Autologous transplant-based wrinkle fillers

One of the primary causes of wrinkles is the breakdown of the skin matrix components, most importantly collagen. A common way to quickly replenish lost collagen is to inject it. However, injected collagen is broken up by the proteolytic enzymes within about 2-4 months, after which the injection needs to be repeated. An alternative is to inject collagen-producing cells (fibroblasts) instead of collagen itself. If the injected fibroblasts take hold in your skin, they can keep producing collagen for a long time. However, the use of fibroblasts from donor skin is difficult because of tissue rejection problems. A better approach is to inject autologous (patient's own) fibroblasts. The problem is that it would take a relatively large skin graft to obtain enough fibroblasts to inject. A far less invasive alternative is to take a small skin sample from a patient, extract the fibroblasts, grow them in tissue culture in sufficient quantities, and then inject into wrinkles and scars.

Such an alternative is indeed available under the brand name Isolagen. In theory, such approach should provide lasting results without the need to repeat the treatment. The results so far seem reasonably encouraging but this process is far more expensive than conventional collagen injections. Also, fibroblast injections for skin rejuvenation are still relatively new and more research is needed to better quantify the benefits.

Autologous fat

Autologous fat transfer (a.k.a. structural fat grafting, fat injections, etc.) is a procedure whereby a patient's own fat is harvested (e.g. from the abdomen), processed and injected into the subcutaneous tissue to add extra volume to depressed areas. In particular, far grafting is often used to restore lost facial volume in the eye area, cheeks, lips, under deep smile lines and so forth. Since the procedure involves autologous (patient's own) fat, there is no risk of rejection or disease transmission. Generally, some of the injected fat integrates in the treated area and stays permanently (for at least a year and often much longer) while the rest dissipates over a few months. Until late 90s, autologous fat transfer had been the only widely-used transplant-based procedure to fill cosmetic facial defects.

The procedure, which is usually done on an outpatient basis within one day, is more complicated than typical fuller injection but still relatively straightforward. The fat is harvested under local anesthesia using suction and a special aspiration needle. Then it is purified, homogenized and treated to prepare for injection. Finally, the fat is injected under local anesthesia in the subcutaneous tissue in the desired area. However, due to many subtleties of the technique, the surgeon's skill and experience are important. The biggest issue is that only a percentage of the injected fat takes hold in the treated area. Furthermore, this percentage may vary widely: from about 10% to 50% depending on a variety of factors. Many surgeons have their favorite harvesting and injection techniques and claim higher than average clinical longevity of the grafts. However, the factors specific to the individual patient and area treated play at least as big a role. If you are interested in fat injections you do need to find an experienced dermatological surgeon but be aware that the longevity of the graft is hard to predict and may be below your expectation. You may have to undergo multiple treatments until sufficient fat has integrated long-term in the treated area - with commensurate inconvenience and expense.

Cultured autologous human fibroblasts (Isolagen)
Autologous fat