Dermal-Subcutaneous Tissue Regeneration with Stromal Vascular Cell Enriched Fat Transfer: A New Frontier for Treatment of Perioral Aging

Goals/Purpose: Successfully treating perioral aging involves addressing each structure from epithelial surface to the dental, osseous support system. Aging facial tissues lose their nutritional vascular network resulting in thinning of basilar dermal microprojections and subsequent tissue laxity. Stromal vascular cells (SVC) increase angiogenesis and promote fat graft retention. Herein, we report our approach to perioral aging, which includes the first clinical applications of SVC enriched fat (SVCEF) to restore aged dermal-subcutaneous tissue during facial rejuvenation.

Methods/Technique: Patients with facial aging were evaluated for degree of photoaging, skin laxity, depth of rhytids,  and status of dental osseous support system. Patients with lesser degrees were treated at surgery with a fractional laser (1550 nm and 1927 nm) and those with more severe photoaging were treated 3-months postoperative with fractional CO2 laser. At surgery, approximately 300mL of fat was harvested. Half was processed using collagenase enzyme to extract the SVC. Remaining fat was washed using a bi-laminar filtration bag. SVC were added to the filtrated fat and SVCEF grafting performed to the face.

Results/Complications: Fifteen patients were treated using dermal-subcutaneous tissue restoration with SVCEF for perioral rejuvenation. Of these, 5 received simultaneous non-ablative, fractional laser at the time of facelift. Five underwent fractional CO2 laser treatment at 3-months. The remaining 5 patients did not receive laser treatments. Reduction of wrinkle depth of radial lip lines was evident in all patients regardless of laser treatment. Subtle, but obvious improvements in skin pigmentation and texture were evident. No complications related SVCEF were noted.

Conclusion: Restoration of dermal-subcutaneous tissue is feasible with SVCEF. Improvement in wrinkle depth, increase in lip fullness and improvement in skin texture and pigmentation was accomplished. Use of SVCEF appears to have beneficial effects on perioral rejuvenation. Histologic verification for dermal and subcutaneous micovasculature and reversal of aging elastin fibers may further explain these results.