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Annals o Medicine and Su ge y
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Re iew
Au ologous a g a ing: Ha es ing echniques
Tomás Fon es
a,1
, Inês B andão
a,b,1
, Ri a Neg ão
a,b
, Ma ia João Ma ins
a,b
, Rosá io Mon ei o
a,b,c,∗
a
Depa amen o de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina, Uni e sidade do Po o, Po o, Po ugal
b
Ins i u o de In es igação e Ino ação em Saúde (I3S), Uni e sidade do Po o, Po o, Po ugal
c
Unidade de Saúde Familia Ped as Rub as, Ag upamen o de Cen os de Saúde Maia-Valongo, Maia, Po ugal
ARTICLE INFO
Keywo ds:
Adipose issue
Au ologous a g a
Recons uc i e su ge y
Plas ic su ge y
Ha es ing echniques
ABSTRACT
Au ologous a g a ing is widely used o so - issue augmen a ion and eplacemen in econs uc i e and aes-
he ic su ge y p o iding a biocompa ible, na u al and inexpensi e me hod. Mul iple app oaches ha e been
de eloped in he pas yea s, a ying in he loca ion o adipose issue dono -si es, use o we ing solu ions,
ha es ing, p ocessing and placing echniques. Despi e many ad ances in his subjec , he lack o s anda diza ion
in he p o ocols and he unp edic abili y o he eso p ion o he g a ed issue pose a significan limi a ion o
g a e en ion and subsequen filling. In his e iew, we discuss se e al app oaches and me hods desc ibed o e
he las yea s conce ning he ha es ing o au ologous a g a s. We ocus on con en s such as he bes dono -si e,
diffe ences be ween exis ing ha es ing echniques (namely issue esec ion, hand aspi a ion o liposuc ion
echniques), ecommended ha es ing cannula diame e s, p essu e applica ion and olume o we ing solu ion
injec ed p io aspi a ion. Resul s and compa isons be ween me hods end o a y acco ding o he ou come
measu ed, hus posing a limi a ion o pinpoin he mos efficien me hods o apply in a g a ing. Addi ionally,
he lack o a s anda d assay o de e mine iabili y o olume augmen a ion o a g a ing emains ano he
limi a ion o ob ain uni e sally accep ed g a ing p ocedu es and p o ocols.
1. In oduc ion
The fi s eco d o an au ologous a ans e p ocedu e da es back o
1893, when Neube ans e ed au ologous adipose issue o a acial
sca dep ession and documen ed he ou comes [1]. Howe e , au o-
logous a g a ing only came in o play as an impo an and easily ac-
cessible fille wi h he ad en o liposuc ion in he 1980s [2]. Since
hen, he numbe o applica ions epo ing on i s use has been g owing,
mos ly because adipose issue is eadily a ailable, na u al, easy o
ha es and inexpensi e. In addi ion, being au ologous, adipose issue
does no igge an immunological esponse ha could lead o ejec ion,
besides associa ing wi h e y li le dono -si e mo bidi y [3]. Fu he -
mo e, his issue can be used no only as a olume eplace bu also as a
issue quali y imp o e [4]. Some clinical applica ions o au ologous a
g a s comp ise: a) aes he ic b eas p ocedu es (p ima y b eas aug-
men a ion, eplacemen o p e ious b eas implan s, e e sal o adia-
ion damage a e b eas cance ea men , b eas econs uc ion o
econ ou ing a e mas ec omy and co ec ion o de o mi ies such as
ube ous b eas o b assie e s ap g oo es [5–9]; b) mas oidec omy,
hinoplas y, acial eju ena ion, hand eju ena ion, glu eoplas y and
la yngoplas y [4,10–16]; c) imp o emen and/o co ec ion o de o -
mi ies obse ed in Pa y-Rombe g synd ome, Poland synd ome, Du-
puy en's and Raynaud's diseases and pec us exca a um [17–22]; d)
ea men o sca s, ulce s and bu ns [23,24].
