Table 1.
Baseline characteristics of the included studies
| Study (year) | Journal, Country | Study design | Age | Sex (male:female) | Total sample (intervention: control) | Anatomical location | Interventions compared | Method of stem cell enrichment | Volume retention assessment |
|---|---|---|---|---|---|---|---|---|---|
| Yoshimura et al. (2008) | Dermatologic surgery, Japan | Case control study | 37.5 years (mean) | 2:4 | 6 (3:3) | Face | CAL versus conventional lipoinjection (non-CAL) | The liposuction aspirate was digested with 0.075% collagenase for 30 minutes at 37 °C, which separated mature adipocytes and connective tissue from the stromal vascular fraction (SVF) containing ASCs. The SVF was then centrifuged and rinsed to isolate the cells, which took about 90 minutes. | High resolution digital camera (Model D30, Canon) |
| Sterodimas et al. (2011) | Aesthetic surgery journal, Brazil | RCT | 45.15 years (mean) | 5:15 | 20 (10:10) | Face | ADSC enriched lipografts versus autologous fat transplant | The SVF was isolated from the aspirated fat through a process involving collagenase digestion, centrifugation, and separation. The SVF and purified fat were mixed and transferred to syringes for injection | NR |
| Gentile et al. (2012) | Stem Cells translational medicine, Italy | Cohort Study | 19–60 years (range) | 0:20 | 20 (10:10) | Abdominal to breast | SVF enhanced autologous fat graft versus centrifuged fat grafting injection | Half of lipoaspirate placed in Celution system, Blood free lipid removed by wash cycle. Celase835 enzymatically digested tissue releasing SVF. Centrifugation -> extraction of SVF Added to 2nd half of lipoaspirate that is washed and filtrated. | MRI |
| Koh et al. (2012) | Annals plastic surgery, South Korea | RCT | 28 years (mean) | 5:5 | 10 (5:5) | Abdominal to face | Microfat grafts and simultaneous human ASC injection versus microfat grafts alone | Human ASCs were extracted from adipose tissue and isolated using standard protocols from the International Society for Cellular Therapy [46]. | 3-dimentional CT scan |
| Li et al. (2012) | Dermatologic surgery, China | Case control study | Intervention: 29.5 years (mean) Control: 29.1 years (mean) | 0:38 | 38 (26:12) | Abdominal or thigh to face | Transplantation with fat mixed with SVF versus fat grafting alone | The suctioned fat was digested with collagenase and then processed to obtain SVF, by separating mature adipocytes, resuspending in erythrocyte lysis buffer, washing to remove collagenase, and collecting the harvested pellet. | CT |
| Chang et al. (2013) | Dermatologic surgery, China | Case control study | 27.5 years (mean) | 8:12 | 20 (10:10) | Abdominal to face | SVF supplemented fat grafting versus fat grafting alone | The SVF was isolated from the fatty tissue using a modification of a method described by Zuk and colleagues. The fluid was filtered, washed and centrifuged to obtain the SVF, which was then mixed with the harvested adipose tissue and injected into subcutaneous tissue in a sterile operating room. | CT |
| Kølle et al. (2013) | Lancet, Denmark | RCT | 28.4 years (mean) | NR | 20 (10:10) | Abdominal to arm | ASC-enriched fat graft versus non-enriched fat graft | ASCs were isolated and expanded in a certified laboratory using GMP-grade reagents. They were then cultured for 2 weeks with a mixture of Dulbecco’s modified Eagle’s medium, antibiotics, heparin, and human platelet lysate, with regular media changes and checks for contamination. | MRI |
| Peltoniemi et al. (2013) | Journal of plastic, reconstructive & aesthetic surgery (jpras), Finland | Case control study | Intervention: 51 years (mean); 29–58 years (range) control: 39 years (mean); 33–63 years (range) | 0:18 | 18 (10:8) | Breast | WAL enriched with stromal stem cells versus WAL alone | The first part of the harvested fat using the WAL technique is processed in the Celution System. The ASCs are isolated and separated from other cells through enzymatic digestion and multiple cycles of automatic centrifugation and washing. The final ASC-rich stroma is mixed with the ordinary fat graft and immediately injected | MRI |
