Fat cells & stem and regenerative cells
Usually, fat cells act as the main filler, however, once they are transplanted by fat grafting, there is a period of time during which they need a blood supply in order to survive. The reality is that some of these cells survive, and some do not. The stem and regenerative cells are critical and when fat is harvest for grafting, some of these cells are left behind, so the fat that is grafted is actually deficient in these cells compared to normal fat.
The number of the cells restored or enriched are left behind
Stem and regenerative cells are critical to the survival of the fat as a graft. In the area where the face the amount of fat is smaller, it is easier to enrich the fat with a larger dose of these cells, which means the benefits of is easier to demonstrate than for example in the breast where the volume is larger
In other words in an area like the face where the amount of fat is smaller, it is easier to enrich the fat with a larger dose of these cells, which means the benefit is easier to demonstrate than for example in the breast where larger volumes of fat are grafted and relatively fewer cells are added to enrich the fat. So it really comes down to whether enriching the fat is cost effective or not. Fat grafts will take without cell enrichment, but they take better with cell enrichment. The problem is that the process adds to the cost, and the fat from which the cells are processed is discarded - so one has to have extra fat available. The stem and regenerative cells are also considered to be responsible for some of the other benefits of fat grafting that have been observed, like improvement in skin quality, improvement in radiation damaged skin etc. In general if you have adequate fat to harvest and you can afford the extra cost, then I think there is a benefit, though the benefit from a cost perspective is hard to quantify. Some studies though are starting to show a cost benefit, such as the RESTORE study in Europe for reconstruction of the breast, where it has been shown by decreasing the number of grafting procedures required, there are cost savings. Similarly Sterodimas has shown in the face that the number of graft procedures with enriched fat is less.
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