Lipotransfer — a procedure in which fat tissue is injected into facial scar tissue — improved mouth function, appearance, and quality of life for people with scleroderma, a study says.
The study, “Stem cell enriched lipotransfer reverses the effects of fibrosis in systemic sclerosis,” was published in the journal PLOS ONE.
Scleroderma is characterized by the appearance of thick scar tissue in the skin and internal organs. One of the main concerns of people with scleroderma is the appearance of fibrosis in the face, which affects their mouth function, appearance, and quality of life, and leads to isolation and psychological distress.
However, there is no medical alternative to improve facial fibrosis, as most treatments focus on the disease manifestations in internal organs.
Autologous lipotransfer is a reconstructive procedure that consists of extracting fat tissue from areas different from the face, like the abdomen or thighs, and injecting it in the face. The treatment reshapes the face, and reverses the effects of fibrosis.
The procedure has been successful in people with scleroderma, burns, and radiation-induced fibrosis. Additionally, it is minimally invasive and has almost no secondary adverse events.
The mechanisms by which lipotransfer reverses fibrosis are not fully understood. But they are thought to be associated with adipose-derived stem cells (ADSCs), a type of cell present in fat tissue, which has anti-inflammatory and immunoregulatory properties.
Researchers in the U.K. have now assessed the impact of lipotransfer, enriched with ADSCs, in patients with scleroderma. Their goal was to reveal the mechanisms by which the procedure reverses fibrosis.
The study included 62 people with scleroderma with signs of facial fibrosis. Participants were between 18 and 65 years old, with a mean age of 56 years, and 98% were female.
Researchers assessed mouth function using the Mouth Handicap in Systemic Sclerosis Scale (MHISS). Quality of life was assessed using physiological indexes that evaluate distress over physical appearance, anxiety and depression, and perceived negative judgment from others before and after the procedure.
Results showed that the treatment overall was well-tolerated. Adverse events included bruising and swelling in the area where fat tissue was removed, which disappeared after two weeks. There was one case of infection in the face, which was solved with oral antibiotics.
Lipotransfer significantly improved the MHISS scores in all categories, including mouth opening, aesthetic, and dry mouth. After the treatment, patients reported having more volume in the mouth and lips, fewer wrinkles, and better color in the lips. Positive effects also were perceived in the cheeks and nose.
Patients who underwent three or more lipotransfer sessions showed better results in all the categories analyzed.
The treatment also significantly improved scores on all psychological measurements.
“We found that the psychological health of the patients in this study was significantly improved,” the researchers said. “In contrast to previously published reports, our study was not limited to treating only the perioral [mouth] area but also the cheeks, chin, nasolabial folds [commonly known as laugh lines], and nose. This approach allowed for a better aesthetic outcome in terms of volume and facial elasticity that may have contributed to the psychological improvement in these patients.”
Researchers observed no significant differences between patients taking immunosuppressors and those who were not, which suggests that the mechanism of action of lipotransfer is not related to the immune system.
“In this study, we demonstrated a significant clinical improvement in orofacial fibrosis in [scleroderma], previously regarded as a disease manifestation without effective therapy,” the researchers said.
The team also cultured scleroderma-derived fibroblasts — the cells responsible for skin fibrosis — together with ADSCs extracted from patients. The goal was to better understand the action of lipotransfer.
They observed that the fibroblasts survived and divided less when cultured along with the ADSCs, than when cultured alone. They also produced fewer markers of fibrosis, and turned off genes involved in fibrosis.
The team concluded that “lipotransfer may reduce dermal fibrosis through the suppression of fibroblast proliferation and key regulators of fibrogenesis [fibrosis development].”
“Autologous stem cell-enriched lipotransfer offers a potentially effective regenerative option to treat oro-facial fibrosis in [scleroderma] that operates independently of immunosuppression and disease subset,” they added.
The team plans to further validate the findings in a controlled trial.