Al hough i has been widely used o decades now, one o he main
issues in au ologous a g a ing is he unp edic able eso p ion a e
ansplan a ion, which may equi e epea ed injec ions and lead o poo
esul s [25,26]. The e o e, he need o op imizing a g a ing me ho-
dology should be o maximal impo ance o minimize a g a loss.
Ha es ed adipose issue is composed o ma u e adipocy es, ex a-
cellula ma ix and a s omal ascula ac ion (SVF), cons i u ed by
diffe en cells including adipose de i ed s em cells (ADSCs), pe icy es,
endo helial cells, e y h ocy es, fib oblas s, ascula smoo h muscle
cells, hema opoie ic cells and o he immune cells (Fig. 1)[2,27,28].
No ewo hy, ecen epo s ha e iden ified adipose issue as he issue
in he body ha con ains he highes pe cen age o adul s em cells
[29,30]. These ADSCs can unde go mul ilineage diffe en ia ion [30–38]
and may be c ucial o a g a ake since ma u e adipocy es ha su -
i e ha es ing p ocedu es will no eplica e and will e en ually die,
gene a ing ha m ul inflamma o y esponses [39]. Indeed, ADSC-
h ps://doi.o g/10.1016/j.amsu.2018.11.005
Recei ed 26 June 2018; Recei ed in e ised o m 31 Oc obe 2018; Accep ed 6 No embe 2018
∗
Co esponding au ho . Depa amen o de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Uni e sidade do Po o, Alameda P o . He nâni Mon ei o,
4200-319, Po o, Po ugal.
E-mail add ess: [email p o ec ed] (R. Mon ei o).
1
Bo h au ho s con ibu ed equally o his wo k.
Annals o Medicine and Su ge y 36 (2018) 212–218
2049-0801/ © 2018 Uni e si y o Po o. Published by Else ie L d on behal o IJS Publishing G oup L d. This is an open access a icle unde he CC BY license
(h p://c ea i ecommons.o g/licenses/BY/4.0/).
T
en iched g a s obse ed in cell-assis ed lipo ans e (CAL) ha e been
associa ed wi h be e g a iabili y and ou come a e ansplan a ion
(Fig. 1)[28,40]. Ye , his is s ill a ma e o deba e, wi h o he clinical
s udies claiming ha he e is no significan diffe ence in he su i al
a e o he ansplan ed a be ween con en ional a g a ing and SVF-
en iched a g a ing and e en adding ha pos ope a i e complica ions
a e mo e o en obse ed in he la e [41]. Acco ding o a ecen me a-
analysis by Laloze e al., ha e alua ed he efficacy o CAL by com-
pa ing 16 s udies, he a su i al a e was significan ly highe wi h
CAL when compa ed wi h con en ional p ocedu es, independen o
injec ion si e (b eas o ace) bu only o small injec ion olumes
(below 100 mL). The same analysis concluded ha CAL associa es wi h
mo e complica ions and did no dec ease he numbe o addi ional
su gical p ocedu es needed a e he fi s a g a ing [41].
So a , many echniques and p ocedu es ha e been documen ed
ega ding he use o adipose issue g a s in econs uc i e su ge y.
Dis inc ha es ing p ocedu es esul in diffe en ou comes o a
g a ake, as obse ed by mul iple in i o analyses, in i o animal
expe imen s and human s udies [25]. Se e al a iables need o be aken
in o accoun in o de o ge he highes cell iabili y and su i al a es
possible. Those include he body loca ion o adipose issue dono -si e,
he ha es ing p ocedu e, he ha es ing cannula, he p essu e applied
o he possibili y o injec ing a umescen solu ion wi h anes he ic be-
o e issue collec ion. He ein, we will summa ize he a ious epo ed
app oaches o ha es ing du ing au ologous a g a ing.
