OBJECTIVE: The purpose of this study was to evaluate the yield, viability, clinical safety, and efficacy of the stromal vascular fraction (SVF) separated with a new protocol with all clinical-grade drugs.
METHODS: SVF cells were isolated from lipoaspirate obtained from 13 participants aged from 30 to 56 years by using a new clinical protocol and the laboratory protocol. The cell yield, viability, morphology, mesenchymal stem cell (MSC) surface marker expression, and differentiation abilities of the SVF cells harvested from the two protocols were compared. Furthermore, three related clinical trials were conducted to verify the safety and efficiency of SVF cells isolated by the new clinical protocol.
RESULTS: There were no significant differences in the yield, viability, morphology, and differentiation potential of the SVFs isolated with the clinical protocol and laboratory protocol. Adipose-derived mesenchymal stem cell (ASC) surface marker expression, including that of CD14, CD31, CD44, CD90, CD105, and CD133, was consistent between the two protocols. Clinical trials have demonstrated the effectiveness of the SVF isolated with the new clinical protocol in improving skin grafting, promoting mechanical stretch-induced skin regeneration and improving facial skin texture. No complications occurred.
CONCLUSIONS: SVF isolated by the new clinical protocol had a noninferior yield and viability to that of the SVF separated by the laboratory protocol. SVFs obtained by the new protocol can be safely and effectively applied to improve skin grafting, promote mechanical stretch-induced skin regeneration, and improve facial skin texture.
BACKGROUND: The trials were registered with the ClinicalTrials.gov (NCT03189628), the Chinese Clinical Trial Registry (ChiCTR2000039317), and the ClinicalTrials.gov (NCT02546882). All the three trials were not patient-funded trials.
METHODS: 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 .

BACKGROUND: Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose.
OBJECTIVE: This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry.
METHODS: A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools.
RESULTS: Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients\' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups.
CONCLUSIONS: Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts.

UNASSIGNED: Pharyngocutaneous fistula (PCF) is a serious complication following total laryngectomy, significantly impacting patients\' quality of life and treatment costs. Management is complex, with potential for recurrence after surgical intervention.
METHODS: We present a case of PCF that developed following laryngectomy. Initial conservative treatment failed to resolve the fistula. A pectoralis major myofascial flap was then attempted, but the fistula recurred. Finally, autologous fat grafting was performed with excellent results.
UNASSIGNED: Conservative management should be the first-line approach for PCF, as most cases respond favorably. However, if the fistula persists, alternative methods should be explored to achieve optimal outcomes. Our case highlights the importance of not persisting with a failed approach. Autologous fat grafting offers a promising alternative with demonstrably positive outcomes.
CONCLUSIONS: Pharyngocutaneous fistula presents a significant challenge in post-laryngectomy care. Surgical repair can be complex with potential complications. Our case demonstrates the effectiveness of autologous fat grafting as a successful treatment modality.

BACKGROUND: The correction of tear trough deformity poses a significant challenge in the context of facial rejuvenation. Our aim was to introduce a technique that corrects tear trough deformity during transconjunctival lower blepharoplasty using minced orbital fat grafts.
METHODS: The medical records of patients who underwent lower blepharoplasty from January 2019 to December 2021 were reviewed. The study included patients with various grades of tear trough deformity, who underwent lower blepharoplasty using minced orbital fat grafts and followed up for at least 6 months. Modified Barton\'s grading for tear trough depression, patient satisfaction, and postoperative complications were evaluated.
RESULTS: A total of ninety-eight patients, with a mean age of 48.07 ± 9.72 years, consisting of 93 (94.9%) females were included in the study. The average duration of follow-up was 7.2 months, ranging from 6 to 13 months. Tear trough depression significantly improved after the operation (preoperative tear trough depression grade mean (SD): 3.11 (0.60); postoperative tear trough depression grade mean (SD): 0.87 (0.66); P < 0.001). 78.5% of the participants reported their outcome as excellent or good, 20.4% reported as fair, and 1.0% (only one patient) reported as no improvement. None of the participants rated their outcome as worsening. No major complication was observed during the follow-up period.
CONCLUSIONS: Minced orbital fat grafting during transconjunctival lower eyelid blepharoplasty has good effectiveness for correcting tear trough deformity without the risk of major complications.
METHODS: 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 .

