Comparison of the Efficacy and Safety of Cell-Assisted Lipotransfer and Platelet-Rich Plasma Assisted Lipotransfer: What Should We Expect from a Systematic Review with Meta-Analysis?

Due to the high absorption rate of traditional autologous fat grafting, cell-assisted lipotransfer (CAL) and platelet-rich plasma (PRP)-assisted lipotransfer were developed. The purpose of this article was to evaluate the efficacy and safety of CAL and PRP in promoting the survival of autologous fat grafting through systematic review and meta-analysis. We searched Pubmed, Cochrane Library, Web of Science, and EMBASE for clinical studies on CAL and PRP-assisted lipotransfer published from January 2010 to January 2020. Then a meta-analysis was performed to assess the efficacy of CAL and PRP-assisted lipotransfer through data analysis of fat survival rate. We also assessed the incidence of complications and multiple operations to analyze their safety. A total of 36 studies (1697 patients) were included in this review. Regardless of the recipient area, CAL and PRP-assisted lipotransfer significantly improved the fat survival rate (CAL vs non-CAL: 71% vs 48%, P < 0.0001; PRP vs non-PRP: 70% vs 40%, P < 0.0001; CAL vs PRP: 71% vs 70%, P = 0.7175). However, in large-volume fat grafting, such as breast reconstruction, both increased the incidence of complications and did not decrease the frequency of multiple operations after lipotransfer. Further prospective studies are needed to evaluate the clinical benefits of CAL and PRP-assisted lipotransfer.

Autologous Fat Grafts by Injection-Ten Years' Experience

The use of surgically excised/mechanically fragmented dermal fat grafts by injection led to the use of suction-aspirated fat for autologous grafts by injection. Efforts to scientifically evaluate the fat survival began with a microscopic evaluation of the integrity of the aspirated fat in a series of patients. The next study consisted of injection of dye-stained fat into the abdominal skin/fat followed by removal and microscopic evaluation of the grafts from 3 months to 1 year later. Also, different sized cannulas for removal and different sized needles for injection of fat were used, with the abdominal skin/fat used as the recipient site. Studies were also done to compare washing versus nonwashing of the fat. These studies and 10 years of clinical evaluation and follow-up has led us to conclude that fat, properly aspirated, properly prepared, and properly injected, is an excellent and permanent substance for soft tissue augmentation.