Library - Face rejuvenation

Plast Reconstr Surg. 2015 Apr;135(4):999-1009. doi: 10.1097/PRS.0000000000001123.

Antiaging treatment of the facial skin by fat graft and adipose-derived stem cells.

Charles-de-Sá L1Gontijo-de-Amorim NFMaeda Takiya CBorojevic RBenati DBernardi PSbarbati ARigotti G.

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1Verona, Italy; and Rio de Janeiro, Brazil From the Department of Neurological and Motor Science, Section of Anatomy and Histology, University of Verona; the Unità di Chirurgia Rigenerativa, Clinica San Francesco; and the Postgraduate Program in Surgical Science, Federal University of Rio de Janeiro.



The regenerative property of fat grafting has been described. However, it is not clear whether the clinical results are attributable to the stem cells or are linked to other components of the adipose tissue. This work is aimed at analysis of the histologic and ultrastructural changes of aged facial skin after injection of fat graft in addition to its stromal vascular fraction, obtained by centrifugation, and to compare the results with those obtained by the injection of expanded adipose-derived mesenchymal stem cells.


This study was performed in six consecutive patients who were candidates for face lift and whose ages ranged between 45 and 65 years. The patients underwent sampling of fat by liposuction from the abdominal region. The injection of fat and its stromal vascular fraction or expanded mesenchymal stem cells was performed in the preauricular areas. Fragments of skin were removed before and 3 months after each treatment and analyzed by optical and electron microscopy.


After treatment with the autologous lipidic component and stromal vascular fraction, the skin showed a decrease in elastic fiber network (elastosis) and the appearance of new oxytalan elastic fibers in papillary dermis. The ultrastructural examination showed a modified tridimensional architecture of the reticular dermis and the presence of a richer microvascular bed. Similar results following treatment with expanded mesenchymal stem cells were observed.


This study demonstrates that treatment with either fat and stromal vascular fraction or expanded mesenchymal stem cells modifies the pattern of the dermis, representing a skin rejuvenation effect.

Med Hypotheses. 2015 Apr;84(4):327-30. doi: 10.1016/j.mehy.2015.01.023. Epub 2015 Jan 30.

Midfacial rejuvenation by hyaluronic acid fillers and subcutaneous adipose tissue–a new concept.

Wollina U1.

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1Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany.


In midface rejuvenation, hyaluronic acid (HA) fillers are commonly used as a versatile tool to improve appearance and to correct V-deformities and loss of volume. The induction of collagen as a major constituent of extracellular matrix (ECM) has been considered to be a basic effect of therejuvenation procedure. Although commonly described as “dermal” soft fillers, histologic studies localized HA filler in the subcutaneous adipose tissue. Deep injection whenever possible lead to prolonged efficacy. Since volumizing HA filler induce mechanical stress not only to fibroblasts but adipocytes and deep injection itself causes minor trauma in the subcutaneous adipose tissue we suggest that the activation of adipose tissue-derived mesenchymal stem cells (ADMSC) is responsible for the observed clinical effects. We present a concept of filler action that discusses interactions of HA with adipocytes, ECM fiber network and ADMSC. Such a concept can explain the prolonged efficacy of deep midfacial filler placement and offers a new understanding to tailor HA fillers in the future.