| Tanikawa et al. (2013) | Plastic and reconstructive surgery journal, Brazil | RCT | Intervention: 18.7 ± 7.6 years (mean ± SD) control: 12.1 ± 2.2 years (mean ± SD) | 5:9 | 14 (7:7) | Lower abdominal to face | Fat grafting with supplementation of ADSC stromal cells versus fat grafting without supplementation of ADSC | The liposuction aspirates were digested with 0.15% collagenase type IA to separate mature adipocytes and connective tissue from the SVF which contains the adipose-derived stromal cells. The SVF was resuspended in water and added to the aspirated fat, then transferred into syringes for injection after mixing and waiting for cell adherence. | CT |
| Bashir et al. (2019) | Stem Cells international, Pakistan | Quasi-experimental Study | Intervention: 30 ± 11 years (mean ± SD) control: 21 ± 5 years (mean ± SD) | 11:26 | 37 (16:21) | Abdominal or lateral thigh to face | Stem cells mixed with fat graft versus fat graft only | Fat harvest for isolation and expansion of ASCs -> expansion of ASCs -> fat harvest, preparation, and enrichment with ASCs (2–4 weeks) -> pre-enriched fat transplant | Ultrasonography |
| Gentile et al. (2015) | Plastic and reconstructive surgery — global open (prs global open), Italy | Case control study | 19–60 (range) | 0:50 | 50 (40:10) | Breast | SVF enhanced fat grafts versus centrifuged fat alone | Half of lipoaspirate placed in Celution system, Blood free lipid removed by wash cycle. Celase835 enzymatically digested tissue releasing SVF. Centrifugation using Coleman procedure -> extraction of SVF added to 2nd half of lipoaspirate that is also washed and filtrated. | MRI |
| Sasaki (2015) | Aesthetic plastic surgery, USA | Case control study | Intervention: 63.3 years (mean) control: 60.5 years (mean) | 4:126 | 130 (38:92) | Abdominal or hip rolls to face | SVF- assisted fat grafting versus combination of PRP/SVF- assisted fat grafting versus conventional fat grafting | A portion of processed adipose tissue is loaded into the Celution System for automated SVF isolation. The SVF is extracted through a process of collagenase digestion, washing, and centrifugation, resulting in a SVF-filled syringe that is mixed with processed fat within 2–4 hours. | 3D Vectra imaging |
| Tissiani et al. (2016) | Stem cells international, Brazil | Case control study | 49.68 years (mean) | 0:17 | 17 (9:8) | Breast | Fat grafts with SVF enrichment versus Fat grafts without SVF enrichment | The SG group collected 600cc of fat which was centrifuged in 50cc conic tubes. The fat was then digested with collagenase and mixed with the SVF for 15 minutes for cell adherence to occur. | MRI |
| Calabrese et al. (2018) | European review for medical and pharmacological sciences, Italy | Cohort study | Intervention: 48.8 years (mean) control: 50.3 years (mean) | 0:105 | 105 (41:64) | Breast | SVF enriched adipose tissue grafting versus AFG | Aspirated adipose tissue divided into 2 parts. 1st part added to Celution system, ADRCs released from bound matrix and concentrated. 2nd part was purified by gravity sedimentation. 1st part added to 2nd part creating ADRC enriched fat graft. | NR |
| Gentile et al. (2019) | Journal of clinical medicine, Italy | Case control study | 56.24 ± 11.44 years (mean ± SD); 25–85 years (range) | 171:0 | 171 (121:50) | Breast | EF-e-A versus engineered fat graft that was not enhanced with ASCs | Half of lipoaspirate placed in Celution system, Blood free lipid removed by wash cycle. Celase835 enzymatically digested tissue releasing SVF. Centrifugation using Coleman procedure -> extraction of SVF added to 2nd half of lipoaspirate that is also washed and filtrated. | MRI |
| Malik et al. (2019) | Indian journal of orthopaedics, India | RCT | 32.10 years (mean); 22–45 years (range) | NR | 10 (5:5) | Amputation stump | AFG enriched with SVF versus autologous fat graft alone | The lipoaspirate was processed to isolate the SVF and purified fat. The SVF was treated with 0.075% collagenase, separated through centrifugation, and analyzed for viability. The purified fat was separated from the rest of the lipoaspirate solution and both the SVF and fat were combined for injection | MRI |
NR: not reported; SVF: stromal vascular fraction; ASC: adipose-derived stem cells; CAL: cell-assisted lipotransfer; EF-e-A: engineered fat graft enhanced with adipose-derived stromal vascular fraction cells; WAL: water-assisted lipotransfer; PRP: platelet‐rich plasm ADRC: Adipose derived regenerative cells; CT: Computed tomography scan; MRI: Magnetic resonance imaging. 3D: 3 dimentional