Overview of Use of Nanofat (fully emulsified tSVF + HD Platelet-Rich Plasma (PRP) in Aesthetic and Regenerative Medicine Cases
Main Article Content
Abstract
Paper presents a brief review of cellular and biocellular uses of both cellular Stromal Vascular Faction (cSVF) elements and evolving applications of tissue Stromal Vascular Fraction (tSVF) components combined with important blood derivatives in repair and regeneration. Use of autologous stem/stromal components in human homeostasis and healing has shaped an evolving paradigm shift in many disciplines of Medicine & Surgery. Mass production or patentability of a patient’s own cell and stromal elements is a very unlikely possibility, making the use of these protections by large pharmaceutical companies unavailable. This is a factor in the financial support for research funding from these entities.
The heterogeneous nature & mixture of autologous cells in the stem/stromal elements offer unique uses and efficacies, which are complimented in the actual multipotent cells and their supportive cells proving to be critically important in optimizing their functions in aging, healing and regeneration processes. Appreciation that the paracrine secretive factors play such an integral role in the regenerative milieu, have led to examination of stem/stromal cell signaling via exosomal & microvesicles paracrine communications.
Discussion of terms, who are providing these services, and the realm of applications evolving is discussed. Appreciation of the contribution of “blood–derived biologicals” (in this context, meaning platelet-rich plasma concentrates or bone marrow derivatives) to enhance the repair and regenerative uses of stem/stromal elements in our own bodies. Use of Nanofat and the blood derivatives are proving to be a most safe and efficacious minimally invasive means of dealing with grafting or orthobiologic therapies.
Keywords:
tSVF, cSVF, Adipose Derived Stem/Stromal Cells, Mesenchymal Stem Cells (MSC), Extracellular Matrix (ECM), Paracrine Signaling, Intercellular Communication, Exosomes/Microvesicles, Biocellular Therapies, Orthobiologic Therapy, PRP, HD PRP, Ultrasound, Chronic Wounds
Article Details
How to Cite
ALXANEDER, Robert W..
Overview of Use of Nanofat (fully emulsified tSVF + HD Platelet-Rich Plasma (PRP) in Aesthetic and Regenerative Medicine Cases.
Medical Research Archives, [S.l.], v. 13, n. 2, mar. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6260>. Date accessed: 14 mar. 2025.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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10. Alexander RW (2016) Understanding Mechanical Emulsification (Nanofat) Versus Enzymatic Isolation of Tissue Stromal Vascular Fraction (tSVF) Cells from Adipose Tissue: Potential Uses in Biocellular Regenerative Medicine. Journal of Prolotherapy 8: 947-960.
11. Alderman, D, Alexander, RW, Harris, G. et al. (2011) Stem cell prolotherapy in regenerative medicine: Background, theory, and protocols. J Prolo 3(3):689-708.
12. Gnecchi, M.; Zhang, Z.; Ni, A.; Dzau, V.J. Paracrine mechanisms in adult stem cell signaling and therapy. Circ. Res. 2008, 103, 1204–1219.
13. Caplan, A. (2007) Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Phys, 213(2): 341-347
14. Gentile, P., Gharles-de-Sa, L et al. (2020) Systematic Review: Adipose-derived mesenchymal stem cells, platelet-rich plasma and biomaterials as new regenerative strategies in chronic skin wounds and soft tissue defects. Internatl J. Molecular Sciences, 21(4): 1236.
15. Everts, P, Podesta, L, Alexander, RW (2024) A comprehensive guide of cellular blood derived and mesenchymal stem cell-based autologous biological preparations for tissue repair, regeneration, and wound healing. Internatl J. Molecular Sci. . 2(20): 7794.
16. Xu" P.. Yu, Q. Juang, H. et al. (2019) Nanotat increases angiogenesis and fat graft survival via VEGF/TGF'-beta and HGF signaling. Intematl J Molecular Sciences. 20(21) 5390.
17. Maltllli. N. 0lira. F. I"rizziero. A. et al. (2020) Guidelines for the use of platelet-rich plasma in the management of musculoskeletal pathologies. Muscles, Ligament and Tendon J. l0(3): 432.
18. Pas. H. Winters. M. Haisma. H. et al. (2017) Stem cell injections in knee osteoarthritis: A svstematic review of the literature. Brit J Sports Med. 5l(15): 1125- 1133.
