Masakazu Kurita

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells

BackgroundLipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis.MethodsTo overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation.ResultsFinal breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation.ConclusionsThe preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

Cell‐Assisted Lipotransfer for Facial Lipoatrophy: Efficacy of Clinical Use of Adipose‐Derived Stem Cells

BACKGROUND Lipoinjection is a promising treatment, but its efficacy in recontouring facial lipoatrophy remains to be established. OBJECTIVE The objective was to evaluate the efficacy and adverse effects of lipoinjection and supplementation of adipose-derived stem/stromal cells (ASCs) to adipose grafts. METHODS To overcome drawbacks of autologous lipoinjection, we have developed a novel strategy called cell-assisted lipotransfer (CAL). In CAL, stromal vascular fraction containing ASCs was freshly isolated from half of an aspirated fat sample and attached to the other half of aspirated fat sample with the fat acting as a scaffold. This process converts relatively ASC-poor aspirated fat into ASC-rich fat. We performed conventional lipoinjection (non-CAL; n=3) or CAL (n=3) on six patients with facial lipoatrophy due to lupus profundus or Parry-Romberg syndrome. RESULTS All patients obtained improvement in facial contour, but the CAL group had a better clinical improvement score than did the non-CAL patients, although the difference did not reach statistical significance (p=.11). Adipose necrosis was found in one non-CAL case who took perioperative oral corticosteroids. CONCLUSION Our results suggest that CAL is both effective and safe and potentially superior to conventional lipoinjection for facial recontouring.

Progenitor-Enriched Adipose Tissue Transplantation as Rescue for Breast Implant Complications

Abstract:  Breast enhancement with artificial implants is one of the most frequently performed cosmetic surgeries but is associated with various complications, such as capsular contracture, that lead to implant removal or replacement at a relatively high rate. For replacement, we used transplantation of progenitor‐supplemented adipose tissue (cell‐assisted lipotransfer; CAL) in 15 patients. The stromal vascular fraction containing adipose tissue progenitor cells obtained from liposuction aspirates was used to enrich for progenitor cells in the graft. Overall, clinical results were very satisfactory, and no major abnormalities were seen on magnetic resonance imaging or mammogram after 12 months. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Surviving fat volume at 12 months was 155 ± 50 mL (Right; mean ± SD) and 143 ± 80 mL (Left) following lipoinjection from an initial mean of 264 mL. These preliminary results suggest that CAL is a suitable methodology for the replacement of breast implants.

Influences of centrifugation on cells and tissues in liposuction aspirates: optimized centrifugation for lipotransfer and cell isolation.

Background: Although injective autologous fat transplantation is one of the most attractive options for soft-tissue augmentation, problems such as unpredictability and fibrosis resulting from fat necrosis limit its universal acceptance. Centrifugation is one of most common methods for overcoming these difficulties. This study was performed to investigate quantitatively the effects of centrifugation on liposuction aspirates to optimize centrifugal conditions for fat transplantation and isolation of adipose-derived stem cells. Methods: Liposuction aspirates, obtained from eight healthy female donors, were either not centrifuged or centrifuged at 400, 700, 1200, 3000, or 4200 g for 3 minutes. The volumes of the oil, adipose, and fluid portions and numbers of blood cells and adipose-derived cells in each portion were examined. The processed adipose tissues (1 ml) were injected into athymic mice, and grafts were harvested and weighed at 4 weeks. Morphologic alterations were observed using light and scanning electron microscopy. Results: Centrifugation concentrated adipose tissues and adipose-derived stem cells in the adipose portion and partly removed red blood cells from the adipose portion. Centrifugation at more than 3000 g significantly damaged adipose-derived stem cells. Centrifugation enhanced graft take per 1 ml centrifuged adipose but reduced calculated graft take per 1 ml adipose before centrifugation. Conclusions: Excessive centrifugation can destroy adipocytes and adipose-derived stem cells, but appropriate centrifugation concentrates them, resulting in enhanced graft take. The authors tentatively recommend 1200 g as an optimized centrifugal force for obtaining good short- and long-term results in adipose transplantation.

Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study.

Background: One issue in the adoption of autologous fat transfer to the breast is concern over mammographic changes that may obscure cancer detection. The authors compared mammographic changes following fat grafting to the breast with changes seen after breast reduction. Methods: Twenty-seven women who had normal preoperative mammograms were treated with fat grafting to the breast, including admixing of autologous adipose stem cells with the fat graft, for cosmetic augmentation. Repeated mammograms were performed 12 months after surgery. As a control group, postsurgical mammograms from 23 reduction mammaplasty patients were compared. Eight academic breast imaging radiologists reviewed each mammogram in a blinded fashion. Outcomes analysis accounting for individual radiologists tendencies was performed using generalized estimating equations. Results: The average volume of fat injected per patient was 526.5 cc. Fifty mammograms (27 lipotransfer, 23 breast reduction) were assessed. Differences in interpretation among individual radiologists were consistently observed (p < 0.10). Differences in abnormality rates were nonsignificant for oil cysts, benign calcifications, and calcifications warranting biopsy. Scarring (p < 0.001) and masses requiring biopsy (p < 0.001) were more common in the reduction cohort. Breast Imaging Reporting and Data System scores were higher after breast reduction (p < 0.001). Significant differences in the recommended follow-up time were also seen (p < 0.01). Conclusions: Compared with reduction mammaplasty, a widely accepted procedure, fat grafting to the breast produces fewer radiographic abnormalities with a more favorable Breast Imaging Reporting and Data System score and less aggressive follow-up recommendations by breast radiologists. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Differential Effects of Three Preparations of Human Serum on Expansion of Various Types of Human Cells

