title: Skin Rejuvenation and Volume Enhancement with the Micro Superficial Enhanced Fluid Fat Injection (M-SEFFI) for Skin Aging of the Periocular and Perioral Regions.
abstract: BACKGROUND
  Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited.
  
  
  OBJECTIVE
  Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions.
  
  
  METHODS
  Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect.
  
  
  RESULTS
  Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively.
  
  
  CONCLUSIONS
  M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging.
  
  
  METHODS
  4 Therapeutic.
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy agennai@mac.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gennai
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zambelli
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Repaci
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Quarto
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Baldelli
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Fraternali
authors.affiliation: Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Bernardini
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D002470:Cell Survival; D002478:Cells, Cultured; D003357:Cosmetic Techniques / Q000009:adverse effects; D004954:Esthetics; D005123:Eye / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008066:Lipolysis; D008297:Male; D008845:Microinjections; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology / Q000601:surgery*; D010781:Photography; D011183:Postoperative Complications / Q000209:etiology; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging; D033581:Stem Cell Transplantation / Q000009:adverse effects; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous; D016896:Treatment Outcome