Fat Grafting

Why Use Concentrated PRP and Fat?

Autologous fat is increasingly being used for breast and other reconstructive procedures as a ‘natural lipo filler’. Our fat is the body’s major source of mesenchymal stem cells, which are considered ‘multi-potent’ or ‘pluripotent’, as they have the ability to differentiate themselves into a number of different types of stem cells that are useful for wound healing[ Hassan WU1, Greiser U, Wang W. Role of adipose-derived stem cells in wound healing. Wound Repair Regen. 2014 May; 22(3):313-25. doi: 10.1111/wrr.12173], tissue repair and regeneration.

The expanding uses for a range of autologous biotherapies, is supported by the increasing body of clinical and scientific[ Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris, M, Fiaschetti V, Floris R, Cervell V. (2013) A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med. 2012 Apr; 1 (4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13] evidence of the synergistic effect of autologous fat and concentrated platelet rich plasma combinations, which is compelling both from a scientific perspective and from the clinical evidence.

Work by Zuk[ Zuk, P., A., Zhu, M., Ashjian, P. et al (2002) Human Adipose tissue is a source of multi-potent stem cells. MolBiol Cell 2002; 13(12):4279-4295.] et al in the early 2000s provided us with insights of the potential of the adipose derived adult mesenchymal stem cells (AD-MSC) describing the importance of the progenitor cells within the stromal vascular fraction (SVF of harvested fat], working in conjunction with the extracellular matrix (ECM) and their overall synergistic effect on the viability of the autologous fat grafts.

Latest thinking suggests that the role of progenitor cells is even more important than previously acknowledged and that the long-term survival of AFG is directly linked to the activation and proliferation of these progenitor cells within the SVF, to differentiate into the target cells for replacement[ Strem, B.M., Hicok, H.C., Zhu, M. (2005) Multipotential differentiation of adipose-derived stem cells. Keio Journal of Medicine. 2005;54(3):132-141 6] [ Alexander, R.W. (2010) Use of PRP in Autologous Fat Grafting. Springer, Berlin.]. This intricate biological ballet occurs within a ‘cellular microenvironment of cell-to-cell/cell to matrix, and autocrine/paracrine signalling,[ Alexander, R.W., Harrell, D.B. (2013) Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting. Clinical, Cosmetic and Investigational Dermatology 2013:6 91-102.] and concentrated platelet rich plasma, rich in chemokines, cytokines and growth factors, considered to optimise the cellular microenvironment.

Use of concentrated PRP with Fat

The combined use of the autologous fat and concentrated platelet rich plasma cPRP, described by Gentile, Orlando (2012) et al.[ Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris, M ,Fiaschetti V, Floris R, Cervell V. (2013) A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med. 2012 Apr;1(4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13 ] improves the viability of the fat graft and

  • Hassan WU1, Greiser U, Wang W. Role of adipose-derived stem cells in wound healing. Wound Repair Regen. 2014 May; 22(3):313-25. doi: 10.1111/wrr.12173
  • Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris, M, Fiaschetti V, Floris R, Cervell V. (2013) A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med. 2012 Apr; 1 (4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13
  • Zuk, P., A., Zhu, M., Ashjian, P. et al (2002) Human Adipose tissue is a source of multi-potent stem cells. MolBiol Cell 2002; 13(12):4279-4295.
  • Strem, B.M., Hicok, H.C., Zhu, M. (2005) Multipotential differentiation of adipose-derived stem cells. Keio Journal of Medicine. 2005;54(3):132-141 6
  • Alexander, R.W. (2010) Use of PRP in Autologous Fat Grafting. Springer, Berlin.
  • Alexander, R.W., Harrell, D.B. (2013) Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting. Clinical, Cosmetic and Investigational Dermatology 2013:6 91-102.
  • Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Curcio CB, Floris, M ,Fiaschetti V, Floris R, Cervell V. (2013) A comparative translational study: the combined use of enhanced stromal vascular fraction and increases [fat] survival rates high, by the addition of concentrated platelet rich plasma, which is rich in chemokines, cytokines and growth factors. The use of the concentrated PRP is considered to optimise the cellular microenvironment.
Safety, Complications, Contraindications to Use of autologous Fat & PRP

Autologous fat grafts and PRP are immunologically neutral and poses no danger of allergic, hypersensitivity or foreign-body reactions.

Sterile technique must be used at every stage of PRP preparation and application. Sterile technique is especially important if a patient has an underlying medical condition that predisposes to infection.

Combination PRP and Fat Bio-active Grafts

The convergence of science and technologies are providing a raft of therapies that are rapidly becoming mainstream in skin rejuvenation, tissue reconstruction and tissue regeneration.

For example, the combination of laser technology, and autologous biotherapies, including autologous concentrated platelet rich plasma (cPRP) and autologous fat grafts, (AFG). However, the key to the successful integration of these technologies and science is the clinical technique, the critical art of combining the technologies and science to optimise individual patient treatment and clinical outcomes.

What is LipoGems®?

LipoGems® refers to the method of processing and purifying fat for use as an injectable filler that has powerful rejuvenation and anti-ageing properties. Fat processed using the LipoGems system is very rich in stem cells and growth factors. When re-injected it can restore volume, tone and texture mainly in the face and hands.

The liposuction and re-injection process is completed during a single session of approximately 90 minutes.

Unlike most other fat transfer methods, LipoGems® does not require the addition of any chemicals or enzymes prior to re-injection. This means that the fat being re-injected contains only your own refined cells.

The LipoGems® fat processing technique is performed on site at the time of extraction. The minimal delay between fat extraction and re-injection greatly reduces the risk of contamination and eliminates the need to add preservatives or chemicals. The LipoGems® platelet-rich plasma improves fat grafting maintenance in breast reconstruction. Stem Cells Transl Med. 2012 Apr;1(4):341-51. doi: 10.5966/sctm.2011-0065. Epub 2012 Apr 13 device is completely disposable and there are no reusable components to the system, which ensures sterility.

