Joris van Dongen

348 Chapter 15 nor patient satisfaction between both groups. Although, a regression analysis of the ‘true skin elasticity’ parameter as a function of age reversed from negative to positive, especially after treatment with lipofilling in combination with PRP. Yet, this reversal was not significant and only notable on one of the two measurement locations in the face. The addition of PRP to lipofilling resulted in a significant faster return to work in comparison with autologous lipofilling alone. In conclusion, lipofilling with or without PRP does not contribute to skin rejuvenation. To further increase the regenerative capacity of lipofilling with PRP, tSVF was used as additive in order to improve skin alterations due to ageing. A comparable prospective clinical trial, as mentioned in chapter9, was subsequently performed in chapter10 . In this study, 28 female subjects were treated with either lipofilling with PRP in combination with tSVF or lipofilling with PRP in combination with placebo control. Skin improvement was measured using the cutometer to measure elasticity, tewameter to measure transepidermal water loss, VISIA camera to analyze superficial spots, wrinkles, skin texture, pores, vascularity and pigmentation as well as the FACE-Q questionnaires to evaluate the opinion of participating subjects. No significant improvement of skin rejuvenation nor improvement in patient satisfaction was seen after lipofilling and PRP with or without tSVF. Results in chapter 10 confirmed our findings of the previous published trial in chapter 9 and showed that the addition of tSVF does not improve skin alterations caused by ageing related factors. In contrast to the results published in chapter 9 and 10 , many studies in literature suggest that lipofilling or any regenerative component of adipose tissue e.g. SVForASCs contribute to facial skin rejuvenation. The aim of chapter 11 was to systematically search in literature to all available studies regarding facial skin rejuvenation by lipofilling, SVF orASCs. Medline, EMBASE (OvidSP) and the Cochrane central register of controlled trials databases were searched until May 2018. Studies evaluating the effect of lipofilling on facial skin quality were included. Skin quality improvement was defined as improvement of skin elasticity, texture and colororhistological improvement. In total, nine studies treating 301 patients were included. Most of the studies reported improvement of skin elasticity or texture or a more homogenous color of the skin after facial lipofilling, however the majority of studies lacked a well-designed study protocol with validated outcome measurements. One study with a proper study design showed no improvement of skin elasticity after facial lipofilling. All histological studies failed to correlate histological changes to clinical improvement and thus it remains unknown whether histological changes result in clinically relevant improvements. Hence, facial lipofilling, SVF or ASC injection does not significantly improve skin quality.