Stem Cells Can Augment Fat Grafts in Treating Facial Atrophy

Treating facial atrophy in localized scleroderma by grafting stem cells from a patient’s own fat tissue appears to be a safe and effective alternative to existing methods, according to a small clinical study.

The findings were published in an article, “A pilot study on ex vivo expanded autologous adipose‐derived stem cells of improving fat retention in localized scleroderma patients,” in the journal Stem Cells Translational Medicine.

Localized scleroderma occurs when the body overproduces collagen in specific areas of the skin, resulting in that skin growing hard and stiff. When this occurs in the face, it leads to the deterioration of skin and soft tissues there, a condition called facial atrophy, which strongly affects the quality of life and mental health of patients.

Grafting fat from a patient’s own tissues to affected regions (autologous fat grafting, or AFG) is the current go-to surgical procedure to treat facial atrophy. In localized scleroderma, however, the transplanted tissue often fails to survive. Another technique, called stromal vascular fraction (SVF)‐assisted fat grafting, has improved fat grafts in some people but has not yet been proven effective in localized scleroderma.

“As a result, the patient has to undergo numerous rounds of grafting procedures to maintain their appearance, which is not only hard on them physically and mentally but poses a financial burden as well,” Chenyu Wang, MD, and Xiao Long, MD, the study’s lead authors, said in a press release.

Wang, Long, and their colleagues from China and the U.K. experimented with adding stem cells from a patient’s own fat, called adipose‐derived stem cells (ADSCs), to the grafts in a clinical trial. Research has shown that ADSCs replicate well, are safe, promote blood vessel growth, and have immune modulating effects.

“ADSCs have shown potential for improving fat retention,” Long said.

The researchers recruited 18 adult participants, nearly 27 years old on average, and with facial atrophy on their foreheads and cheeks, for a six-month study comparing conventional AFG, ADSC-assisted fat grafting, and SVF‐assisted fat grafting.

Each type of surgery was performed on six participants. Facial atrophy severity and the volume of the graft were recorded for each participant. Five plastic surgery experts evaluated clinical outcomes in each patient.

Three months later, fat retention in the ADSC‐assisted group was significantly higher (61.25%) than that of the SVF-assisted (45.69%) or conventional (41.26%) groups. This trend continued at the six-month follow-up, which showed a significantly higher fat retention of 49.83% in the ADSC-assisted group, compared to 31.75% in the SVF-assisted group, and 21.86% in the conventional group.

The investigators also examined facial atrophy with MRI scans, before surgery and at the six-month follow-up. Scans revealed no complications or hazards associated with the ADSC-assisted grafts.

“Although this pilot study was with a limited number of participants and relatively brief follow-up, it showed that the ADSCs-assisted fat grafting was not only safe and well-tolerated in [localized scleroderma] patients, but it also may be more feasible and superior to conventional fat grafting or SVF-assisted fat grafting in improving facial atrophy,” the researchers wrote, adding that larger and longer-term studies should be done to confirm these results.

Anthony Atala, MD, the journal’s editor-in-chief, said the study “suggests that fat grafts combined with their stem cells potentially provide for a safe and feasible alternative to conventional treatment methods to correct facial atrophy that can occur for scleroderma patients.”