Hi, are there any techniques yet for growing fat from stem cells?

Question

I’d like to add some fat back from a procedure where the doctor went overboard on the lipo. I have enough fat I think to hold a graft in the spots that the doctor went overboard. I’ve purposely tried to gain a bit, but I don’t have a lot to take from another spot to do the grafting. I know growing fat is in the future. I just wondered if there’s been any progress in this area. Thank you!

Joseph L. Grzeskiewicz, MD, FACS · Answer

You are correct to suggest that in order to succeed with fat transfer, we must have enough fat in a donor site to get the job done.  How much that might be depends entirely upon what the "job" is.  In other words, if you have only small contour irregularities, we might only need a small amount of fat; on the other hand if we have larger defects, or they are greater in surface area or number, then we will need more fat.  The truth of the matter is that we already are actually are at a place where fat "grows" from stem cells.  The issue with stem cells right now has more to do with the fact that the FDA has not approved the use of "pure"stem cell preparations outside of research protocols in the US, so we are using variations of prepared fat, often called "micronized," "fractionated," or "nanofat" in some instances.  But, this is all the same thing - it is simply fat tissue that has been treated to clean it and convert it to smaller particles, but the stem cells have not been formally "extracted" and concentrated as they would in a true stem cell preparation.  In reality, this is how the resultant fatty tissue that grows from a fat transfer actually works, though.  The stem cells and so-called adipocyte progenitor cells - those cells that are further along the path from multipotent stem cells toward becoming mature differntiated fat cells, or adipocytes - contained in the grafted fat will become the fat cells that we see later as a result of the transfer.  Furthermore, adding things like PRP (Platelet Rich Plasma) or PRF (Platelet Rich Fibrin) has been shown to assist with this process, as the growth factors in those platelets sort of "supercharge" the fat graft and help with that cell maturation process.  There is research that shows also that stem cells alone are probably not the best solution for things like this either; we need more of the "stuff" contained in whole fat grafts, along with things like PRP or PRF. That being said, any of this involving fat transfer will only work if we have sufficient fat to get the job done.
So, what do we do if there is no fat available for transfer?  There are still a few options that might work, and I have had great success with these things in cases just like this, where we have a contour defect, either due to prior surgery, or trauma, or just a naturally occuring thing, but we don't have sufficient fat to transfer.  While almost everyone has at least some fat that can be harvested for a smaller transfer, especially if the surgeon is enterprising and diligent, and/or uses something like the Vaser to maximize fat harvest, there are those cases in which harvesting any appreciable amount of fat is impractical.  In those cases, one of the easiest and most basic ideas is to simply do a "lipo-shifting" or "equalization" procedure.  This works well if there is a good amount of fat in the areas surrounding the contour depressions that we want to correct.  In this technique we use a specialized lipoplasty cannula designed to "break up" the fat, but we don't use any suction on it to remove the fat.  We simply break it up in a more even way, allowing it to stay in place, and then we "spread it around" evenly under the skin, where it then behaves sort of like little "autografts" - fat is shifted around the area of irregularity in order to make it more smooth and evenly distributed.  This works pretty well in most instances, and it can be a good option in the right case.  Another good option is to consider a filler like Sculptra, or Poly  L-Lactic Acid ("PLLA") injections.  I have used Sculptra many times for areas of the body other than the face, like the buttocks, thighs, chest, hands, and arms, when we either don't have fat or don't want to use fat for whatever reason.  The Sculptra won't be permanent, but it stimulates collagen, which can often be very long lasting (years) and correct the contour deficits, especially if they are relatively minor.  We can also add PRP or PRF to Sculptra as well, and this could boost blood supply and vascularity as well as collagen production, equating to possbily better fill volumes and better retention over time.   One other option that is similar to Sculptra is called Renuva.  It is unique type of injectable product called adipose matrix, which means it is the non-cellular part of adipose tissue harvested from other human donors, treated and prepared as an injectable product, and injected like any other filler.  In addition, PRP and PRF can be added to this as well.  The big difference between this and your own fat graft is that this does not have the same cells that a fat graft would have, thus, while it has the growth factors and stuff like that in a fat graft, it will require that your body "provide" its own stem and progenitor cells at the site of injection to produce the results.  One other downside in this product is the cost - if we only need a small amount, it will likely be a good option, but for larger areas, or multiple defects, it will likely be cost prohibitive, and something like Sculptra would be a better choice.  Lastly, PRP and PRF can be used alone, but as you have probably gathered by now, they are not the "complete package," in that they lack a lot of the cells and growth factors that the other options have, and they don't have the same ability to stimulate collagen like Sculptra does, so they will produce only modest results if used alone.  We are still trying to figure out everything that is going on at the cellular and tissue level when we inject things like fat, or stem cells for that matter, PRP/PRF, and combinations of all of the above.  It's a very complex thing, and we are only now beginning to develop some understanding of the process.
The bottom line here is that we are aleady using a number of options other than fat transfer to help with contour irregularities, especially when fat transfer is not available to us.  I personally am always a bit partial to fat grafting if possible, but when it is not possible, I don't hesitate to offer the other options. T The best course of action for you is to consult with a board certified surgeon who has lots of experience with body contouring of all types and knows about all of these different options that I have mentioned.  That way you can be evaluated individually, and the best option for your specific case can be identified based on all factors to be considered.  Best of luck to you!

Gilbert Lee, MD · Answer

Thank you for your questions. Fat grafting is a very common way to correct defects caused from over aggressive liposuction procedures. Without a photo, its hard to assess how much fat grafting you would need to correct the problem. If there are small divets left from the lipo, you would only need a small amount of fat. If its a larger area, you would need more donor fat. Currently, the FDA has not approved "growing" stemcells outside of the body. I recommend you schedule a consultation with a board certified Plastic Surgeon who is experienced in fat grafting. They will be able to assess your specific anatomy and come up with a plan to correct the area in need. In our office, we offer 3D imaging to give our patients an accurate idea of what their final result will look like. Good luck!

Milan Doshi, MS, MCh · Answer

Thank you for your question. Post lipo deformity is  full of scar tissue with less vascularity where grafted fat survivalists quite less. You may require more sessions. Please consult board certified plastic surgeon and discuss in detail. Dr Milan Doshi, Mumbai, India.

Daniel Del Vecchio, MD · Answer

Commercial cloning of fat Is not happening any time soon in the USA.  There are some promising filler materials that may stimulate fat growth in development;  they may be on the market in 2-3 years Best regards-

Mats Hagstrom, MD (license on probation) · Answer

my best guess is that the ability to grow fat may be feasible  in the future but this may still limit the ability to correct excess of previous liposuction.  The primary problem with fat grafting to correct previous liposuction is that the area tends to be a void of healthy host tissue to support the graft.  In order for tissue grafting to work there has to be an abundance of live vascular tissue to support the grafted tissue.  In the case of  previous excessive liposuction this is often not the case.  Fat can be grafted into the devoid area but unfortunately it tends to not survive well.  Best, Mats Hagstrom MD

Hi, are there any techniques yet for growing fat from stem cells?

Answers (5)

More Facial Fat Transfer Questions

What are the risks and benefits of having a fat transfer alongside blepharoplasty?

Facial fat transfer: Are antibiotics required?

What happens to a facial fat transfer if you loose or gain weight?

Can fat grafting to the temples cause lumps or unevenness?

Fat grafting under eyes 6 weeks post op. How long will it take for my eyes to go back to normal again?

What are the risks/side effects of having fat grafting to the temple area?

WE SEND PRETTY
EMAILS