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Page 2 of 10 Ohashi. Plast Aesthet Res 2020;7:26 I http://dx.doi.org/10.20517/2347-9264.2020.15

INTRODUCTION
Fat grafting is used worldwide for volume augmentation. Recently, it has become clear that fat grafting has
[1-6]
a regenerative effect (revitalization/fertilization) which leads to rejuvenation .

However, one of the biggest problems of fat grafting is the unpredictable retention rate for volume
[7]
augmentation. Additionally, skin rejuvenation effects vary . Injections must often be repeated to achieve
the targeted results [7-10] .

Another problem associated with fat grafting is the painful process of harvesting fat, which is also time-
consuming for both patients and doctors. Accordingly, it would be advantageous to both patients and
plastic/aesthetic surgeons if fat could be harvested during one procedure and cryopreserved for later use.

The cryopreservation method has been researched for a long time, and many doctors conclude that the
use of cryopreserved fat is useful and safe when appropriate methods are used [11-13] . However, most of these
studies are experimental, and documented clinical use of such fat is scarce [14,15] .

The aim of this study was to determine the safety and benefits of the clinical use of cryopreserved fat.

METHODS
Patients and methods
Patients: Table 1.

From Aug 2015 to Dec 2018, we harvested fat from 490 patients and sent it to a cell processing center (CPC)
(CellSource Co., Ltd., Tokyo, Japan) for cryopreservation at -196 °C.

Flowchart of harvesting, cryopreserving, and repeat injection
At our clinic, we harvest patients’ fat for same-day use. The residual fat is sent to the CPC. The CPC
(CellSource Co.) cryopreserves the fat using their own cryoprotective agent at -196 °C. The company will
then send back the thawed fat to our clinic for repeat injections [Figure 1].

Anesthesia
Usually, we use a combination of local anesthesia with tumescent technique and intravenous anesthesia.

Harvest in the clinic
When harvesting the patients’ fat, we use a tumescent technique (20 mL of 8.4% sodium hydrogen
carbonate, 1 mL of epinephrine, and 50 mL of 1.0% lidocaine per 1000 mL of saline) with suction pressure
of less than 1 atm.

Choice of donor site
Fat is typically harvested from the thighs, lower abdomen, and flanks (so-called LFD: localized fat deposit) ,
[17]
because these areas bleed the least and are the easiest sites from which to harvest fat.

First injection at the clinic
We usually inject the fat on the same day it is harvested. Fat grafting is used not only for volume
augmentation but also for regenerative effects such as skin rejuvenation. When we use the fat for volume
augmentation, we apply the so-called “Coleman technique”, and for skin rejuvenation, we use the nanofat
[5,6]
or squeezed fat technique .