Joris van Dongen

262 Chapter 11 Skin color A more homogeneous skin color was noticed after lipografting in two studies (n=97). 23,24 Trivisonno et al. reported declined concentrations of hemoglobin and melanin measured with a validated skin surface profilometry analyzer (Antera 3D multispectral analyzer, Miravex Limited, Dublin, Ireland), ninety days postoperative (p<0.05). 24,101 A dermatologist also reported decreased pigmentation and redness of the skin with the use of a non-validated 3-grade scale. 24 The skin redness score decreased from 2.29 ± 0.64 to 1.14 ± 0.36 and the skin melanin pigmentation score decreased from 2.33 ± 0.58 to 1.24 ± 0.44 (p<0.05). Song et al. reported that 80% and 72.2% of the included subjects scored ‘high’ on improvement in skin pigmentation measured by visual evaluation of photographs for respectively two different injection techniques: 1) lipografting with an electric injection device and 2) conventional hand push injection (p>0.05). 23 However, no statistical analysis was used to analyze this improvement. Amirkhani et al. assessed the effect of cSVF on the skin color (n=16). No difference in pigmentation and melanin production was measured with a validated Mexameter six months postoperative (p>0.05) (Table 6). 18,101 Skin elasticity Increased skin elasticity was reported in two studies, while another study failed to show increased skin elasticity after cSVF and Nanofat injections as well as lipografting, respectively (n=144). 18,25,96 In a non-controlled study,Amirkhani et al. showed increased skin elasticity after injection of cSVF measured with a validated cutometer (C&K Electronic, Cologne, Germany), six months postoperative compared to preoperative P<0.001). 18 Liang et al. reported increased skin elasticity using the non-validated SOFT5.5 in a controlled study following PRF enriched Nanofat one, twelve and twenty- fourmonths postoperative.Although, no comparisons between the intervention and the control group have been made. 96 In a double-blinded, randomized placebo-controlled trial,Willemsen et al. demonstrated no increase in skin elasticity after lipografting with or without the addition of PRP measured with a validated cutometer, twelve months postoperative (p>0.05). 25 Yet, reversal of the correlation between true skin elasticity and age (from negative to positive) might suggest a small effect of lipografting. The reversal of this correlation was stronger when using lipografting with PRP in comparison with lipografting alone. However, these results were not significant, most likely due to the small sample size caused by too many dropouts (p=0.055) (Table 6). Histological outcome Three studies showed histological and/or histomorphometric improvement of skin biopsies after treatment with lipografting, PRP-enriched lipografting, cSVF-