BACKGROUND: The extracellular matrix isolated from adipose tissue, known as acellular adipose matrix (AAM), represents a novel biomaterial. AAM functions as a scaffold that not only supports stem cell proliferation and differentiation but also induces adipogenesis and angiogenesis. This study aims to investigate the volumetric effects and microenvironmental changes associated with injectable AAM in comparison to conventional fat grafting.
METHODS: AAM was manufactured from fresh human abdominoplasty fat using a mechanically modified method and then transformed into an injectable form. Lipoaspirate was harvested employing the Coleman technique. A weight and volume study was conducted on athymic nude mice by injecting either injectable AAM or lipoaspirate into the scalp (n=6 per group). After eight weeks, graft retention was assessed through weight measurement and volumetric analysis using micro-computed tomography (micro-CT) scanning. Histological analysis was performed using immunofluorescence staining for perilipin and CD31.
RESULTS: Injectable AAM exhibited similar weight and volume effects in murine models. Histological analysis revealed comparable inflammatory cell presence with minimal capsule formation when compared to conventional fat grafts. Adipogenesis occurred in both AAM-injected and conventional fat graft models, with no significant difference in the blood vessel area (%) between the two.
CONCLUSIONS: In summary, injectable AAM demonstrates effectiveness comparable to conventional fat grafting concerning volume effects and tissue regeneration in soft tissue reconstruction. This promising allogeneic injectable holds the potential to serve as a safe and effective \"Off-the-Shelf\" alternative in both aesthetic and reconstructive clinical practices.
METHODS: 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 .

BACKGROUND: Despite high complication rates, patients persistently present for single-stage augmentation mastopexy. In empty, deflated breasts, we perform one-stage augmentation mastopexy; however, in heavy ptotic breasts, our preference is to stage the procedure with mastopexy and fat graft first. With volume from fat grafting focussing on the upper pole and cleavage areas, many of our patients avoid implants altogether. This reduces subsequent risks of waterfall deformity, implant displacement, rupture and a lifetime of implant exchanges.
OBJECTIVE: We aim to describe our findings and technique for reducing progression to the second stage of a two-stage augmentation mastopexy with the appropriate use of moderate to high volume of fat grafting at the primary operation.
METHODS: This is a retrospective review of all patients who presented to the senior author (KT) requesting breast implants and requiring mastopexy, from January 2018 to December 2022.
RESULTS: Over the five-year period, 137 patients were identified. Seventy-one (51.8%) underwent single-stage augmentation mastopexy, 55 (40.1%) underwent mastopexy with fat grafting and 11 (8.0%) underwent mastopexy with no fat grafting. Our key finding in this study is that 52 of 66 (78.8%) of planned staged patients, who underwent mastopexy with or without fat grafting, were happy with the volume attained and no longer wished to undergo further implant augmentation.
CONCLUSIONS: In selected patients, appropriate volume and position of fat grafting at the time of primary mastopexy can significantly obviate the need for a second stage implant (alloplastic) augmentation.
METHODS: 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 .

OBJECTIVE: Fat grafting has been widely used for soft-tissue augmentation. External volume expansion (EVE) is a favorable tool for improvement in the rate of fat graft retention. However, few studies have focused on the most appropriate time for its implementation. In this study, BALB/c nude mice were used to investigate the effective time for the implementation of external volume expansion to improve the rate of fat retention.
METHODS: Sixteen mice were divided into four groups, and EVE was performed at different time points before or both before and after fat grafting. Fat tissue from a human donor was injected into the mice following EVE. Visual assessment, micro-computed tomography analysis, and histopathological evaluation were used to assess fat retention.
RESULTS: After 10 weeks, the group that underwent EVE 5 days before fat grafting demonstrated a significantly higher preserved fat volume, as determined by micro-computed tomography (p<0.05). Moreover, the group that received additional EVE after fat grafting exhibited a higher retention rate compared to the groups receiving EVE only before grafting (p<0.05). Histopathological analysis indicated that swelling, edema, and inflammation were more pronounced in the group with EVE immediately before grafting, while angiogenesis and lipogenesis were more active in the group with additional EVE after grafting.
CONCLUSIONS: EVE is a safe and effective approach for improving the rate of fat graft retentions. Furthermore, the timing of external tissue expansion plays a crucial role in fat retention. Based on our animal study, performing EVE immediately before and after fat grafting may be an effective strategy for enhancing the rate of fat graft retentions.

