Expanded Stem Cells, Stromal-Vascular Fraction, and Platelet-Rich Plasma Enriched Fat: Comparing Results of Different Facial Rejuvenation Approaches in a Clinical Trial

Abstract

Background: In a previous study, the authors demonstrated that treatment with expanded adipose-derived stem cells or stromal vascular fraction (SVF)-enriched fat modify the pattern of the dermis in human beings, representing a skin rejuvenation effect. Considering that expanded stem cells require a cell factor, the authors wanted to assess similar results by replacing them with platelet-rich plasma (PRP), which is easier to obtain and for which an empirical regenerative effect has been already described.

Objectives: To determine if PRP injection could replace the cutaneous regenerative effect of adipose-derived stem cells.

Methods: This study was performed in 13 patients who were candidates for facelift. The patients underwent sampling of fat by liposuction from the abdomen and submitted to one of three protocols: injection of SVF-enriched fat or expanded adipose-derived stem cells or fat plus PRP in the preauricular areas. Fragments of skin were removed before and 3 months after treatment and analyzed by optical and electron microscopy.

Results: The use of fat plus PRP led to the presence of more pronounced inflammatory infiltrates and a greater vascular reactivity, increasing in vascular permeability and a certain reactivity of the nervous component. The addition of PRP did not improve the regenerative effect.

Conclusion: The use of PRP did not have significant advantages in skin rejuvenation over the use of expanded adipose-derived stem cells or SVF-enriched fat. The effect of increased vascular reactivity may be useful in pathological situations in which an intense angiogenesis is desirable, such as tissular ischemia.

Figure 1.

Orcein stained skin. (A) Control. (B) Treated. In the specimen treated with fat plus PRP, the presence of elastosis in reticular dermis and elastic material (thinner fibers) in the papillary dermis are visible. Scale bars: 70 µm.

Figure 2.

Hematoxylin and eosin stained skin. (A) Control. (B) Treated. Comparing the control (A) and skin treated with fat plus PRP (B), small mononuclear cell infiltrates are visible in the dermis of treated skin. Scale bars: 200 µm.

Figure 3.

Hematoxylin and eosin stained skin. (A) Control. (B) Treated. In the specimen treated with fat plus PRP (B), a mild oedema and disorganized adipose tissue are visible at the dermoepidermal junction. Scale bars: 200 µm.

Figure 4.

Scanning electron microscopy of the skin. (A,C) Control. (B,D) Treated. At low magnification, no modifications are visible in the skin treated with fat plus PRP. However, at high magnification, in the deep dermis, isolated lymphocytes are visible among the connective bundles that appear separated by wide extracellular spaces. Scale bars: (A,B) 500 µm, (C,D) 50 µm.

Figure 5.

Transmission electron microscopy of the skin after treatment with fat plus PRP. (A) Perivascular infiltrates. (B) Reduplicated vascular basement lamina. (C) Oedema among the connective fibers of the dermis. (D) Activated vascular endothelium is visible. Scale bars: (A) 10 µm, (B) 2 µm, (C) 5 µm, (D) 2 µm.

Figure 6.

Transmission electron microscopy of the skin after treatment with fat plus PRP. (A-D) Ultrastructural aspects of adipocytes at the dermoepidermal junction (the white area of all specimens). The area is rich in vessels (A) and nerves (C). The connective tissue around the adipocytes forms a thick layer (B). The adipocyte can show cytoplasmic alteration and can be surrounded by oedema (D). Scale bars: (A,C,D) 5 µm, (B) 2 µm.

Figure 7.

Transmission electron microscopy of the skin. After treatment with fat plus PRP (A,B), activated fibroblasts are visible in the dermis. Scale bars: 1 µm.