Fat grafting is one of the great innovations in plastic surgery from the past decade as a stand alone procedure or as an enhance to many other plastic surgery procedures. As a natural graft materials with usually good availability, it is an unrivaled visual and reconstructive soft tissue reconstruction method. But in spite of its many attributes, fat grafting is not a completely dependable soft tissue creation method. Much investigation and research has gone into fat harvest and graft preparation plus injection, but no universal method has been discovered that may consistently produce a consistently reliable graft take.
One fat graft preparation method that has been looked at through the years is the addition of a ‘ priming’ or stimulating real estate agent. The objective is to either improve how many of the intact transplanted fat cells will survive or increase conversion from the coincidental stem cells that are known to exist in body fat to become new lipid-laden fat cells. Done years ago simply by mixing in insulin, today’ s potential fat graft stimulator is platelet-rich plasma (PRP). High concentrations associated with platelets would theoretically have a favorable effect on both adipocytes and stem cells.
PRP is an organic blood extract product that is rich in growth factors which have well-documented effectiveness in wound healing. Through such development factors as PDGF, TGF beta and VEGF, enhanced blood vessel ingrowth and deposition of extracellular matrix has been shown in many animal studies.
Animal correctly also shown that PRP can improve fat graft take and reduce the formation of oil cysts probably due to its revascularization effects. But despite the theory and pet research the use of PRP in fat grafting remains risky with few clinical studies that have even investigated the potential effects.
Like any drug, the effects of PRP on fat would be expected to be dose dependent. Considering that the average PRP volume extracted from a 20 to 60cc blood draw would be just a few ccs, its addition one example is to a BBL (Brazilian Butt Lift) would be expected to have zero effect on fat graft survival. In facial fat grafting, however , where graft volumes could be expected to be in between one and 50ccs, a few ccs of PRP will be more likely to be effective. Thus it likely all comes down to an anticipated concentration effect.
No one yet knows the actual ratio of PRP to fat graft volume needs to be or would be expected to work. I currently operate on the idea that PRP should be used when the fat graft in order to PRP ratio is at least 10: 1 or a 10% PRP composition volumetric ratio. Studies have shown that PRP may have its strongest effect on the differentiation of adipocyte-derived stem cells into fat cells. This may make the finest contribution to final graft volume persistence. While vascular budding or endothelial sprouting may have a more minor impact.
The use of PRP in fat grafting (lipofilling) remains more theoretical than proven science. But the insufficient any side effects with PRP allows for the its generous clinical use and investigation.
Image Resources: Dr . Barry Eppley
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