Advertisement

Comparison of Conventional and Platelet‐Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis

  • Author Footnotes
    ⁎ These authors contributed equally and are co-first authors.
    Mengfan Wu
    Footnotes
    ⁎ These authors contributed equally and are co-first authors.
    Affiliations
    Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, P. R. China
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally and are co-first authors.
    Mehran Karvar
    Footnotes
    ⁎ These authors contributed equally and are co-first authors.
    Affiliations
    Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
    Search for articles by this author
  • Qinxin Liu
    Affiliations
    Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, P. R. China
    Search for articles by this author
  • Dennis P. Orgill
    Affiliations
    Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
    Search for articles by this author
  • Adriana C. Panayi
    Correspondence
    Corresponding author: Adriana C. Panayi, MD, Harvard Medical School, 75 Francis St., Boston MA 02115.
    Affiliations
    Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally and are co-first authors.

      Abstract

      Background

      Autologous fat grafting (FG) is a popular technique for soft-tissue augmentation, but the fat survival rate is unpredictable. Platelet-rich plasma (PRP) has emerged as an adjuvant to enhance fat graft survival.

      Objectives

      This literature review and meta-analysis aimed to investigate the effect of PRP on the survival rate of fat grafting.

      Methods

      A comprehensive systematic literature search was done to identify clinical studies on PRP and fat cotransplantation in PubMed, Cochrane Library, Web of Science, and EMBASE databases up to May 2020. The reference lists of selected articles were reviewed to identify any additional related articles. A meta-analysis was conducted to compare PRP + FG and conventional FG in terms of fat graft survival rate, patient satisfaction rate, and recovery time after surgery.

      Results

      Eleven studies consisting of 1125 patients were analyzed. Patients were followed up from 3 to 24 months post-FG. The fat survival rate varied from 20.5% to 54.8% in FG alone and from 24.1% to 89.2% in the PRP + FG groups. The survival rate was significantly higher and recovery time was significantly lower in the PRP + FG group than in the FG alone group. However, there was no significant difference in the patient satisfaction rate between the groups.

      Conclusions

      This study demonstrates that PRP-enhanced fat transplantation has better efficacy than conventional fat grafting. Further studies are required to provide the optimum concentration of PRP and the long-term efficacy of the technique. There is not enough evidence to compare the rate of complications with PRP and fat cotransplantation and conventional fat grafting.