2. Ha es ing
Dis inc ha es ing p ocedu es lead o diffe en ou comes o a g a
ake. As a o emen ioned, de ails such as he bes dono -si e, wha adi-
pose issue ha es ing echnique o use, wha ha es ing cannula dia-
me e o choose, wha p essu e o apply o a oid he dec ease o cell
iabili y o he possibili y o injec ing a umescen solu ion wi h anes-
he ics be o e issue collec ion a e aken in o accoun in o de o ge he
highes cell iabili y and su i al a es possible.
2.1. Wha is he bes dono si e?
When i comes o choose he body loca ion o ha es ing, flank,
abdomen, high and knee a e he mo e consis en ly used dono -si es. Li
e al. compa ed a issue g a s ha es ed om 6 women and diffe en
dono -si es (flank, uppe and lowe abdomen, la e al and inne high).
The adipose issue was implan ed subcu aneously in o nude mice and
g a s we e ha es ed and analyzed a 12 weeks. Au ho s ound no
significan diffe ences among g a s om dis inc dono si es ega ding
weigh , olume and his ological ea u es (including in eg i y, cys s,
inflamma ion, fib osis and neo ascula iza ion). Also, he le els o cell
su ace ma ke s and SVF did no diffe . Thus, au ho s sugges ed ha
ac o s like accessibili y and pa ien p e e ence should be conside ed
p imo dial c i e ia o dono -si e selec ion [42]. Simila ly, Ullmann
e al. epo ed no diffe ence in e ms o weigh , olume and his ological
ea u es, such as ascula iza ion and fib osis, be ween a om 3 dono
si es ( high, abdomen, and b eas ) om a 48 yea -old woman ha we e
implan ed in o a nude mice model [43]. Likewise, Lim e al. concluded
ha bo h abdominal and non-abdominal sou ces o a p esen ed equal
success in co ec ing c anio acial so - issue deficiencies in 27 pa ien s
wi h c anio acial mac osomia (n = 19) o T eache Collins synd ome
(n = 8) [44]. This was also suppo ed by Small e al. ha ound no
diffe ence in olume e en ion be ween a ha es ed om abdomen o
highs, in a e ospec i e s udy in ol ing 73 pa ien s ha unde wen
b eas econs uc ion [45].
On he o he hand, Padoin e al. conduc ed a p ospec i e c oss-
sec ional s udy in 25 women ha unde wen liposuc ion in 4 o mo e
dis inc a eas. Mesenchymal s em cell we e ex ac ed and quan ified
om lipoaspi a es and esul s e ealed a highe concen a ion o cells in
samples collec ed om he lowe abdomen and inne high when
compa ed o hose collec ed om he uppe abdomen, ochan e ic
egion, knee and flank [46].
Recen ly, Tsekou as e al., in a s udy in ol ing 40 dono women,
epo ed he ou e high adipose issue o ha e significan ly highe SVF
cell coun in compa ison o any o he si es such as inne high, ab-
domen, wais and inne knee. Also, inne and ou e high we e asso-
cia ed wi h a significan ly highe numbe o ADSCs when compa ed o
abdominal, wais , and inne knee lipoaspi a es [47].
O no e, Di Ta an o e al. e alua ed supe ficial and deep adipose
issue (SAT and DAT, espec i ely) collec ed om 16 emale dono s
unde going fi s - ime liposuc ion. Addi ionally, ull- hickness skin spe-
cimens om he abdominal wall we e collec ed om 3 cada e dono s
o his ological and immunohis ochemis y analysis o he hypode mal
laye s. Resul s e ealed ha SAT was homogeneously p esen in all
body a eas, whe eas DAT was mo e abundan in he abdomen, hips,
knee, pe i ochan e ic a ea, uppe inne high, and pos e io
Fig. 1. Lipoaspi a e componen s and en ichmen o he aspi a ed a by cell-assis ed lipo ans e (CAL).
SVF, s omal ascula ac ion; ADSCs, adipose de i ed s em cells.
