Effect of Washes and Centrifugation on the Efficacy of Lipofilling With or Without Local Anesthetic.

Autologous fat grafting (AFG) is now a widely used technique for soft-tissue filling, providing a natural outcome and gaining increasing popularity. Unfortunately, this kind of procedure is still not perfect in terms of engraftment efficiency, and no standardized protocol yet exists that enables an efficient prediction of clinical outcome. Techniques differ between surgeons who are still striving for the best clinical outcome and patient satisfaction. Despite ongoing research and a real will to refine the technique, the major disadvantage of lipofilling persists, namely fat graft resorption, leading to variable and unpredictable results.1,2 Numerous parameters of the lipofilling procedure have been described by many teams as being critical to graft survival.3–6 Some intervene before the procedure, such as infiltration with the influence, in particular, of local anesthetics,7–9 others during the harvesting phase, such as aspiration pressure10–13 or the size of the cannula,14,15 and others after liposuction, such as the washing or centrifugation of adipose tissue.10,16–20 Of all the parameters identified, our team has recently shown that two of them could have a major impact on cell survival. Indeed, we initially demonstrated in vitro that conventional clinical concentrations of lidocaine were toxic to adipose-derived stem cells,21 but we also showed in vivo that the speed and duration of centrifugation carried out to wash and compact the tissue could strongly influence graft survival and the amount of oil present therein.22 However, no study has so far shown, in vivo, the influence of repeated washings and centrifugations on graft survival, with or without lidocaine. It is this work that has been conducted to compare the different adipose tissue preparation techniques following liposuction. The effects of a simple decantation, single or multiple washes followed by centrifugation, in the presence or absence of lidocaine during harvesting, were analyzed to investigate graft survival in vivo in immunodeficient mice. The effectiveness of the graft was evaluated through a detailed analysis via scoring of several parameters including the size of the grafts, the amount of oil, and the presence of fibrosis. Finally, according to the results of our study, we propose 2 protocols that use lidocaine or not to obtain the best results during lipofilling.