Enrico Guarino, MD, PhD
Elite Aesthetic Institute LLC, Eagle, ID


Introduction: Regenerative cells found in human fat are a mixed population of stromal and vascular cells found around blood vessels and between adipocytes in the matrix of fat. Most of these cells are covalently bound to small blood vessels in the matrices of fat that surround adipocytes. By definition, Stromal Vascular Fraction (SVF) is composed of stromal and vascular cells. A small proportion of the stromal cells are stem cells, which have been shown to be capable of differentiating into different structures (pluripotency). SVF cells have been shown to have beneficial effects are associated with numerous trophic factors, growth factors, cytokines, cell signaling molecules, etc., and represent an orchestra of regenerative cells that can be found in human fat. In order to have the highest percentage of SVF and stem cells, the best system involves the use of enzymes that we cannot use in normal outpatient activities. the quality of fat that allows us to have the highest percentage of SVF and SC is represented by the nano fat. Nano fat technology based on Tonnard and Verpaele’s original work is characterized by the fat and tissue parcel size, which is 400 to 600 μm or less. A series of devices are used to modify harvested fat into smaller parcels and nano fat. These products each have different injectability characteristics and are used for different applications, including deep fat compartment and periosteal grafting, superficial fat compartment grafting, and dermal and epithelial nano fat delivery. In this preliminary work, we decided to use an FDA-approved device (MiniTC) that gave us the guaranty of the quality and quantity of nano fat stable for all patients. The aim of our job was to evaluate the use of a definite dosage of stable nano fat quantity injected with a standard quantity in the retains face ligaments for obtaining a lifting effect connected with the fat injected and a regenerative effect related to the adult mesenchymal cells present in this kind of fat.

Materials and Methods: Patients who required non-surgical facial treatment were enrolled. Were excluded patients who all patients who had undergone facial surgery in the past three years or patients had been treated with fillers or traction threads in the past twelve months; pregnant patients were also excluded. On the day of treatment, we took the patient took pictures with a standard method and with a device capable of reconstructing the volumes and profiles of the face (Quantificare). After local anesthesia with Klein solution with infiltration of solution 2 to 1, we remove 40 cc of fat for processing with the Mini TC fat kit. Once ready, the nano fat was injected, in standard quantities, into the deep insertion planes of the ligaments. For each side of the face were injected 2.5 cc of nano fat with the use of a 23G sharp needle. All patients were subjected to a follow-up visit after 1, 6, and 12 months with photos taken and administering a satisfaction test of the results.

Results: From January 2019 to February 2021, we treated 40 patients (32 women, 8 men) whit a median age of 56yy (36 - 69yy). All the patients completed the protocol. After the 1 month, we observed a reduction of less than 10 % of the volume obtained with the fat injection in 20 patients, 20 % in 5 patients, and no evidence of a reduction in the 15 remaining patients.

Take Home Message

We want to demonstrate the usefulness of the fat-derived adult mesenchymal cells for a regenerative action on the retains face ligaments for a no surgical face lifting. With this method, after a simple procedure of fat grafting and fat processing, we obtain a standard volume of nano fat to inject into anatomical areas in the origin of the ligament with a standard procedure like the use of hyaluronic acid.