T. Fon es e al. Annals o Medicine and Su ge y 36 (2018) 212–218
213
compa men o he a m. SVF cell ac ion om abdominal SAT li-
poaspi a es showed highe iabili y and highe exp ession o bo h
s em/s omal su ace an igen endoglin (CD105) and ascula en-
do helial g ow h ac o (VEGF) when compa ed wi h DAT om he
same ha es ing si e. O e all, SAT was associa ed wi h be e s em
p ope ies hus sugges ing i s p e e able use as a dono si e [48].
2.2. Ha es ing p ocedu es and p essu e: impac on g a su i al
A e choosing he body dono -si e, he nex s ep is o choose he
ha es ing me hod. Di ec excision, sy inge hand aspi a ion and suc-
ion-assis ed liposuc ion using a ious p essu es (and also using di -
e en mechanisms o c ea e ha p essu e) a e some o he cu en ly
used echniques [49–51]. In addi ion, liposuc ion can also be assis ed
by a liquid-je , ul asound pulses o lase ene gy [52–54].
In o de o pe o m liposuc ion o manual aspi a ion, nega i e
p essu es a e equi ed. Despi e he di e gence be ween ha es ing
echniques (and dis inc p essu es) sugges ed by diffe en au ho s o
ob ain be e unc ional g a s, i is well accep ed ha high acuum
p essu es o con en ional liposuc ion a e mo e auma ic o he issue
leading o adipocy e s uc u al dis up ion [55,56].
The diffe en ypes o ha es ing echniques wi h dis inc p essu es
a e summa ized and compa ed in Table 1.
2.3. Wha is he ideal cannula?
The cha ac e is ics o he cannula used o collec a , mainly i s
diame e and numbe o holes, influence he success o a g a p o-
cedu es. Campbell e al. epo ed an in e ed ela ionship be ween
cellula damage and he diame e o he ins umen used o ex ac a
[64].
Mul i-pe o a ed cannulas help educe p essu e on each hole, de-
c easing damage in he samples collec ed [65]. T i isonno e al. com-
pa ed 2 mm and 3 mm diame e cannulas, bo h wi h 170 mm leng h
and a ounded ip. The 2 mm cannula had 5 ound spi ally placed po s,
each wi h a 1 mm diame e , and he 3 mm cannula had a single side
loca ed 3 × 9 mm po . The 2 mm cannula concu en ly acili a ed
ha es ing om mo e supe ficial and ascula ized laye s o adipose
issue, and educed pa ien discom o and auma. In addi ion, his
2 mm cannula was able o isola e mo e ADSCs, and wi h a highe po-
en ial o capilla y-like s uc u e o ma ion han he 3 mm cannula.
Ne e heless, ADSC iabili y, mo phology and p oli e a ion capaci y
did no a y significan ly be ween he wo cannulas [66]. Alha bi e al.
compa ed a mic o-ha es ing 2 mm cannula wi h ou 600 μm gauged
o ifices and a blun ip wi h a con en ional 3 mm single hole blun ip
cannula, wi h he fi s claiming significan ly highe iabili y and mi-
g a ion o isola ed ADSCs [67]. Howe e , Rubino e al. concluded ha
a ha es ed wi h a 3 mm cannula showed mo e adipocy e densi y han
a ha es ed wi h a 2 mm cannula [68]. E dim e al. showed an in-
c ease in g a iabili y in a ha es ed om 10 emale pa ien s using a
6 mm cannula du ing liposuc ion compa ed wi h g a s ob ained by
4 mm and 2 mm cannulas [69]. A p ospec i e s udy by Ozsoy e al.
concluded ha a g ea e numbe o iable adipocy es was ob ained
wi h a 4 mm-diame e cannula when compa ed wi h 2 o 3 mm can-
nulas [70].
Al hough he op imal cannula size s ill lacks consensus, i is well
accep ed ha i should be la ge enough o a oid shea s ess and o
p ese e adipocy es and SVF cells [70–72].
