Comparative Analysis of a New Automatic System and Four Existing Techniques for Autologous Fat Grafting

Abstract

Background: Autologous fat grafting is increasingly used worldwide and is a very attractive technique in many ways. However, treatment duration and postinjection tissue resorption remain problematic elements, which are largely related to the preparation method used. Moreover, few scientific studies objectively compare different fat preparation methods. This study analyzes the efficiency and quality of lipoaspirates prepared with a new filtration/centrifugation system (Adipure) in comparison with several existing techniques.

Methods: Patient lipoaspirates were processed by five different techniques: decantation, centrifugation, Macrofill, Puregraft, and Adipure. Adipose tissue was evaluated in vitro for tissue resorption and oil formation, as well as in vivo after subcutaneous injections in immunodeficient mice. Adipose grafts were collected after 1 month, weighed, and analyzed by histology with a detailed scoring method.

Results: Decanting gives inferior results to all other techniques, in terms of amount of tissue and oil in vitro, or graft weight and histological analysis in vivo. Methods using classical Coleman centrifugation (1200g), or a modified one (400g) associated with washes (Macrofill) produce very similar results, both in vitro and in vivo. Techniques using filtration systems (Puregraft and Adipure) produce less oil overall and have a higher grafting efficiency. The best results regarding grafting efficiency and oil quantity are found with the Adipure device.

Conclusions: A combination of filtration and very low-speed centrifugation potentiates the advantages of these techniques, in terms of graft efficiency. The adipose tissue purification being done in a few minutes, in an automatic way, undoubtedly provides a strong advantage for the use of this new system.

Fig. 1.

Comparative and representative photographs of adipose tissue preparations with the different devices and techniques used. A, Decantation; B, Coleman, C, Puregraft, D, Macrofill.

Fig. 2.

AdiMate machine and Adipure single-use kit.

Fig. 3.

In vitro evaluation of adipose tissue (A) and oil quantity (B) after purification with five different techniques (n = 5 patients). Graphs represent the mean of 25 plates of 24 wells (five plates per patient) per technique ± SEM. Purified samples were incubated in the presence of a culture medium for 48 hours. A, The adipose tissue phase was measured. §§§P < 0.005 compared with all conditions. ***P < 0.005 compared with decantation and Macrofill conditions. # P < 0.05 compared with Puregraft condition. ¤P < 0.05 compared with decantation. B, The oil supernatant was measured. §§§§P < 0.0001 compared with all conditions. ****P < 0.0001 compared with decantation and Macrofill conditions. ##P < 0.01 compared with Coleman’s condition.

Fig. 4.

In vivo evaluation of fat grafts 1 month after subcutaneous implantation. Fat grafts were performed in mice after purification with five different techniques (n = 5 patients, n = 6 injections per technique per patient). The entire graft was removed after 1 month and weighed. Results are expressed as mean ± SEM. *P < 0.1 compared with Puregraft condition. ##P < 0.01 and ####P < 0.0001 compared with decantation condition. §§P < 0.01 compared with Coleman and Macrofill conditions.

Fig. 5.

In vivo evaluation of fat grafts 1 month after subcutaneous implantation. Fat grafts were performed in mice following purification with five different techniques (n = 5 patients, n = 6 injections per technique per patient). The entire graft was removed after 1 month. Histological scoring was performed on HE with Masson’s trichrome-stained sections. Longitudinal sections were prepared from two different graft depths. A, Global scoring includes oil vacuole, inflammation, fibrosis and adipocyte size and shape. *P < 0.05 and **P < 0.01 compared with decantation condition. #P < 0.1 compared with Coleman condition. Results are expressed as mean ± SEM. B, Oil vacuoles specific scoring. **P < 0.05 and ****P < 0.001 compared with Macrofill and Coleman conditions. #P < 0. 1; ###P < 0.001 and ####P < 0.0001 compared with decantation condition.

Fig. 6.

Histological results of grafts recovered 1 month after injection according to the different techniques. Representative histological images of HE-stained sections from (A) decantation technique, (B) Coleman technique, (C) Puregraft protocol, (D) Macrofill protocol, and (E) Adipure protocol. The scale bar represents 5mm.