Objectives: As the field of regenerative medicine has rapidly expanded during the last three years, aesthetic practitioners looking to incorporate this into their practice have a confusing number of options. The goal is to identify procedures that work and clinical situations in which their easy application will generate patient satisfaction.
Topics covered include progenitor cells created mechanically with FDA approved devices, "shapers", the use of growth factors, defensins and small peptides, exosomes, and other nanoparticulate delivery options that can enhance traditional fat grafting techniques.
Introduction: Educated patients are looking for injectable and topically applied therapies that minimize down time but last longer than fillers. While fat adds a broad soft fill, shaping of the face can be achieved with the addition of hDAM and with an injectable regenerative implant. hADSCs can be generated using a mechanical nanofat processing device, and follicular stem cells with a device specific for stiffer tissue.
Defensins can be used topically for epidermal regeneration. Exosomes are nanoparticulate vesicles that carry growth factors smaller than 200 nm to a topical destination.
Materials / method: Traditional fat harvested for transfer is considered macrofat. This holds a shape better than small particles as some stroma is included. Milling of fat produces millifat and microfat, which can be injected with a smaller gauge cannula. Nanofat and follicular progenitor cells have no adipocytes present. Intradermal injection of these can produce dermal fibroblasts and can stimulate miniaturized hair follicles. By adding exosomes topically to treated skin, healing can be accelerated and the surface improved. Defensins regenerate the epidermis and combine well with fat transfer procedures.
Results: Enhancement of fat grafting is essential to produce good clinical outcomes. In patients who need volume, creation of a defined shape is helpful. For patients who also have aging skin, intradermal injection of nanofat can "resurface" skin with minimal down time, especially in the infraorbital region. Progenitor cells other than follicular cells can be created using the European device off label. Topical biologicals such as defensins and exosomes can optimize the appearance of skin with rapid healing due to growth factors and endogenous stem cell stimulation.
Conclusion: The use of particulate fat to enhance traditional fat grafting has changed the way we treat patients. By adding "shapers" such as hDAM and an injectable hollow implant that is stackable, a defined correction can be obtained. With the inclusion of biologicals, both skin and hair restoration can enhance the final outcome in a cost effective way. These procedures are time efficient and can be easily mastered by aesthetic practitioners.
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