2.4. Is he e a diffe ence in we o d y aspi a ion ou comes?
The e a e a ew ypes o liposuc ion echniques acco ding o he
olume o injec ed solu ion in o he a dono -si e. The d y echnique
consis s o di ec aspi a ion wi hou injec ing any p epa a ion solu ion
and i is nowadays obsole e due o blood loss ha can accoun o
20–50% o he aspi a ed olume [25,73–75]. In he we echnique,
p oposed by su geons Clay on and He e , he a dono -si e is injec ed
wi h a we ing solu ion (which may con ain saline, anes he ics and
o he subs ances) p io o aspi a ion, ollowing a a io o infil a e o-
lume: aspi a ed olume lowe han 1:1, esul ing in a blood loss o
4–30% o he aspi a ed olume [75–77]. La e , in he supe we ech-
nique p oposed by Fodo e al., a a io o infil a e o o al aspi a e o
1:1 was used and was associa ed wi h educed blood loss o 1–2% o he
aspi a ed olume [43,75,76].
Finally, he umescen echnique, in oduced by Klein, p esen ed a
la ge olume o infil a e wi h a a io o infil a e olume o o al as-
pi a e olume o 2–3:1. This echnique is accompanied by a educed
blood loss o a ound 1% o he aspi a ed olume and does no equi e
gene al anes hesia, he e o e being conside ed as he sa e p ocedu e
o la ge aspi a ions and wi h imp o ed aes he ic esul s. Tumescen
anes hesia mus be injec ed 45 min be o e ha es ing o ensu e hyd o-
dissec ion and bloodless collec ion [74,75,78].
Lidocaine alone has been associa ed wi h dec eased adipocy e
unc ion, wi h Moo e e al. finding ansien changes o lipolysis and
glucose anspo in he p esence o local anes he ic. In e es ingly, e-
mo al o lidocaine h ough washing ha es ed lipoaspi a e e u ned
hese le els o no mal [79]. Tumescen anes hesia can also be a ehicle
o d i e subs ances wi h a gi en effec o he adipose issue o be ha -
es ed (Table 2). Local anes he ics, ei he wi h o wi hou asocon-
s ic o agen s we e ound no o ha e a significan effec on long- e m
su i al o g a ed a , con adic ing he hypo hesis p oposed by Moo e
e al. sugges ing ha lidocaine inhibi ed g ow h o adipocy es [79,80].
Agos ini e al. e ified ha his omo phome ic cha ac e is ics (like
c oss-sec ional p ofile, cy oplasmic im, connec i e issue, amo phous
g ound subs ance, acuoles, cy oplasmic swelling/dis up ion, apop osis
o nec osis) and cell iabili y did no significan ly diffe be ween d y
and we ha es ing liposuc ion [73].
3. Conclusion
Au ologous a g a ing has become inc easingly used as a me hod
o mul iple olume filling applica ions. The majo obs acle o he
widesp ead o i s clinical use is he lack o s anda dized guidelines
du ing ha es ing, p ocessing and implan a ion s eps [91]. Indeed,
many au ho s ha e ecognized ha he e is no uni e sally accep ed
me hodology o a g a ing [92,93].
Fa is a delica e issue and mus be handled wi h maximal ca e o
main ain i s iabili y [6]. The ideal me hodology o app oach au o-
logous a g a ing has been a majo ocus in he las yea s, bu pa ien -
ela ed ac o s should also be aken in o accoun when designing a
s udy.
Dono -si e mo bidi y, like hema oma o , mo e equen ly, local
de o mi ies caused by liposuc ion, and ecipien -si e complica ions,
such as in ec ions and, al hough e y unlikely, pulmona y embolism,
ca diac a es , o deep enous h ombosis, ep esen d awbacks o
adipose issue ansplan . Ne e heless, au ologous a g a ing is e-
po ed o be a e y sa e p ocedu e wi h e y low mo bidi y [94].