19. Caplan, A. l. (2007). Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. Joumal of Cellular Physiology. 213(2). 341-347.
20. Nakagami, H.; Maeda, K.; Morishita, R.; lguchi, S.; Nishikawa, T.; Takami, Y; Kikuchi, Y; Saito, Y.; Tamai, K.; Ogihara, T.; et al. (2005) Novel autologous cell therapy in ischemic limb disease through growth factor secretion by cultured adipose tissue-derived stromal cells. Arter. Thromb. Vasc. Biol. 25: 2542-2547.
21. Shantsila, E.; Watson, T.; Lip, G. (2007) Endothelial progenitor cells in cardiovascular disorders. J. Am. Coll. Cardiol. 49: 741-752.
22. Alexander, RW. (2019) Overview of cellular stromal vascular fraction (cSVF) and biocellular uses of stem/stromal cells and matrix (tSVF + HD-PRP) in regenerative medicine, aesthetic medicine, and plastic surgery. J Stem Cell Res Dev. DOI 10/24966/SRDT-2060/S1003.
23. Dicker, A.; Le Blanc, K.; Astrdm, G. et al. (2005) Functional studies of mesenchymal stem cells derived from adult human adipose tissue. Exp. Cell Res. 308: 283-290.
24. Gimble, J.; Katz, A.; Bunnell, B. (2016) Adipose-derived stem cells for regenerative medicine Circ. Res. 100: 1249-1260.
25. Tonnard, P, Vaepaele, A., Peeters, G., et al. (2013) Nanofat grafting: basic research and clinical implications. Plas Recon Surg. 132(4):1017-1026, Doi: 10.1097/PRS.0b013e31829fe1b0.
26. Sadati, K., Corrado, A., Alexander, RW. (2006) Platelet-Rich plasma (PRP) utilized to promote greater graft volume retention in autologous fat grafting. Amer J Cosm Surg. 23(4): 203-211.
27. Kim, W; Park, B.; Park, S. et al. (2009) Antiwrinkle effect of adipose-derived stem cell: Activation of dermal fibroblast by secretory factors. J. Dermatol. Sci. 53: 96-102.
28. Everts. P. A.. Onishi. K., Jayaram. P., (2019). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Internat J. of Molecular Sciences. 2(20): 7794.
29. Newman, R.E.; Yoo, D.; LeRoux, M.A, et al. (2009) Treatment of inflammatory diseases with mesenchymal stem cells. lnflamm. Allergy Drug Targets. 8, 110-123.
30. Zhou, T.; Yuan, Z; Weng, J. et al. (2021) Challenges and advances in clinical applications of mesenchymal stromal cells. J. Hematol. Oncol. 14:
31. Gentile, P. (2020) Systematic Review: Adipose-derived mesenchymal stem cells, platelet-rich plasma and biomaterials as new regenerative strategies in chronic skin wounds and soft tissue defects. Internatl J. Molecular Sciences, 21(4): 1236.
32. Rigotti. G.. Charles-de-Sri. L.. Gontijo-de-Amorim. N. et al. (2016). Expanded Stem Cells. Stromal-Vascular Fraction. And Platelet-Rich Plasma Enriched Fat: Comparing Results of Different Facial Rejuvenation Approaches in a Clinical Trial. Aesthetic Surg J., 36(3): 261-270
33. Tate-Oliver, K, Alexander, RW. (2013) Combination of autologous adipose-derived tissue stromal vascular fraction plus high density platelet-rich plasma or bone marrow concentrates in Achilles Tendon Tears. J Prolo, 5:895-912.
34. Fitzpatrick, J., Bulsara, M., Zheng, M. et al. (2017) The effectiveness of platelet-rich plasma in the treatment of tendinopathy: A meta-analysis of randomized controlled clinical trials. Am J. Sports Med. 45(1): 226-233 Doi: 10.1177/0363546516643716.
35. Andia, I, Maffulli, N. (2013) Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 9(12): 721-730 Doi: 10.1038/nrrheum.2013.141.
36. Alderman, D. (2024) Micronized Fat/PRP Knee Health. Presented at “Catch The Wave Of Regenerative Therapies” at the 5th Annual Global Conference, SDARTS , August 2024, San Diego, CA.
