Early Intervention with Highly Condensed Adipose-Derived Stem Cells for Complicated Wounds Following Filler Injections

Abstract

Background: A rise in cosmetic procedures has seen the use of fillers become more prevalent. Complications resulting from use of fillers have prompted introduction of various medical and surgical interventions. Recently, stem cell therapies have become more widely used as a new treatment option for tissue repair and regeneration.

Methods: We utilized adipose-derived stem cells (ASCs) for tissue regeneration in patients with filler-related complications such as necrosis. All 12 patients were treated with ASCs and some patients had additional treatment. After relief of symptoms, wound surface area was compared in terms of pixel numbers and scar condition was evaluated using the Vancouver Scar Scale (VSS).

Results: In general, we achieved satisfactory resolution of filler-related complications in a short period of time without serious side effects. The average number of days from stem cell treatment to symptom relief was 7.3 days. The proportion of wound surface area from photographic record was 4.39 % before treatment, decreasing considerably to 1.01 % following treatment. Last, the VSS showed almost all patients scored below 3, with two patients receiving scores of 7 and 8; the average score was 2.78 (range from 0 to 8).

Conclusions: ASCs are a new treatment option for post-filler injection wounds such as necrosis. Using stem cells, we were able to obtain satisfactory results in a short period of time without complications requiring surgical procedures. We suggest stem cell injections could be used as the first option for treatment of complications from filler injections.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Adipose-derived stem cells; Filler complication; Necrosis; Tissue repair.

Fig. 1

The extracted SVF samples were sent to laboratory for cell counting using a hemocytometer. There were about 1 × 10⁵ cells per 1 ml of SVF

Fig. 2

A 42-year-old woman developed skin necrosis of the nose following a filler (Cutegel) injection into the nasal dorsum and tip. Nine days after debridement and stem cell injection, necrotic tissue almost disappeared, and partial raw surface was showing. After 2 months, except for erythema, the wound was healing well. One year after treatment, remnant scar was still showing, but the erythema had decreased considerably

Fig. 3

A 35-year-old female developed necrotic changes following a filler (unknown) injection into the nasal dorsum and tip. Three days after the filler injection, the patient came to the clinic with erythema and necrosis. Stem cell therapy was started, and after 3 days, necrotic tissue disappeared and partial raw surface was showing on the nasal tip. One week after stem cell injection, mild erythema remained, and after 7 weeks, the wound had healed into normal skin

Fig. 4

A 23-year-old female patient came to hospital suffering from pain, edema, skin necrosis, and pus discharge following a filler injection (Artecoll) into the forehead, nasal ridge, and tip. Seven days after debridement and stem cell injection, the wound had totally healed except for mild erythema and scarring. One month later, the scarring and erythema showed no considerable change, but after 6 months, no complications were shown

Fig. 5

As compared with normal wound healing or PRP wound healing process, in the early stage of wound healing, early direct movement of the stem cells allows direct differentiation to the dermis, vessels, and epidermis, secreting various growth factors. As a result, almost perfect wound healing can occur without blood clot and scab in the late stage