Re iewing and compa ing ha es ing echniques epo ed in he
li e a u e comp ises a big challenge gi en he eno mous ou come
a iables and he mul iple ac o s o ake in o accoun o each me hod
desc ibed (e.g. dono loca ion, ype o a aspi a ion, p essu e, cannula
ype, e c), he e o e no allowing us o gi e a s aigh o wa d answe o
he ques ion o which me hod is he bes o assu e he highes quali y
a g a . Also, when e iewing some o he ha es ing me hods and
p essu es applied o collec adipose issue, we ha e concluded ha mos
s udies ocus on endpoin s such as in i o coun and iabili y o cells,
howe e hese endpoin s ha e no been p o ed o ansla e in o be e
a g a su i al in humans [95].
Op imizing a g a ing me hodology in he u u e is o maximal
impo ance, since pa ien - ela ed ac o s a e mos o he imes un-
changeable and success may ely almos only on effec i e a g a ing
echniques.
T. Fon es e al. Annals o Medicine and Su ge y 36 (2018) 212–218
214
Table 1
Compa ison be ween ha es ing echniques and diffe en p essu es.
Techniques Me hods Resul s Re e ence
Manual aspi a ion (sy inge) and
PAL (350 and 700 mmHg)
T ochan e ic a ha es ed om 3 heal hy pa ien s aged 36,
43 and 58 yea s. Numbe o isola ed SVF cells was assessed.
Cell yield wi h a p essu e o 350 mmHg, assis ed o no ,
was highe han ha ob ained a 700 mmHg. Cell yield
wi h PAL (350 mmHg) was significan ly supe io o
aspi a ion wi h a sy inge (p < 0.05).
Mojallal e al.
[57]
Yea : 2008
Manual aspi a ion (275, 394 and
550 mmHg) and PAL (350 and
700 mmHg)
Compa a i e s udy in 15 heal hy man and women aged
25–60 yea s, unde going abdominal cosme ic su ge y.
Samples unde wen his ological analysis in o de o e i y
he in eg i y and unc ionali y o he ha es ed adipocy es
and ADSCs.
Values o nega i e p essu e p oduced by he sy inges as
well as p essu es o 350 and 700 mmHg ob ained by PAL
did no lead o diffe ences in he numbe o adipocy es and
iabili y o he ADSCs ex ac ed.
Cha les-de-Sá
e al. [58]
Yea : 2015
Manual aspi a ion and PAL
(375 mmHg)
Fa issue was ob ained om 9 dono s unde going
abdominoplas y. Samples we e di ided in o 2 a sec ions,
ha es ed using ei he manual aspi a ion o PAL. Numbe
o isola ed ADSCs was coun ed and p oli e a ion a e and
cell iabili y we e assessed. The abili y o isola ed ADSCs o
diffe en ia e in o ma u e adipocy es was analyzed by gene
ma ke exp ession.
PAL e ealed a leas simila quali y and quan i y o ADSCs
as manual aspi a ion. Cells ha es ed by PAL had highe
exp ession le els o diffe en ia ion ma ke s (e.g.
adiponec in).
Keck e al. [51]
Yea : 2014
PAL a high p essu e (760 mmHg)
and low p essu e
(250 mmHg)
Abdominal lipoaspi a ion was pe o med on 3 pa ien s on
he opposi e sides o he flank a e infil a ion wi h
umescen solu ion. Adipocy e su i al and cell iabili y
we e measu ed in i o.
Adipocy e coun was 47% highe when aspi a ed a low
p essu e compa ed wi h high p essu e, immedia ely a e
ha es ing. Cell iabili y was significan ly highe a day 7
wi h low-p essu e aspi a ion.
Che iyan e al.
[59]
Yea : 2014
PAL ( <760 mmHg) and issue
esec ion
6 heal hy women unde wen abdominoplas y su ge y.