How is the fat collected?

The fat used in the LipoGems® system is collected using a very small tumescent liposuction system. This means that during the liposuction process, a formulation consisting of saline, local anaesthetic and adrenaline is injected into the extraction area to limit discomfort, swelling or bleeding. This technique also helps to separate the skin from the fat that lies below it, limiting any damage to the tissue during the liposuction process.

The tumescent liposuction technique involves the use of cannula that are much smaller than the ones used in conventional liposuction. A cannula is a blunt needle that has holes on the side of it rather than at the end like a standard needle. All forms of liposuction create some bruising and swelling, but the area affected is usually small, as is the volume of fat removed. The liposuction site usually recovers fully within a few weeks. There is no need for any stitches. The LipoGems® procedure is usually performed under local anaesthesia.

The volume of fat taken from an area like the buttock or hip will vary depending on the volume of LipoGem® fluid required for the area being treated – for facial rejuvenation usually between 50-80 ml.

How is the fat processed?

LipoGems® uses a saline solution in conjunction with a mechanical system to wash away impurities from the harvested fat. This concentrates the stem cell and growth factor components that comprise healthy fat cells. The Lipogem fluid contains only material that came from your body, and no chemicals or enzymes are added to the fat at all during processing.

A series of specialised screens and agitators inside the LipoGems® device break up the fat into small clusters of less than 50 cells. These clusters are small enough to inject with ease and have increased potency compared to larger cell clusters. The consistency of the LipoGems® fat is optimal for mesenchymal cells to flourish. Mesenchymal cells are stem cells that specialize in tissue repair. These cells are concentrated and reactivated in the LipoGems® process when the fat cells are refined. These cells aid tissue recovery and rejuvenation.

Fat processed with the LipoGems® system has a better than average graft survival, and has been proven to improve the quality of surrounding tissue as well as the general appearance of the overlying skin.

After the fat has been processed by the LipoGems® system, it is free of inflammatory factors, blood and cellular debris that are released during the fat harvesting phase.

Is there any downtime and what results will I get?

Unlike some other fat transfer systems. Fat processed with LipoGems flows easily and does not cause significant discomfort during or after injecting. The re-injection is performed via cannula and local anaesthetic is used in most cases. Pain or tenderness in the extraction area can be expected for a few days, as well as minor bruising. Bruising in the re-injection sites is less common, but can occur due to a cannula not being as fine or sharp as a regular needle.

LipoGems® offers volume enhancement to areas like the mid face and under the eyes, while also offering greatly improved tone, elasticity and vitality to the overlying skin.

LipoGems® is fat tissue that doesn’t have its own blood supply; therefore it needs to be placed near blood vessels to ensure the survival and prosperity of the fat cells. This is why LipoGems® is particularly suited for facial rejuvenation as its injected superficially into tissue that is rich in vessels.

Using the LipoGems® system for larger area for fat transfer is a more extensive process, because the larger quantity of fat injected means more fat cells will die off due to not having access to a rich blood supply. Therefore to substantially increase breast size using LipoGems®, several treatments might be required. LipoGems® is commonly used to eliminate nerve pain associated with scar tissue. There are other fat transfer method that are used for larger body areas.

Areas particularly suited to LipoGems® rejuvenation Include:
  • Tear troughs
  • Mid face
  • Nasolabial folds
  • Lips and around the mouth
  • The back of hands
Patient Information- PRP Bio-Active Fat Grafts (Fat transfer) Frequently Asked Questions

What is PRP Bio-Active Fat Grafts Procedure?
A small sample of your own blood [approximately 60mls], is processed in a highly specialised, state of the art Arthrex Angel® system or the Arthrex ACP™ Conditioned Plasma System, specifically designed to extract the Platelet Rich Plasma [PRP] in a safe, clinical manner and then this Platelet Rich Plasma [PRP] is injected or applied in combination therapies to the targeted areas.

The autologous fat used for the procedure is collected in the LipoGems® system using a very small tumescent liposuction system. This means that during the liposuction process, a formulation consisting of saline, local anaesthetic and adrenaline is injected into the extraction area to limit discomfort, swelling or bleeding. This technique also helps to separate the skin from the fat that lies below it, limiting any damage to the tissue during the liposuction process. The LipoGems®system uses a saline solution in conjunction with a mechanical system to wash away impurities from the harvested fat. This concentrates the stem cell and growth factor components that comprise healthy fat cells. The Lipogem fluid contains only material that came from your body, and no chemicals or enzymes are added to the fat at all during processing.

Is there any downtime and what results will I get?
Fat processed with LipoGems® flows easily and does not cause significant discomfort during or after injecting. The re-injection is performed via cannula and local anaesthetic is used in most cases. Pain or tenderness in the extraction area can be expected for a few days, as well as minor bruising.

How long will the procedure take?
The procedure will take on average 30-120 mins.

What changes will I notice?
Platelet Rich Plasma aids in the preservation and enhancement of hair follicle viability during and after hair transplantation and the reinvigoration of dormant hair follicles and stimulates new growth. Your hair texture will improve as new tissue cells grow and visible results may take 3-6 weeks. The results continue to improve over time months and last approximately 1 - 2 years. Best results are attained through 1 to 3 consecutive treatments.

We are all unique and so results will depend upon a number of factors including your overall health status, age, dietary variations, whether you smoke, as well as a number of other health factors, including your unique skin type.

Are there any contra-indications to the use of Platelet Rich Plasma?
You must inform your specialist if you are taking medication, including blood thinning [anti-coagulant] medication, undergoing steroidal, or any long-term therapies.


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