      Keywords

      To read this article in full you will need to make a payment

      Reference

        • Gir P
        • Brown SA
        • Oni G
        • Kashefi N
        • Mojallal A
        • Rohrich RJ.
        Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage.
        Plast Reconstr Surg. 2012; 130: 249-258
        • Coleman SR.
        Structural fat grafting: more than a permanent filler.
        Plast Reconstr Surg. 2006; 118: 108S-120S
        • Fredman R
        • Katz AJ
        • Hultman CS.
        Fat Grafting for Burn, Traumatic, and Surgical Scars.
        Clin Plast Surg. 2017; 44: 781-791
        • Piccolo NS
        • Piccolo MS
        • Piccolo MT.
        Fat grafting for treatment of burns, burn scars, and other difficult wounds.
        Clin Plast Surg. 2015; 42: 263-283
        • Rigotti G
        • Marchi A
        • Galie M
        • et al.
        Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.
        Plast Reconstr Surg. 2007; 119 (discussion 1423-1404): 1409-1422
        • Griffin MF
        • Almadori A
        • Butler PE.
        Use of Lipotransfer in Scleroderma.
        Aesthet Surg J. 2017; 37: S33-S37
        • Gause 2nd, TM
        • Kling RE
        • Sivak WN
        • Marra KG
        • Rubin JP
        • Kokai LE.
        Particle size in fat graft retention: A review on the impact of harvesting technique in lipofilling surgical outcomes.
        Adipocyte. 2014; 3: 273-279
        • Pu LL.
        Mechanisms of Fat Graft Survival.
        Ann Plast Surg. 2016; : S84-S86
        • Shoshani O
        • Shupak A
        • Ullmann Y
        • et al.
        The effect of hyperbaric oxygenation on the viability of human fat injected into nude mice.
        Plast Reconstr Surg. 2000; 106 (discussion 1397-1398): 1390-1396
        • Khouri Jr., RK
        • Khouri RE
        • Lujan-Hernandez JR
        • Khouri KR
        • Lancerotto L
        • Orgill DP
        Diffusion and perfusion: the keys to fat grafting.
        Plast Reconstr Surg Glob Open. 2014; 2: e220
        • Suga H
        • Eto H
        • Aoi N
        • et al.
        Adipose tissue remodeling under ischemia: death of adipocytes and activation of stem/progenitor cells.
        Plast Reconstr Surg. 2010; 126: 1911-1923
        • Kato H
        • Mineda K
        • Eto H
        • et al.
        Degeneration, regeneration, and cicatrization after fat grafting: dynamic total tissue remodeling during the first 3 months.
        Plast Reconstr Surg. 2014; 133: 303e-313e
        • Baran CN
        • Celebioglu S
        • Sensoz O
        • Ulusoy G
        • Civelek B
        • Ortak T.
        The behavior of fat grafts in recipient areas with enhanced vascularity.
        Plast Reconstr Surg. 2002; 109 (1652): 1646-1651
        • Carpaneda CA
        • Ribeiro MT.
        Percentage of graft viability versus injected volume in adipose autotransplants.
        Aesthetic Plast Surg. 1994; 18: 17-19
        • Wu M
        • Li Y
        • Wang Z
        • et al.
        Botulinum Toxin A Improves Supramuscular Fat Graft Retention by Enhancing Angiogenesis and Adipogenesis.
        Dermatol Surg. 2020; 46: 646-652
        • Lee SK
        • Kim DW
        • Dhong ES
        • Park SH
        • Yoon ES.
        Facial Soft Tissue Augmentation using Autologous Fat Mixed with Stromal Vascular Fraction.
        Arch Plast Surg. 2012; 39: 534-539
        • Yu P
        • Zhai Z
        • Jin X
        • Yang X
        • Qi Z
        Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review.
        Aesthetic Plast Surg. 2018; 42: 511-519
        • Sinno S
        • Wilson S
        • Brownstone N
        • Levine SM.
        Current Thoughts on Fat Grafting: Using the Evidence to Determine Fact or Fiction.
        Plast Reconstr Surg. 2016; 137: 818-824
        • Oranges CM
        • Striebel J
        • Tremp M
        • et al.
        The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence.
        Plast Reconstr Surg. 2019; 143: 1099-1107
        • Cucchiani R
        • Corrales L.
        The Effects of Fat Harvesting and Preparation, Air Exposure, Obesity, and Stem Cell Enrichment on Adipocyte Viability Prior to Graft Transplantation.
        Aesthet Surg J. 2016; 36: 1164-1173
        • Vyas KS
        • Vasconez HC
        • Morrison S
        • et al.
        Fat Graft Enrichment Strategies: A Systematic Review.
        Plast Reconstr Surg. 2020; 145: 827-841
        • Martinez-Zapata MJ
        • Marti-Carvajal AJ
        • Sola I
        • et al.
        Autologous platelet-rich plasma for treating chronic wounds.
        Cochrane Database Syst Rev. 2016; CD006899
        • Foster TE
        • Puskas BL
        • Mandelbaum BR
        • Gerhardt MB
        • Rodeo SA.
        Platelet-rich plasma: from basic science to clinical applications.
        Am J Sports Med. 2009; 37: 2259-2272
        • Frautschi RS
        • Hashem AM
        • Halasa B
        • Cakmakoglu C
        • Zins JE.
        Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review.
        Aesthet Surg J. 2017; 37: 353-362
        • Xiong BJ
        • Tan QW
        • Chen YJ
        • et al.
        The Effects of Platelet-Rich Plasma and Adipose-Derived Stem Cells on Neovascularization and Fat Graft Survival.
        Aesthetic Plast Surg. 2018; 42: 1-8
        • Liu B
        • Tan XY
        • Liu YP
        • et al.
        The adjuvant use of stromal vascular fraction and platelet-rich fibrin for autologous adipose tissue transplantation.
        Tissue Eng Part C Methods. 2013; 19: 1-14
        • Hu Y
        • Jiang Y
        • Wang M
        • Tian W
        • Wang H.
        Concentrated Growth Factor Enhanced Fat Graft Survival: A Comparative Study.
        Dermatol Surg. 2018; 44: 976-984
        • Liao HT
        • Marra KG
        • Rubin JP.
        Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review.
        Tissue Eng Part B Rev. 2014; 20: 267-276
        • Fontdevila J
        • Guisantes E
        • Martinez E
        • Prades E
        • Berenguer J.
        Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: no effect of PDGF.
        Plast Reconstr Surg. 2014; 134: 219e-230e
        • Cervelli V
        • Palla L
        • Pascali M
        • De Angelis B
        • Curcio BC
        • Gentile P.
