Joris van Dongen

242 Chapter 10 a higher ratio than 1:1 for respectively cSVF and lipofilling did not increase the survival rate in animal models. 45,46 Ahigher survival rate of transplanted SVF enriched fat grafts might also result in a greater regenerative effect on the overlaying skin. Compared to our study, these animal models used a significant higher ratio of cSVF/lipofilling and therefore patients might undertreat in this study. However, all other studies only used animal models and did not investigate the effect of SVF enriched lipofilling on skin quality. Moreover, all other studies used enzymatic isolated SVF instead of mechanical isolated SVF. Hence, those results are difficult to compare to clinical outcomes of this study. A limitation of this study is the use of the VISIA analysis to evaluate skin quality because this device is not validated; for that reason, the VISIA analysis was only used as secondary outcome, while the validated cutometer was used as primary outcome. There is also a lack of power in this study due to a low sample size with only fourteen subjects in each group and five subjects not completing the entire study. Besides, this study was terminated prematurely because the required pace of inclusion was not met endanger completion of the study. Designing a well-designed prospective randomized controlled trial with a strong power and completing it is challenging in regenerative aesthetic surgery, but definitely necessary to further develop the field. In conclusion, lipofilling and PRP with tSVF did not improve skin elasticity, recovery nor subject satisfaction in a healthy population in this study. PRP supplemented lipofilling with tSVF can be considered a safe procedure. However, some controversy remains regarding tSVF/lipofilling ratios, concentration of PRP and optimal isolation method procedure to isolate cSVF or tSVF requiring further elaboration in the future.