Platelet-Rich Fibrin in Fat Grafts for Facial Lipofilling: A Randomized, Controlled Split-Face Clinical Trial

Abstract

Objective: Previous studies have reported that platelet-rich fibrin (PRF) may enhance the efficacy of fat grafts in facial lipofilling. However, these studies either lacked objective data or were not randomized, controlled trials. Thus, we aimed to objectively evaluate the efficacy of PRF in facial lipofilling.

Methods: A controlled, split-face, randomized trial (January 2018 to May 2019) based on 18 patients who underwent fat grafts for bilateral temple lipofilling was performed. Each patient received a combination of an autologous fat graft and PRF on one side and a fat graft combined with an equal volume of saline on the other side. The effects of PRF were evaluated by comparing the remaining bilateral fat graft volumes through a digital three-dimensional reconstruction technique. Improvements in the appearance and recovery time of each temple were assessed by both a surgeon and patients who were blinded to the treatment assignment. Complications were also recorded.

Results: Bilateral temple lipofilling showed no evidence of fat embolism, vascular/nerve injury, infection, massive edema, or prolonged bruising. Three-dimensional reconstruction data and the assessments from both the surgeon and patients revealed no significant differences in fat graft retention volume between the PRF-positive and PRF-negative lipofilling groups. However, recovery time in the PRF-positive lipofilling sites was significantly shortened compared with that of the PRF-negative lipofilling sites.

Conclusion: Facial filling with autologous fat grafts is effective and safe. Our results show that PRF does not markedly improve fat graft volume retention in the temple but significantly reduces postoperative recovery time.

Trial registration number: ChiCTR2100053663.

Keywords: clinical trial; facial lipofilling; fat grafts; plastic surgery; platelet-rich fibrin.

Figure 1

Platelet-rich fibrin preparation. (A) Intravenous blood was collected with a disposable syringe. (B) The blood was centrifuged at 3,000 rpm for 10 min. (C) A platelet-rich fibrin clot was taken out of the syringe. (D) A platelet-rich fibrin clot. (E) The platelet-rich fibrin clot was cut into fragments of 1 × 1 mm. (F) The fragments of the platelet-rich fibrin clot were mixed with the refined fat, and the mixture was subsequently transferred to 1 ml Luer-Lok syringes for injection.

Figure 2

Three-dimensional (3D) reconstruction was used to calculate facial volume changes. (A) A patient's preoperative plain photograph. (B) Postoperative plain photograph 3 months after fat graft to the temples. (C) The pre- and postoperative images were automatically registered by Geomagic Studio 12 software, which produced 3D colorimetric topography for volumetric discrepancy analysis. (D) Preoperative 3D image. (E) Postoperative 3D image at 3 months. (F) 3D colorimetric analysis was used to calculate facial volume changes in each side.

Figure 3

Scatter plot at 3 months. (A) The average fat retention rate at 3 months postoperatively. (B) Surgeon scores. (C) Patient satisfaction scores. (D) Patient recovery times.

Figure 4

A case of a 28-year-old patient. (Top) Preoperative view. (Bottom) Postoperative view 3 months after fat graft to the temples; 16 ml of PRF-enhanced fat was transferred into the right temple, while the left side received the same volume of fat combined with saline.