37. Suh, Y., Ahn, B., Kim. M., et al. (2019) Nanofat and platelet-rich plasma for the treatment of atrophic scars: A comparative study. J. Cosm Derm. l8(4): 1053-1059. Doi: l0.1111/jocd.12785.
38. Everts, P, Podesta, L, Alexander, RW (2024) A comprehensive guide of cellular blood derived and mesenchymal stem cell-based autologous biological preparations for tissue repair, regeneration, and wound healing. Internatl J. Molecular Sci. . 2(20): 7794.
39. Fadadu, P., Mazzola, A., Hunter, C., et al. (2019) Review of concentration yields in commercially available platelet-rich-plasma (PRP) systems: A call for PRP Standardization. Reg. Anesth. Pain Med. 44:652-659.
40. Alexander, RW. (2011) Autologous fat grafts as mesenchymal stromal/stem cell source for use in prototherapy: A simple technique to acquire lipoaspirants. J. Prolo. 3(3):680-688.
41. Alexander, RW (2024) Unpublished data
42. Alexander, RW. (2020) Overview of COVID-19 Lung Damage Clinical Trial Using Cellular Stromal Vascular Fraction (cSVF) and Functional Respiratory Imaging (FRI) Analysis of Pulmonary Injury & Post-Viral (SARSCoV-2) Adult Respiratory Distress Syndrome (ARDS). Stem Cell Res. 1(1)-1-19.
43. Alexander, RW. (2023) Preliminary Report on Residual Lung Damage in Long COVID-19 Using AD-cSVF In Clinical Trial NCT#04326036. J Stem Cell Res.4(2):1-26.
44. Guo, J., Nguyen, A., Banyard, D., et al. (2019) Stromal vascular fraction: A regenerative reality: Part 2: Mechanism of action. J Plas Recon and Aesth Surg. 69(2): 180-188.
45. Kokai, L., Marra, K., Rubin, J. (2020) Adipose stem cells: Biology and clinical applications for tissue repair and regeneration. J. Trans Res. 63(4): 399-408.
46. Xu, H., Zhang, C., Zhang, S. et al. (2023) Stem cell enriched fat grafts versus autologous fat grafts in reconstructive surgery. 76(3): 570-580.
47. Alexander, RW. (2023) Preliminary Report on Residual Lung Damage in Long Covid-19 Using AD-cSVF in Clinical Trial (NCT#04326036). J. Stem Cell Res. 4(2): 1-26.
2. Zuk P (2013) Adipose-Derived Stem Cells in Tissue Regeneration: A Review. Stem Cells Pg: 35.
3. Alexander RW (2012) Understanding adipose-derived stromal vascular fraction (AD-SVF) cell biology and use on the basis of cellular, chemical, structural and paracrine components: a concise review. Journal of Prolotherapy 4: 855-869.
4. Everts, P., Podesta, L., Alexander, RW (2024), Comprehensive Guide Of Cellular Blood Derived & MSC cell based Autologous Prep Tissue Repair, Regeneration, and Wound Healing. Intertech Open.1006741, Sept 2024, Doi: 10,5772/intechopen.1006741
5. Alexander, Robert W., (2019) “Overview of Cellular Stromal Vascular Fraction (cSVF) & Biocellular Use of Stem/Stromal Cells & Matrix (tSVF +HD PRP) in Regenerative Medicine, Aesthetic Medicine, and Plastic Surgery”, Journal of Stem Cell Research, Development & Therapy, Doi: 10 24966/SRDT-2060/S1003.
6. Everts, P., Onishi, K., Jayaram, P. et al. (2020) Platelet-rich Plasma: New performance understandings and therapeutic considerations in 2020, Internat J Molecular Sciences, 7794.
7. Etulain, J. (2018), Platelets in wound healing and regenerative medicine. Platelets, 29 (6): 556-568.
8. Hu, M, Borrelli, M, Lorenz, H. et al. (2018) Mesenchymal stromal cells and cutaneous wound healing: A comprehensive review of the background, role, and therapeutic potential. Stem Cell Internatl, 6901983.
9. Everts, P., Podesta, L., Alexander, RW (2024), Comprehensive Guide of Cellular Blood Derived & MSC cell based Autologous Prep Tissue Repair, Regeneration, and Wound Healing. Intertech Open.1006741, Sept 2024, Doi: 10,5772/intechopen.1006741
10. Alexander RW (2016) Understanding Mechanical Emulsification (Nanofat) Versus Enzymatic Isolation of Tissue Stromal Vascular Fraction (tSVF) Cells from Adipose Tissue: Potential Uses in Biocellular Regenerative Medicine. Journal of Prolotherapy 8: 947-960.
