Does facial lipografting improve skin quality?

Aesthetic providers should think twice before telling patients that autologous facial lipografting will improve facial skin quality, according to a newly published review of studies looking the effects of facial lipografting on skin quality.¹

In fact, while review authors found facial lipografting appears safe, scientific evidence showing facial lipografting, cellular stromal vascular fraction or adipose tissue-derived stromal cell injections actually improve facial skin quality is lacking, according to the review.

Study author Berend van der Lei, M.D., Ph.D., professor of Aesthetic Plastic Surgery at the University Medical Centre of Groningen and medical director of Bey Bergman Clinics, The Netherlands, tells Dermatology Times that he and coauthors were surprised by their findings. After all, many publications, including that by Coleman SR published in Plastic and Reconstructive Surgery in 2006 described improved age-related skin changes from lipografting or lipofilling.

“… the authors state in these articles that this improvement of observed skin quality - only made by subjective observations after lipofilling - is the effect of the stem cells present in the fat,” says Dr. van der Lei.

But Dr. van der Lei says he and colleagues doubt the claim because the lipofilling increases volume, thereby stretching skin and visibly improving some indicators of skin quality.

Review authors searched scientific databases for studies evaluating autologous lipografting’s effect on facial skin quality, including skin texture, color, elasticity. They looked at histologic outcomes and safety data. The search yielded 4595 studies but only nine, with a total 301 patients, met the review criteria. Of the nine, two papers were level of evidence II; two were level of evidence III; and five were level of evidence IV studies. Eight were prospective controlled studies and six of those were controlled but only two of those six were randomized.

The authors couldn’t do a meta-analysis because the studies used different metrics and had different outcomes. All but one of the nine studies reported improved skin elasticity, skin texture and color after treatment with lipografting, cellular stroma vascular fraction or nanofat. And three studies showed histologic improvement in skin, but all used the same patients for the intervention and control groups. The review suggests that facial lipografting can be considered a safe procedure.

Across studies, the quality of evidence was low due to poor study design, according to the review.

Low quality evidence is part of a bigger problem when researching aesthetic procedures, the authors write. The authors cite a study published in 2008 in the Annals of Plastic Surgery looking at three major plastic surgery journals.² Researchers found only 1.83% of published studies were randomized clinical trials.

The review authors propose improving the quality of evidence from future clinical trials of facial lipofilling with a statement included in the review. The statement includes what would be needed for designing a proper clinical trial on facial lipofilling.

The review’s results don’t suggest providers shouldn’t use facial lipografting; rather, they should use it for volumization without making claims about skin quality improvement. Dr. van der Lei says he still uses lipofilling in practice for facial rejuvenation but mainly for recovery of volume loss in the fat compartments due to facial aging.

“We almost always combine lipofilling with facelift surgery. We never use lipofilling as a single treatment for only skin improvement,” he says. “When skin improvement is necessary, we use other treatment strategies such as chemical peeling, laser treatment or microneedling.”

Based upon laboratory work and other studies, Dr. van der Lei and colleagues think lipofilling has a regenerative effect on damaged skin, such as burn wounds and scars.

“We think that in case of damaged tissue, lipofilling with stems cells indeed has a regenerative effect, but not on aged skin,” he says.

Dr. van der Lei and colleagues are starting randomized prospective studies on fat grafting’s regenerative potential, with and without platelet-rich plasma.

Disclosures:

Dr. van der Lei reports no relevant disclosures.

References:

• Van dongen JA, Langeveld M, Van de lande LS, Harmsen MC, Stevens HP, Van der lei B. The Effects of Facial Lipografting on Skin Quality: A Systematic Review. Plast Reconstr Surg. 2019;144(5):784e-797e.

• Momeni A, Becker A, Antes G, et al. Evidence-based plastic surgery: controlled trials in three plastic surgical journals (1990-2005). Ann Plast Surg. 2008;61(2):221-5.