Subcu aneous adipose issue o he abdomen was analyzed.
SVF isola ed om abdominal a ha es ed om pa ien s
(n = 6).
Cell yield and iabili y o ADSCs we e assessed. Cell
pheno ypes we e de e mined by immunos aining and
FACS, and doubling imes we e calcula ed. Senescence
a ios o he cells we e measu ed. Mul ipo ency was
e alua ed by induced diffe en ia ion analyses.
No diffe ences in mul iplica ion a es, senescence a ios
and mul ipo ency o cul u ed ADSCs.
Ba zelay e al.
[50]
Yea : 2015
PAL (760 mmHg) and issue
esec ion
Adipose issue ob ained om pai ed issue esec ion and
PAL adipose issue om he abdomen o 3 heal hy women
aged 26–54 yea s.
In i o analysis: samples we e p ocessed o isola e he SVF.
ADSC yield and cell iabili y we e assessed. Adipogenic and
os eogenic diffe en ia ion capaci y we e assessed in i o
using pheno ypic s aining and quan ifica ion o gene
exp ession.
In i o analysis: ADSCs we e applied in an in i o mouse
model o issue epai o e alua e hei egene a i e
po en ial.
Lowe ADSCs yield in SVF cells using PAL (42.4%) in
compa ison o issue esec ion (55.8%).
No diffe ence in he o he pa ame e s.
Dusche e al.
[60]
Yea : 2016
WAL (375 mmHg) and manual
aspi a ion (290 mmHg)
8 women we e included in he s udy and he wo
echniques we e used o each pa ien . The lipoaspi a es o
subcu aneous abdominal a we e collec ed on bo h side o
he umbilic in each pa ien .
In i o analysis: cell yield, iabili y and immunopheno ype
o he SVF ac ion. Os eogenic and adipogenic
diffe en ia ion and immunosupp essi e capaci y o ADSCs
was assessed in i o.
In i o analysis: immunosupp essi e capaci y o ADSCs
du ing a delayed- ype hype sensi i e esponse model in
mice.
Equi alen numbe o iable cells, fib oblas colony-
o ming uni s and immunopheno ype.
In e es ingly, ADSCs isola ed om manual liposuc ions
showed significan ly highe immunosupp essi e po en ial
han hose om WAL in i o bu no in i o.
Bony e al. [61]
Yea : 2015
LAL and PAL Fa issue ob ained om he b eas o 7 men aged 19–24
yea s diagnosed wi h gynecomas ia.
In i o analysis: cell yield, iabili y, plu ipo ency, su ace
ma ke s exp ession and apop osis o ADSCs we e assessed.
No diffe ence in su ace and cellula diffe en ia ion
ma ke s.
Lowe numbe o iable ADSCs and highe apop osis
indica o s in LAL, 24 h a e ha es ing, bu hese
diffe ences we e e e sed a e 72 h.
Yildiz e al.
[62]
Yea : 2016
Fa issue ob ained om 12 heal hy women be ween he
ages o 33–55 yea s who we e unde going elec i e
lipoaspi a ion o he abdomen. Each pa ien unde going
lase -assis ed liposuc ion (n = 6) was ma ched o age
(wi hin 2 yea s) wi h a pa ien unde going suc ion-assis ed
liposuc ion (n = 6). Age-ma ched pa ien s unde wen
liposuc ion p ocedu es on he same day. LAL and PAL could
no be ha es ed om he same ana omical loca ion.
In i o analysis: Cell yield, cell iabili y and p oli e a ion,
su ace ma ke pheno ype, os eogenic diffe en ia ion and
adipogenic diffe en ia ion capaci y o ADSCs.
In i o analysis: egene a i e capaci y o ADSCs in a c anial
de ec in nude mice.
All in i o pa ame e s such as cell yield, iabili y,
p oli e a ion and equency o ADSCs we e all significan ly
less wi h LAL compa ed o PAL.