11. Alderman, D, Alexander, RW, Harris, G. et al. (2011) Stem cell prolotherapy in regenerative medicine: Background, theory, and protocols. J Prolo 3(3):689-708.
12. Gnecchi, M.; Zhang, Z.; Ni, A.; Dzau, V.J. Paracrine mechanisms in adult stem cell signaling and therapy. Circ. Res. 2008, 103, 1204–1219.
13. Caplan, A. (2007) Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Phys, 213(2): 341-347
14. Gentile, P., Gharles-de-Sa, L et al. (2020) Systematic Review: Adipose-derived mesenchymal stem cells, platelet-rich plasma and biomaterials as new regenerative strategies in chronic skin wounds and soft tissue defects. Internatl J. Molecular Sciences, 21(4): 1236.
15. Everts, P, Podesta, L, Alexander, RW (2024) A comprehensive guide of cellular blood derived and mesenchymal stem cell-based autologous biological preparations for tissue repair, regeneration, and wound healing. Internatl J. Molecular Sci. . 2(20): 7794.
16. Xu" P.. Yu, Q. Juang, H. et al. (2019) Nanotat increases angiogenesis and fat graft survival via VEGF/TGF'-beta and HGF signaling. Intematl J Molecular Sciences. 20(21) 5390.
17. Maltllli. N. 0lira. F. I"rizziero. A. et al. (2020) Guidelines for the use of platelet-rich plasma in the management of musculoskeletal pathologies. Muscles, Ligament and Tendon J. l0(3): 432.
18. Pas. H. Winters. M. Haisma. H. et al. (2017) Stem cell injections in knee osteoarthritis: A svstematic review of the literature. Brit J Sports Med. 5l(15): 1125- 1133.
19. Caplan, A. l. (2007). Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. Joumal of Cellular Physiology. 213(2). 341-347.
20. Nakagami, H.; Maeda, K.; Morishita, R.; lguchi, S.; Nishikawa, T.; Takami, Y; Kikuchi, Y; Saito, Y.; Tamai, K.; Ogihara, T.; et al. (2005) Novel autologous cell therapy in ischemic limb disease through growth factor secretion by cultured adipose tissue-derived stromal cells. Arter. Thromb. Vasc. Biol. 25: 2542-2547.
21. Shantsila, E.; Watson, T.; Lip, G. (2007) Endothelial progenitor cells in cardiovascular disorders. J. Am. Coll. Cardiol. 49: 741-752.
22. Alexander, RW. (2019) Overview of cellular stromal vascular fraction (cSVF) and biocellular uses of stem/stromal cells and matrix (tSVF + HD-PRP) in regenerative medicine, aesthetic medicine, and plastic surgery. J Stem Cell Res Dev. DOI 10/24966/SRDT-2060/S1003.
23. Dicker, A.; Le Blanc, K.; Astrdm, G. et al. (2005) Functional studies of mesenchymal stem cells derived from adult human adipose tissue. Exp. Cell Res. 308: 283-290.
24. Gimble, J.; Katz, A.; Bunnell, B. (2016) Adipose-derived stem cells for regenerative medicine Circ. Res. 100: 1249-1260.
25. Tonnard, P, Vaepaele, A., Peeters, G., et al. (2013) Nanofat grafting: basic research and clinical implications. Plas Recon Surg. 132(4):1017-1026, Doi: 10.1097/PRS.0b013e31829fe1b0.
26. Sadati, K., Corrado, A., Alexander, RW. (2006) Platelet-Rich plasma (PRP) utilized to promote greater graft volume retention in autologous fat grafting. Amer J Cosm Surg. 23(4): 203-211.
27. Kim, W; Park, B.; Park, S. et al. (2009) Antiwrinkle effect of adipose-derived stem cell: Activation of dermal fibroblast by secretory factors. J. Dermatol. Sci. 53: 96-102.
28. Everts. P. A.. Onishi. K., Jayaram. P., (2019). Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Internat J. of Molecular Sciences. 2(20): 7794.
