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Intraoperative Strategies for Minimal Manipulation of Autologous Adipose Tissue for Cell‐ and Tissue

IFAAS Faculty, Dr Steve Cohen and his colleagues reviewed Intraoperative Strategies for Minimal Manipulation of Autologous Adipose Tissue for Cell‐ and Tissue‐Based Therapies.

The ease of harvest with minimal donor morbidity, and plentiful access, makes adipose tissue a convenient source for autologous cell‐ and tissue‐based therapies for regenerative medical purposes.

The tissue stromal vascular fraction is a heterogeneous cell population containing adipose‐derived stem/stromal cells, isolated from adipose tissue using nonenzymatic dissociation, which has been successfully used in translational studies and clinical trials.

The aim of this narrative literature review is to describe and discuss the effective, alternative, recognized methods for obtaining cell‐ and tissue‐therapy products with minimal manipulation. Optimization of these methods has the potential to offer unprecedented opportunities to further bring effective regenerative therapies at the point of care in a widely variable application group in wound, orthopedic, musculoskeletal, and plastic‐reconstructive fields.

Enzyme V.S. Enzyme Free

Adipose tissue is a loose connective tissue; therefore, flexible collagen fibers play a pivotal role in the tissue structural organization.

The “classical” method of isolation of multipotent cells from adipose tissue is based on the enzymatic digestion by collagenase followed by differential centrifugation. But due to the following reasons, recently, many efforts have been made in order to develop collagen‐free methods for isolating stromal/vascular cells and some of these procedures have been patented.

Below is a comparison between methods for cellular stromal vascular fraction and tissue stromal vascular fraction isolation from the adipose tissue complex.

Enzyme-Free Methods of Adipose Tissue Processing with Emulsification:

A variety of analogous methods aiming at producing mechanically emulsified fat have been developed for the purpose of 1) reducing the number of mature adipocytes, which constitute more than 90% of adipose tissue volume. 2) Increasing beneficial effect on fat grafting, promoting nutrient and oxygen, which in tissues has a diffusion limit below 200 μm within the graft, reducing necrosis 3) Promoting hypoxic stress resistance in order to achieve the increase in engraftment of cSVF.

Below are the short presentation of the principle methods between Nanofat and ITR2 for obtaining emulsified tSVF:

Nanofat: The process consists in mechanical emulsification and filtering of the lipoaspirate to obtain a loose, homogeneous liquid suspension, which can be directly administered to patients for regenerative purposes via very small injectors. Nanofat grafting has been used in procedures such as facial skin rejuvenation, hair restorative procedures, and to promote wound and scar healing. A major drawback of the original procedure is represented by the limited amount of material that can be handled using intersyringe shuffling. Some suggested that after using the method, stromal cell viability is half and the yield is 12‐fold less that of enzymatic digestion isolation. The testing protocols have not been standardized; moreover, forces applied to obtain manual emulsification of adipose tissue are in large part operator‐dependent.

Injectable Tissue Replacement and Regeneration: The technique referred as “Injectable Tissue Replacement and Regeneration—ITR2”61 is designed to replace and regenerate losses in deep and superficial fat compartments, bone, skin as well as in capillary density, elastin, and collagen tissues.

Candidates for the procedure are patients having different types of facelifts who have associated volume loss and patients having laser therapies, where skin damage with thinning of the dermis and epithelium, fat, and bone loss has occurred. The technique begins with a specific topographical facial assessment for all areas of volume loss and contour deficiencies; then these areas can be treated using two to three different size and types of fat grafts. One is a millifat parcel of 1.5 to 2.0 mm used for deep compartment and bone losses; the second, a microfat parcel of 1.0 mm, used for superficial fat losses above the facial musculature and in buccal fat pad if deficiency exists; and the third is a cellular optimized nanofat made with LipocubeNano.

Nanofat is administered in the ITR2 using several methods including syringe delivery, automated delivery, microneedling with a variety of devices, and compounding the nanofat into a unique nanofat biocreme. ITR2 in combination with facelift surgery has been shown to achieve progressive improvement of facial volume up to 24 months after surgery.


Ongoing clinical testing under strict Institutional Review Board‐type oversight is still necessary to identify the critical features of safety and optimal efficacy of the cSVF and tSVF products, either as cell‐enrichment or parenteral systemic uses. Each method has different advantages and disadvantages, but additional rigorous comparative studies are needed to define the best strategy. Moreover, a necessary condition for further clinical translation is represented by standardization of the procedures as well as of the clinical results of the transplantation studies.



Learn More about ITR2 & ABC Face Lifting in Dr Steve Cohen's Operation Room this coming February:

IFAAS Mini-Fellowship

Dr Steve Cohen's Injectable Tissue Replacement,

Regeneration & ABC Face Lift

Feb 20-21, 2020

San Diego, CA, United States


More Upcoming Aesthetic Trainings Happening Globally

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