Improving Facial Fat Graft Survival Using Stromal Vascular Fraction-Enriched Lipotransfer: A Multicenter Randomized Controlled Study

Background: Although previous clinical studies have reported that cell-assisted lipotransfer increases the fat survival rate in facial fat transplants, most were case studies without quantitative evaluation. A multicenter randomized controlled study was performed to evaluate the safety and efficacy of the stromal vascular fraction (SVF) in facial fat grafts. Methods: Twenty-three participants were enrolled for autologous fat transfer in the face, and assigned randomly to the experimental (n = 11) or control (n = 12) group. Fat survival was assessed using magnetic resonance imaging at 6 and 24 weeks postoperatively. Subjective evaluations were performed by the patients and surgeons. To address safety concerns, results of an SVF culture and the postoperative complications were recorded. Results: The overall fat survival rate was significantly higher in the experimental group than in the control group (6 weeks, 74.5% +/- 9.99% versus 66.55% +/- 13.77%, P < 0.025; 24 weeks, 71.27% +/- 10.43% versus 61.98% +/- 13.46%, P < 0.012). Specifically, graft survival in the forehead was 12.82% higher in the experimental group when compared with that in the control group at 6 weeks (P < 0.023). Furthermore, graft survival in the forehead (P < 0.021) and cheeks (P < 0.035) was superior in the experimental group at 24 weeks. At 24 weeks, the aesthetic scores given by the surgeons were higher in the experimental group than in the control group (P < 0.03); however, no significant intergroup differences were noted in the patient-evaluated scores. Neither bacterial growth from SVF cultures nor postoperative complications were noted. Conclusion: SVF enrichment for autologous fat grafting can be a safe and effective technique for increasing the fat retention rate.