29. Newman, R.E.; Yoo, D.; LeRoux, M.A, et al. (2009) Treatment of inflammatory diseases with mesenchymal stem cells. lnflamm. Allergy Drug Targets. 8, 110-123.
30. Zhou, T.; Yuan, Z; Weng, J. et al. (2021) Challenges and advances in clinical applications of mesenchymal stromal cells. J. Hematol. Oncol. 14:
31. Gentile, P. (2020) Systematic Review: Adipose-derived mesenchymal stem cells, platelet-rich plasma and biomaterials as new regenerative strategies in chronic skin wounds and soft tissue defects. Internatl J. Molecular Sciences, 21(4): 1236.
32. Rigotti. G.. Charles-de-Sri. L.. Gontijo-de-Amorim. N. et al. (2016). Expanded Stem Cells. Stromal-Vascular Fraction. And Platelet-Rich Plasma Enriched Fat: Comparing Results of Different Facial Rejuvenation Approaches in a Clinical Trial. Aesthetic Surg J., 36(3): 261-270
33. Tate-Oliver, K, Alexander, RW. (2013) Combination of autologous adipose-derived tissue stromal vascular fraction plus high density platelet-rich plasma or bone marrow concentrates in Achilles Tendon Tears. J Prolo, 5:895-912.
34. Fitzpatrick, J., Bulsara, M., Zheng, M. et al. (2017) The effectiveness of platelet-rich plasma in the treatment of tendinopathy: A meta-analysis of randomized controlled clinical trials. Am J. Sports Med. 45(1): 226-233 Doi: 10.1177/0363546516643716.
35. Andia, I, Maffulli, N. (2013) Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 9(12): 721-730 Doi: 10.1038/nrrheum.2013.141.
36. Alderman, D. (2024) Micronized Fat/PRP Knee Health. Presented at “Catch The Wave Of Regenerative Therapies” at the 5th Annual Global Conference, SDARTS , August 2024, San Diego, CA.
37. Suh, Y., Ahn, B., Kim. M., et al. (2019) Nanofat and platelet-rich plasma for the treatment of atrophic scars: A comparative study. J. Cosm Derm. l8(4): 1053-1059. Doi: l0.1111/jocd.12785.
38. Everts, P, Podesta, L, Alexander, RW (2024) A comprehensive guide of cellular blood derived and mesenchymal stem cell-based autologous biological preparations for tissue repair, regeneration, and wound healing. Internatl J. Molecular Sci. . 2(20): 7794.
39. Fadadu, P., Mazzola, A., Hunter, C., et al. (2019) Review of concentration yields in commercially available platelet-rich-plasma (PRP) systems: A call for PRP Standardization. Reg. Anesth. Pain Med. 44:652-659.
40. Alexander, RW. (2011) Autologous fat grafts as mesenchymal stromal/stem cell source for use in prototherapy: A simple technique to acquire lipoaspirants. J. Prolo. 3(3):680-688.
41. Alexander, RW (2024) Unpublished data
42. Alexander, RW. (2020) Overview of COVID-19 Lung Damage Clinical Trial Using Cellular Stromal Vascular Fraction (cSVF) and Functional Respiratory Imaging (FRI) Analysis of Pulmonary Injury & Post-Viral (SARSCoV-2) Adult Respiratory Distress Syndrome (ARDS). Stem Cell Res. 1(1)-1-19.
43. Alexander, RW. (2023) Preliminary Report on Residual Lung Damage in Long COVID-19 Using AD-cSVF In Clinical Trial NCT#04326036. J Stem Cell Res.4(2):1-26.
44. Guo, J., Nguyen, A., Banyard, D., et al. (2019) Stromal vascular fraction: A regenerative reality: Part 2: Mechanism of action. J Plas Recon and Aesth Surg. 69(2): 180-188.
45. Kokai, L., Marra, K., Rubin, J. (2020) Adipose stem cells: Biology and clinical applications for tissue repair and regeneration. J. Trans Res. 63(4): 399-408.
46. Xu, H., Zhang, C., Zhang, S. et al. (2023) Stem cell enriched fat grafts versus autologous fat grafts in reconstructive surgery. 76(3): 570-580.
47. Alexander, RW. (2023) Preliminary Report on Residual Lung Damage in Long Covid-19 Using AD-cSVF in Clinical Trial (NCT#04326036). J. Stem Cell Res. 4(2): 1-26.