Tissue augmentation with fibrin sealant and cultured fibroblasts: a preliminary study

Nonoperative subdermal tissue augmentation is one of the most frequently performed procedures in plastic surgery and dermatological practice. Many products, from biological to synthetic filler substances, are currently available. However, none has achieved ideal clinical efficacy, especially regarding volume maintenance and longevity. We examined the use of fibrin sealant as a biological and fully degradable matrix for dermal augmentation in combination with precultured human fibroblasts and hyaluronic acid gel (HYAFF).

Four implant preparations were studied: fibrin glue only (F); 1% HYAFF mixed in fibrin glue (FH); 1.8 × 10(6) cells/ml of fibrin glue (FC); and 1% HYAFF and 1.8 × 10(6) cells/ml of fibrin glue (FHC). Each mouse was given two separate subcutaneous injections of implant material. At 1, 3, and 6 weeks two mice from each group were sacrificed, such that there was an n = 4 for each implant group at each time point. The mice were grossly examined for implant retention and the implants were evaluated by means of immunohistochemistry for fibrosis, integration into surrounding tissue, presence of elastin, and blood vessel infiltration.

Only the implants in the cell-containing groups, FC and FHC, remained after 6 weeks. Moreover, with the exception of a mild inflammatory response, no adverse affects of the cell-seeded implants were noted.

Presence of fibroblasts increases implant durability. Further studies should evaluate the ideal hyaluronic acid and fibroblast concentration for long-term longevity.