A frequent problem following cleft lip repair is insufficient lip volume and unappealing aesthetics. Autologous fat grafting is a method of improving the appearance of post-correction deformity. The aim of this review is to evaluate the effectiveness of autologous fat grafting in improving the aesthetics of cleft lip deformity. The benefits of adipose-derived stem cells (ADSCs), benefits and complications of fat grafting, timing of grafting, and harvest and transplant techniques will be examined. This review process used \"PubMed\" and \"Google Scholar\" as primary databases. Searches were performed using combinations of key terms: \"Fat Graft,\" \"Cleft Lip,\" \"Vermillion,\" \"Autologous Fat Transplantation,\" and \"Adipocyte Derived Stem Cell.\" Reviews of reference lists for additional pertinent data were performed. Autologous fat grafting may be performed during primary repair or as a secondary correction. Statistically significant improvements in appearance were observed in some or all measured variables regardless of repair timing. Both timing options show favorable outcomes; however, there is more evidence in support of grafting as a secondary correction. Some degree of graft reabsorption will occur, lending evidence to the practice of overcorrecting to accommodate losses. Graft retention is stabilized by the 12-month mark. The presence of ADSCs within the graft aids in graft stabilization and retention. Despite a lack of longitudinal data to examine graft retention throughout a patient\'s lifetime, autologous fat grafting appears to be a safe and minimally invasive method of repairing deformity secondary to cleft lip repair supported by follow-up data as far as two years postoperatively with minimal reported complications.

BACKGROUND: Autologous fat grafting is hampered by unpredictable graft survival, which is potentially regulated by ferroptosis. Glutathione (GSH), a powerful antioxidant used in tissue preservation, has ferroptosis-regulating activity; however, its effects on fat grafts are unclear. This study investigated the effects and mechanisms of GSH in fat graft survival.
METHODS: Human lipoaspirates were transplanted subcutaneously into the backs of normal saline-treated (control) or GSH-treated nude mice. Graft survival was evaluated by magnetic resonance imaging and histology. RNA sequencing was performed to identify differentially expressed genes and enriched pathways. GSH activity was evaluated in vitro using an oxygen and glucose deprivation (OGD) model of adipose-derived stem cells.
RESULTS: Compared with control group, GSH induced better outcomes, including superior graft retention, appearance, and histological structures. RNA sequencing suggested enhanced negative regulation of ferroptosis in the GSH-treated grafts, which showed reduced lipid peroxides, better mitochondrial ultrastructure, and SLC7A11/GPX4 axis activation. In vitro, OGD-induced ferroptosis was ameliorated by GSH, which restored cell proliferation, reduced oxidative stress, and upregulated ferroptosis defense factors.
CONCLUSIONS: Our study confirms that ferroptosis participates in regulating fat graft survival and that GSH exerts a protective effect by inhibiting ferroptosis. GSH-assisted lipotransfer is a promising therapeutic strategy for future clinical application.

BACKGROUND: Autologous adipose tissue often experiences ischemia and hypoxia after transplantation, leading to low retention rates and unstable operative impacts due to necrotic absorption. Platelet-rich plasma (PRP) can enhance fat regeneration and increase the fat retention rate after transplantation. However, the quick release of growth factors (GFs) in PRP decreases therapeutic efficiency. This study aimed to achieve a slow release of PRP to promote fat retention.
METHODS: We prepared a dual-network hydrogel (DN gel) based on FDA-approved PRP and sodium alginate (SA) through a simple \"one-step\" activation process. In vivo study, adipose tissue with saline (control group), SA gel (SA gel group), PRP gel (PRP gel group), and DN gel (DN gel group) was injected subcutaneously into the dorsum of nude mice. At 4 and 12 weeks after injection, tissues were assessed for volume and weight. Hematoxylin and eosin staining (HE) and immunofluorescence staining were performed for histological assessment.
RESULTS: DN gel exhibits long-lasting growth factor effects, surpassing conventional clinical PRP gel regarding vascularization potential. In fat transplantation experiments, DN gel demonstrated improved vascularization of transplanted fat and increased retention rates, showing promise for clinical applications.
CONCLUSIONS: DN gel-assisted lipofilling can significantly improve the retention rate and quality of transplanted fat. DN gel-assisted lipofilling, which is considered convenient, is a promising technique to improve neovascularization and fat survival.
METHODS: 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.