Background: To avoid potential risks of animal-derived products such as viral transmission and immunologic reactions, usefulness of human-derived products in manipulation of cells for cell-based therapies has been investigated but has not yet been completely clarified. Methods: Three types of human sera—serum from whole blood, serum from platelet-rich plasma, and serum from platelet-poor plasma—were prepared from blood samples obtained from the same four volunteers. The authors investigated the biochemical profiles of the three serum preparations as well as their potential as culture additives using three types of human cells: dermal fibroblasts, adipose-derived stem/stromal cells, and umbilical vein endothelial cells. Results: Platelet counts differed among serum from whole blood (100 percent), platelet-rich plasma (75.1 percent), and platelet-poor plasma (12.6 percent), resulting in differential concentrations of platelet-derived growth factor and epidermal growth factor, although other biochemical values such as total protein and albumin were similar. Serum from whole blood and platelet-rich plasma highly enhanced proliferation of dermal fibroblasts compared with the effects of serum from platelet-poor plasma, but no differences in proliferative efficacy were observed in cultures of adipose-derived stem/stromal cells and vascular endothelial cells. Conclusions: Serum from platelet-rich plasma, which is less invasive to prepare than serum from whole blood, was superior to serum from platelet-poor plasma as a substitute for animal-derived serum in culture expansion of dermal fibroblasts. Although autologous or human-derived serum preparations may be of great use in cell-based therapies, this usefulness strongly depends on the target cell species and the purpose of the cell culture.

Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck

Sclerotherapy is effective in the treatment of vascular malformations. However, in lesions with relatively high blood flow, its effect is not always adequate. We therefore developed a three-grade classification of vascular malformations to facilitate the selection of treatments according to vascular flow. We also developed the technique of embolosclerotherapy, in which transarterial embolisation is done before sclerotherapy to control blood flow in the lesion during sclerotherapy. We now have 14 years’ experience with 112 cases of vascular malformations of the head and neck treated with sclerotherapy. Results were evaluated with pretreatment and post-treatment photographs, and reduction of volume was calculated on findings from magnetic resonance imaging. Clinical improvement in 110 cases was graded as excellent in 32 (29%), good in 48 (43%), fair in 19 (17%), and poor in 11 (10%). In 84 cases, mean rate of reduction of volume was 35%. The most common complication was haemolytic haemoglobinuria (n=37, 33%). Our results suggest that this three-grade classification is useful to judge resistance to sclerotherapy and decide on treatment. Our experience indicates that ethanolamine oleate (EO), with or without arterial embolisation, was effective using our classification of vascular dynamics. We consider EO to be equivalent or superior to other sclerosants such as ethanol.

Ectopic fibrogenesis induced by transplantation of adipose-derived progenitor cell suspension immediately after lipoinjection.

Adipose tissue has its own tissue-specific progenitor cells, a subpopulation of which has been shown to have multipotency and called adipose stem cells or adipose-derived mesenchymal stem cells (1,2). During a clinical trial in which soft tissue is augmented by transplantation of progenitor-enriched

Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians.

Background: Periorbital skin hyperpigmentation, so-called dark circles, is of major concern for many people. However, only a few reports refer to the morbidity and treatment, and as far as the authors know, there are no reports of the condition in Asians. Methods: A total of 18 Japanese patients underwent combined therapy using Q-switched ruby laser to eliminate dermal pigmentation following topical bleaching treatment with tretinoin aqueous gel and hydroquinone ointment performed initially (6 weeks) to reduce epidermal melanin. Both steps were repeated two to four times until physical clearance of the pigmentation was confirmed and patient satisfaction was achieved. Skin biopsy was performed at baseline in each patient and at the end of treatment in three patients, all with informed consent. Clinical and histologic appearances of periorbital hyperpigmentation were evaluated and rated as excellent, good, fair, poor, or default. Results: Seven of 18 patients (38.9 percent) showed excellent clearing after treatment and eight (44.4 percent) were rated good. Only one (5.6 percent) was rated fair and none was rated poor. Postinflammatory hyperpigmentation was observed in only two patients (11.1 percent). Histologic examination showed obvious epidermal hyperpigmentation in 10 specimens. Dermal pigmentation was observed in all specimens but was not considered to be melanocytosis. Remarkable reduction of dermal pigmentation was observed in the biopsy specimens of three patients after treatment. Conclusion: The new treatment protocol combining Q-switched ruby laser and topical bleaching treatment using tretinoin and hydroquinone is considered effective for improvement of periorbital skin hyperpigmentation, with a low incidence of postinflammatory hyperpigmentation.

Tissue reactions to cog structure and pure gold in lifting threads: a histological study in rats.

BACKGROUND Thread lifting has become popular as a minimally-invasive suspension procedure, but there is little basic and clinical evidence in the literature on the long-term effects. OBJECTIVES The authors investigate the effects of two types of lifting threads in a rat model over the course of seven months. METHODS The dorsal skin of 18 Wistar rats was implanted with a 20-mm fragment of one of three types of thread: nonabsorbable monofilament cog, pure gold (24 karat) with no cog, and pure gold-coated cog. Six rats were in each group. Tissue samples were harvested and histologically evaluated at one, three, and seven months. RESULTS Histological assessment indicated (1) acute tissue reactions to the regular cog thread involving myofibroblasts and (2) delayed tissue reactions to the pure gold thread involving giant cells. The gold-coated cog thread showed a combination of the histological reactions associated with the cog thread and the pure gold thread, including faint early reactions, strong delayed reactions, and long-lasting capsule formation. Notably, the gold coating gradually came loose from the thread surface, suggesting that the release of tiny gold particles may promote longer-lasting tissue reactions. CONCLUSIONS The combination of cog structure and pure gold coating was evaluated for the first time in this study and results suggest that the gold-coated cog thread has clinical potential.