Corrispondence and brief communication
August 2007
Adipocyte survival in Adipofilling®
Alberto Cavalchini
Two theories have been put forward with regard to the outcome of
traditional autologous fat transplants. One holds that the
adipocytes progressively die and are replaced by histiocytes, which
phagocytize cell residues; this process may be accompanied by the
formation of cystic micro-cavities and fibrotic strands. On the
other theory recognizes that fat grafts can display long-term
survival.
The stress to which implanted lobules are subjected leads to lysis
of the adipocytes and the release of fatty acids and glycerol. These
may alter the local osmotic balance and favor the onset of edema;
this in turn worsens septal capillary perfusion, which has already
been altered by the mechanical injury suffered during
transplantation.
Damage to the microcirculation may be the prime cause of the
fibrosis documented histologically in recent publications reporting
on biopsies taken in the months following localized autologous fat
transplants. This fibrosis is the most important aspect, together
with the progressive volume reduction of the fat implanted and the
mechanical quality of the grafts of autologous fat globules
performed by means of traditional procedures. This outcome] is in
line with the experimental evidence presented in the article by José
Guerrerosantos, Gonzalez Mendoza et al., published back in 1996;
these authors demonstrated that the volume increase of the
individual autologous fat grafts, even if implanted beneath the deep
subcutaneous fascia, both places metabolic strain on the adipocytes
in the central portion of the graft – owing to their distance from
the capillary bed – and gives rise to the ischemia of the same
cells, on account of the compression exerted by the fat.
By contrast, Adipofilling® seems to obviate these disadvantages both
macroscopically and microscopically. Indeed, the histological images
of biopsy samples of soft tissues previously implanted by means of
the new Adipofilling® technique clearly reveal the vitality of the
adipocytes, whether individual or grouped together in small clumps.
References
Latoni J. D., Deirdre M. M. and Wolfe S. A. Overgrowth of fat
autotransplanted for correction of localized steroid induced
atrophy. Plast. Reconstr. Surg. 106: 1566-1569, 1999.
Guerrerosantos J., Gonzalez Mendoza A., Masmela Y. Long-term
survival of free fat grafts in muscle: an experimental study in
rats. Aesth. Plast. Surg. 20:403-408, 1996.
Adipofilling and cellular trophism
Pietro Morini
From the histological and histochemical standpoint, subcutaneous tissue ageing involves a regressive biotrophic process which is manifested by: the reduced contiguity of the adipocyte membranes, the aggregation of poorly perfused cells, increased fibrohistopoiesis in response to stress factors, rarefaction of the capillary network, frequent stasis of fluids in the extracellular matrix, and especially the expansion of the interstitial spaces among cells. Functional deficit is the result of a structure which is empty, or rather bereft of the cellular components that regulate its primary function: the adipocytes. Adipofilling transforms the adipose tissue obtained by means of liposuction or surgery into cellular tissue: viable adipocytes, stromal cells and connective material. When the resulting material is injected, it is initially palpable to the touch, just like a non-reabsorbable material. However, after a few minutes of delicate massaging, the cellular and connective components penetrate into the connective meshwork, thus fleshing out the area. Once this happens, the sensation of a hard oedema disappears. By penetrating into the stroma and becoming an integral part of it, Adipofilling enables the subcutaneous tissue to recover its normal consistency in a short time, in spite of the volume increase. The difference between Adipofilling cell grafting and the lobular grafting involved in lipofilling seems to lie in the relationship between the injected material and the connective stroma. In the case of Adipofilling, the adipocytes are integrated within the stroma; in lipofilling, they push the stroma aside. The vascular and trophic implications are obvious.