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Page 6 of 9 Kawakibi et al. Plast Aesthet Res 2023;10:48 https://dx.doi.org/10.20517/2347-9264.2022.120

site vascularity and subsequently improves fat graft survival with future rounds. Furthermore, the ideal
number of AFT rounds in scleroderma patients remains unclear and varies among studies. The first round
of AFT favorably impacts the skin, which allows for larger volume AFT in subsequent rounds, increased
[7]
graft retention, and more favorable long-term outcomes . Overcorrection at the initial AFT surgery can
compensate for expected partial resorption and reduce the need for repeat procedures . However, as the
[72]
skin in scleroderma patients is not as elastic due to fibrosis, it is essential to stop fat grafting when the skin
begins to blanch to prevent skin necrosis. Although repeat procedures might be indicated due to partial
graft resorption, long-term satisfactory outcomes are often achieved [7,73,74] .

CONCLUSION
AFT can be utilized for its regenerative and volume-enhancing properties for the treatment of scleroderma.
The growing body of data supports the use of AFT to reverse fibrosis, mitigate inflammation, and promote
angiogenesis, which are essential mechanisms that drive the progression of scleroderma. Our experience at
the University of Michigan, utilizing the Coleman method for harvesting and processing fat, demonstrates
that AFT improves various scleroderma manifestations of the hand and face, including perioral skin quality,
[7]
facial animation, hand range of motion, and hand pain . These findings, which are consistent with other
published studies, open the door to AFT as a new potential intervention in treating the cutaneous
manifestations of scleroderma with significant implications for improving the quality of life of patients.
Large cohort studies are essential to further characterize the clinical outcomes observed in scleroderma
patients treated with AFT and will shed light on the optimal timing for AFT, the volume needed in different
locations, and the AFT practices that will maximize fat graft retention rates. In conclusion, AFT provides an
advantage over current treatment options available for scleroderma patients and it merits further
investigation clinically for the treatment of the hand and face manifestations of the disease.

DECLARATIONS
Authors’ contributions
Wrote the manuscript, and the manuscript was reviewed and edited: Kawakibi AR, Khouri AN, Cederna PS,
Strong AL

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declare no conflict of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.