compared with that in 3 months after operation. Fat liquefaction and subcutaneous nodule formation occurred respectively in 1 patient in simple transplantation group within 3 months after operation. The treatment satisfaction of patients in mixed transplantation group was significantly higher than that in simple transplantation group in 3 and 6 months after operation (Z=-2.566, -3.084, P<0.05 or P<0.01). Six months after operation, the second operation rate of patients in mixed transplantation group was 7.84% (4/51), which was significantly lower than 22.22% (12/54) in simple transplantation group (χ2=4.199, P<0.05). At the second operation, compared with those of simple transplantation group, the cells of fat transplanted in the first operation of patients in mixed transplantation group were more plump, without collapse or dryness, and the cells were closely arranged, with smaller gap; the tubular and the cord-like microvascular structure on the cell surface were more abundant, and the cell gap was full of network-like microvascular structure that grew into the adipose tissue. (2) The fifth passage of cells isolated and cultured from rat fat grew adherently to the wall, with long fusiform or spindle shape, showing shoal-of-fish-like growth. Vimentin and cytokeratin-18 were highly expressed in the cells. Cells showed osteogenic and adipogenic differentiation ability by induction. The positive expression rates of CD29 and CD44 were higher than 90.00%. The cells were identified as ADSCs. After 28 days of injection, the collagen fibers in the dermis of skin tissue at the injection area of rats in blank control group were finely arranged. In simple scar group, a large amount of collagen was deposited in the dermis of skin tissue at the injection area of rats, the fiber bundles were thick and loosely unevenly arranged, and a large number of inflammatory infiltration and scattered muscle fibers were observed. In ADSCs transplantation group, the collagen fibers in the dermis of skin tissue at the injection area of rats were thicker than those of blank control group, with still neat arrangement, and a small amount of scattered muscle fiber and inflammatory infiltration was observed. After 28 days of injection, the expression of α-SMA in ADSCs transplantation group was mainly in microvessels in the dermis of skin tissue at the injected area of rats, and the number of α-SMA and TGF-β1 positive cells was (49±12) and (63±10) cells per 20-fold field of view, respectively, which was similar to (35±16) and (44±17) cells per 20-fold field of view of blank control group (P>0.05), all significantly less than (135±13) and (121±23) cells per 20-fold field of view of simple scar group (P<0.05).@*Conclusions@#Compared with those of autologous simple granule fat transplantation, autologous nano-fat mixed granule fat transplantation has better filling fullness in the treatment of patients with scar facial depression and atrophy. The filling effect lasts longer, and the improvement of scar texture is more obvious. As showed in the rat scar model experiment, the mechanism may be that ADSCs inhibit the expressions of α-SMA and TGF-β1, thus inhibiting the formation of scar.
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Since the autologous fat transplantation was reported by a German surgeon, Gustav Neuber, in 1893, the technical method of autologous fat transplantation, the transplantation concepts and application range have undergone tremendous changes and progress. In recent years, with the advanced research on adipose derived stem cells (ADSCs), the application field of autologous fat has been widespread. From initially used for soft tissue filling, it gradually expanded to orthopedic surgery, reconstructive surgery and cosmetic surgery, such as treatment of scar, skin and tendon adhesion, Renault syndrome, breast enhancement, facial rejuvenation and body shaping. The Nanofat transplantation technology originated from autologous fat transplantation, and it is not an exact nanotechnology for the technology itself. However, due to its remarkable effect on local skin rejuvenation, the Nanofat transplantation has become one of the hot issues in orthopedics in recent years.
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Objective@#To treat the depressed scars by injecting nanofat and investigate its therapeutic effect.@*Methods@#Autologous fat was harvested from abdomen or thigh using low-pressure suction. The lipoaspirate was mechanically emulsified after rinsing. Emulsification of the fat was achieved by shifting the fat between two 5 ml syringes connected to each other by a three direct connector. After this emulsification process, the fatty liquid was again filtered over the sterile nylon cloth. Nanofat was injected into the dermis of depressed scars using a 26-gauge needle and the injection volume was 1-2 ml/cm2. After three months, another injection would be performed if the depressed scar remained obvious.@*Results@#From January 2016 to October 2017, eighteen patients and thirty-three depressed scars were treated. There was a temporary erythema of the injected area that lasted two to three weeks. The clinical result gradually improved over time and were maximal from three months postoperatively for most cases. Three months after nanofat injecting, the cavity of scars was significantly decreased; The color of scars were significantly improved and more close to the adjacent skin; The stiffness of scars was also obvious decreased. The follow-up ranged 4 months to 18 months and the average was 11.0±4.6 months. Seventeen patients were satisfied with the result, one patients was not satisfied and the satisfaction rate was 94%. No infections, fat cysts, granulomas, or other unwanted side effects were observed.@*Conclusions@#Nanofat injecting is a definite and effective treatment for depressed scars with fewer complications.
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Objective@#To investigate the clinical efficacy of combined nano-fat and structural fat transplantation for periocular rejuvenation, such as fine wrinkle, darkness and volume loss.@*Methods@#Structural fat was harvested by Coleman′s structural fat grafting technique from thigh and was grafted at different layers for depression correction. Nano-fat was harvested by Tonnard′s nano-fat technology from thigh and was injected smoothly intradermally and subcutaneously for correction of fine wrinkle and darkness.@*Results@#The patients were followed up for 3—12 months, 6 months in average. Satisfactory result was achieved in 42 cases after only one operation. No complication happened. 2 cases was unsatisfied due to upper eyelid fullness. 4 cases didn′t get improvement in periocular darkness.@*Conclusions@#Combined nano-fat and structural fat transplantation are effective for periocular rejuvenation, including depression deformity and skin darkness.