        Autologous platelet-rich plasma mixed with purified fat graft in aesthetic plastic surgery.
        Aesthetic Plast Surg. 2009; 33: 716-721
        • Panic N
        • Leoncini E
        • de Belvis G
        • Ricciardi W
        • Boccia S.
        Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses.
        PLoS One. 2013; 8: e83138
        • Cochrane
        Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019).
        2019
        • Higgins JP
        • Thompson SG
        • Deeks JJ
        • Altman DG.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Cervelli V
        • Gentile P
        • Scioli MG
        • et al.
        Application of platelet-rich plasma in plastic surgery: clinical and in vitro evaluation.
        Tissue Eng Part C Methods. 2009; 15: 625-634
        • Gentile P
        • Orlandi A
        • Scioli MG
        • et al.
        A comparative translational study: the combined use of enhanced stromal vascular fraction and platelet-rich plasma improves fat grafting maintenance in breast reconstruction.
        Stem Cells Transl Med. 2012; 1: 341-351
        • Gentile P
        • Di Pasquali C
        • Bocchini I
        • et al.
        Breast reconstruction with autologous fat graft mixed with platelet-rich plasma.
        Surg Innov. 2013; 20: 370-376
        • Gentile P
        • De Angelis B
        • Pasin M
        • et al.
        Adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical evaluation for cell-based therapies in patients with scars on the face.
        J Craniofac Surg. 2014; 25: 267-272
        • Sasaki GH.
        The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging.
        Aesthetic Plast Surg. 2015; 39: 833-846
        • Sasaki GH.
        A Preliminary Clinical Trial Comparing Split Treatments to the Face and Hand With Autologous Fat Grafting and Platelet-Rich Plasma (PRP): A 3D, IRB-Approved Study.
        Aesthet Surg J. 2019; 39: 675-686
        • Cervelli V
        • Bocchini I
        • Di Pasquali C
        • et al.
        P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP.
        Biomed Res Int. 2013; 2013434191
        • Sadati KS
        • Corrado AC
        • Alexander RW.
        Platelet-Rich Plasma (PRP) Utilized to Promote Greater Graft Volume Retention in Autologous Fat Grafting. 2006; 23: 203-211
        • Salgarello M
        • Visconti G
        • Rusciani A.
        Breast fat grafting with platelet-rich plasma: a comparative clinical study and current state of the art.
        Plast Reconstr Surg. 2011; 127: 2176-2185
        • Willemsen JC
        • van der Lei B
        • Vermeulen KM
        • Stevens HP.
        The effects of platelet-rich plasma on recovery time and aesthetic outcome in facial rejuvenation: preliminary retrospective observations.
        Aesthetic Plast Surg. 2014; 38: 1057-1063
        • Willemsen JCN
        • Van Dongen J
        • Spiekman M
        • et al.
        The Addition of Platelet-Rich Plasma to Facial Lipofilling: A Double-Blind, Placebo-Controlled, Randomized Trial.
        Plast Reconstr Surg. 2018; 141: 331-343
        • Cervelli V
        • Scioli MG
        • Gentile P
        • et al.
        Platelet-rich plasma greatly potentiates insulin-induced adipogenic differentiation of human adipose-derived stem cells through a serine/threonine kinase Akt-dependent mechanism and promotes clinical fat graft maintenance.
        Stem Cells Transl Med. 2012; 1: 206-220
        • Jin R
        • Zhang L
        • Zhang YG.
        Does platelet-rich plasma enhance the survival of grafted fat? An update review.
        Int J Clin Exp Med. 2013; 6: 252-258
        • Keyhan SO
        • Hemmat S
        • Badri AA
        • Abdeshahzadeh A
        • Khiabani K.
        Use of platelet-rich fibrin and platelet-rich plasma in combination with fat graft: which is more effective during facial lipostructure?.
        J Oral Maxillofac Surg. 2013; 71: 610-621
        • De Pascale MR
        • Sommese L
        • Casamassimi A
        • Napoli C.
        Platelet derivatives in regenerative medicine: an update.
        Transfus Med Rev. 2015; 29: 52-61
        • Sommeling CE
        • Heyneman A
        • Hoeksema H
        • Verbelen J
        • Stillaert FB
        • Monstrey S.
        The use of platelet-rich plasma in plastic surgery: a systematic review.
        J Plast Reconstr Aesthet Surg. 2013; 66: 301-311
        • Modarressi A.
        Platlet Rich Plasma (PRP) Improves Fat Grafting Outcomes.
        World J Plast Surg. 2013; 2: 6-13
        • El-Sharkawy H
        • Kantarci A
        • Deady J
        • et al.
        Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties.
        J Periodontol. 2007; 78: 661-669
        • Bendinelli P
        • Matteucci E
        • Dogliotti G
        • et al.
        Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-kappaB inhibition via HGF.
        J Cell Physiol. 2010; 225: 757-766
        • Luck J
        • Smith OJ
        • Mosahebi A.
        A Systematic Review of Autologous Platelet-Rich Plasma and Fat Graft Preparation Methods.
        Plast Reconstr Surg Glob Open. 2017; 5: e1596
        • Pu LL.
        Towards more rationalized approach to autologous fat grafting.
        J Plast Reconstr Aesthet Surg. 2012; 65: 413-419
        • Leitner GC
        • Gruber R
        • Neumuller J
        • et al.
        Platelet content and growth factor release in platelet-rich plasma: a comparison of four different systems.
        Vox Sang. 2006; 91: 135-139
        • Abellan Lopez M
        • Bertrand B
        • Kober F
        • et al.
        The Use of Higher Proportions of Platelet-Rich Plasma to Enrich Microfat Has Negative Effects: A Preclinical Study.
        Plast Reconstr Surg. 2020; 145: 130-140
        • Liu R
        • Long Y
        • Liu L
        • Zhao X.
        Effect of Platelet-Rich Fibrin on Fat Grafting in Animal Models: A Meta-Analysis.
        Aesthetic Plast Surg. 2020; 44: 570-578
        • Haug V
        • Panayi AC
        • Kadakia N
        • et al.
        Use of venous couplers in microsurgical lower extremity reconstruction: A systematic review and meta-analysis.
        Microsurgery. 2020;
        • Panayi AC
        • Orkaby AR
        • Sakthivel D
        • et al.
        Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.
        Am J Surg. 2019; 218: 393-400