Joris van Dongen

263 Facial lipografting on skin quality: a systematic review enriched lipografting and cultured ASCs. 20-22 All studies used the same patients for the intervention group as well as the control group. In an observer-blinded, randomized clinical trial, Covarrubias et al. compared lipografting with no treatment and demonstrated an increase in dermis thickness, presence of immature collagen and arteries sixty-nine days postoperative (n=16, p<0.001). 21 No increase or decrease was seen in the presence of mature collagen. In two non-blinded, non-randomized studies conducted by the same research group, three different types of treatments were performed: 1) PRP-enriched lipografting; 2) cSVF-enriched lipografting; and 3) injection of culturedASCs (n=13). 20,22 Three months postoperative skin biopsies were compared with preoperative skin biopsies. The different types of treatment were not compared with each other. After all three types of treatment, the reticular dermis showed a decrease in elastic fiber network with more dissociated elastic fibers, a smoother surface and a smaller diameter. 20,22 Additionally, after cSVF-enriched lipografting and cultured ASCs the reticular dermis showed a decrease in collagen fibers. 20 Additionally, the number of oxytalan elastic fibers in the papillary dermis was increased. 20,22 Moreover, after injection of PRP-enriched lipografting increased inflammatory infiltrates and vasculature was seen (Table 6). Complications Six out of the nine studies reported on the occurrence of no significant complications after lipografting, cSVF or Nanofat treatment (n=196, Table 6). 18,19,23-25,96 Liang et al. reported fourteen small complications: five patients had a transient infection, seven patients suffered from temporarily paresthesia and two patients noticed pigmentation changes which lasted for more than twelve months. 96 DISCUSSION This systematic review demonstrates that substantial evidence is lacking that the use of lipografting or a component of adipose tissue i.e. cSVF or ASCs rejuvenates healthy human facial skin, as was advocated by Coleman. 7 This review also demonstrates that the use of facial lipografting or a substance of adipose tissue can be considered to be a safe procedure. In general, most included studies of this review reported positive results. However, the level of evidence in five out of nine included studies was lowwith an OCEBM evidence level of just 4. 18,20,22-24 Therefore, the reported outcomes of these studies should be interpreted with caution. Low levels of evidence were caused by poor study designs: