Joris van Dongen

79 FAT procedure to obtain SVF for regenerative purposes survival are important mechanisms in angiogenesis. 30 Furthermore, the ECM in FAT- SVF influences the migration and morphogenesis of angiogenesis. 31 ECM contains several proteins such as collagen and fibronectin, which are important during the wound healing process. 32 Hence, we surmise that FAT-SVF might also be a suitable cell-based therapy for stimulating wound healing or regeneration of damaged tissue, as we already have experienced in two illustrative cases (rest of series will be published when the prospective clinical trials have been finished). Firstly, a 62-year-old female patient suffered for nine months from prolonged redness and scar formation on her right cheek after a too deep peeling with trichloroacetic acid (TCA) that did not want to subside.Within three weeks after injectionwith 1 ml of FAT-SVF, the deep red coloured scar became brighter and turned into nearly normal skin (Fig. 7). In the second case, a 33-year-old female patient received an injection of FAT-SVF in the lateral 5 cm of the horizontal incision after a mamma reduction. Two weeks postoperative, full dehiscence of the wounds occurred, after cheese wiring of the barbed suture, except for the area treated by FAT-SVT (Fig. 7). 33 Probably, FAT-SVF injection accelerated wound healing, making the premature scar better resistant to mechanical forces in an earlier phase during wound repair compared to the non-treated wound edges. Autologous adipose tissue transplantation to replace lost volume or to improve wound healing and revise dermal scars i.e. fibrotic lesions is routinely performed nowadays. Ideally, anti-scar treatment would resolve the existing scar which would involve the degradation of excessively deposited ECM, the removal of unwanted cells such as myofibroblasts and finally the restoration of the original tissue architecture of the dermis including its subcutaneous adipose tissue. We argue that initially the filler effect of fat grafts is less relevant than its anti-scarring properties, Thus, enrichment of anti-scarring cells or matrix, which are both present in the FAT-SVF, might favor the process. At later stages, the precursor cells of adipocytes that reside within FAT-SVF, will regenerate the subcutaneous adipose tissue. Treatment of fibrosis in organs such as heart, kidney or liver, or in osteoarthritic joints such a knee or temporomandibular, with bulky lipografts is undesirable, due to tissue damage caused by injection of large volumes. Therefore, the reduction of the volume of lipoaspirate, as can be achieved with our FAT procedure, to generate an injectable ECM-based cellularized therapeutic gel, that act as an instructive scaffold for repair, seems to be a promising alternative.