In i o, ADSCs om LAL led o significan ly less osseous
healing in compa ison o PAL.
Chung e al.
[53]
Yea : 2013
(con inued on nex page)
T. Fon es e al. Annals o Medicine and Su ge y 36 (2018) 212–218
215
E hical app o al
N/A.
Sou ces o unding
This wo k was suppo ed by FEDER –Fundo Eu opeu de
Desen ol imen o Regional, h ough NORTE 2020 P og ama
Ope acional Regional do No e - NORTE-01-0145-FEDER-000012 and
Ins i u o de In es igação e Ino ação em Saúde (P oje o Es a égico
UID/BIM/04293/2013).
Au ho con ibu ion
Tomás Fon es: da a collec ion and w i ing he manusc ip .
Inês B andão: da a collec ion, da a analysis and w i ing he manu-
sc ip .
Ri a Neg ão: s udy design.
Ma ia João Ma ins: s udy design.
Rosá io Mon ei o: s udy design and da a analysis.
Conflic s o in e es
None o decla e.
Resea ch egis a ion numbe
N/A.
Gua an o
Inês B andão.
Rosá io Mon ei o.
P o enance and pee e iew
No commissioned, ex e nally pee e iewed.
Acknowledgemen s
This wo k was suppo ed by FEDER –Fundo Eu opeu de
Desen ol imen o Regional, h ough NORTE 2020 P og ama
Ope acional Regional do No e - NORTE-01-0145-FEDER-000012 and
Ins i u o de In es igação e Ino ação em Saúde (P oje o Es a égico
UID/BIM/04293/2013).
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Techniques Me hods Resul s Re e ence
UAL and PAL Fa issue ob ained om 3 heal hy women aged 28–48
yea s, unde going elec i e liposuc ion o he abdomen.
Two lipoaspi a e samples we e ha es ed om iden ical
si es in each pa ien , wi h PAL being pe o med be o e
UAL.
In i o analysis: Cell yield, iabili y and p oli e a ion,
su ace ma ke pheno ype, os eogenic, adipogenic and
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excisional wound in nude mice
Equi alen esul s be ween bo h echniques. Cells
ha es ed a e sui able o cell he apy and issue
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Yea : 2016
ADSCs, adipose de i ed s em cells; FACS, fluo escence-ac i a ed cell so ing; LAL, lase -assis ed liposuc ion; PAL, powe -assis ed liposuc ion; SVF, se um ascula
ac ion; UAL, ul asound-assis ed liposuc ion; WAL, wa e -je assis ed liposuc ion.
Table 2
We ing solu ions used in umescen anes hesia.
We ing solu ions Desc ip ion Examples
C ys alloid solu ions Diluen s o anaes he ics. Iso onic saline 0.9% NaCl (Neu alizes he acidic pH o
lidocaine. Associa ed wi h bu ning sensa ion.)
Lac a ed Ringe 's solu ion (Does no cause bu ning
sensa ion and educes he sodium load.)
[81,82]
Vasocons ic o s Cons ic he blood essels, educe blood loss, and amelio a e issue pe usion wi h he
anaes he ics by inc easing he du a ion and he quali y o anes hesia.
Ad enaline (epineph ine) L-o ni hine 8- asop essin
[81–84]
Local anaes he ics Allow absence o pain sensa ion du ing liposuc ion. Lidocaine
P ilocaine
A icaine
[85–88]
Buffe s Raise he pH o he solu ion and a oid he bu ning sensa ion. Augmen he p opo ion o
nonionized lipid soluble lidocaine, which can mo e apidly en e he ne e cells.
Sodium bica bona e
[82,89]
An ioxidan s Reduce oxida i e s ess in he a g a . Amelio a e su i al o ADSCs and p ese e g a
olume.
N-ace ylcys eine
[90]
T. Fon es e al. Annals o Medicine and Su ge y 36 (2018) 212–218
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