Fat Grafting and Adipose Stem Cells for Facial Systemic Sclerosis: A Systematic Review of the Literature.

Background: The oro-facial modification occurring in systemic sclerosis are detrimental for patients, but the therapeutic options are limited.

Objectives: This systematic review aimed to perform an up-to-date appraisal of the literature focusing on fat grafting and other adipose stem cell-based therapies for the treatment of facial systemic sclerosis, determining its efficacy and safety, and investigating the current practice for treatment optimization.

Methods: The review was prospectively registered in PROSPERO (CRD42021286268) and followed the PRISMA principles. Multiple databases were searched and only original studies were included.

Results: Over the 12 studies matching the inclusion criteria, 174 patients were treated. Of them, 87.3% (n = 152) were considered to have improved. The complications, graded with the Clavien-Dindo grading system, were grade 1 (no treatment required) or 2 (antibiotic required). Patients received an average of 2.5 ± 3.68, median 1.35 (range 1-14), lipotransfer procedures. Overall, an amount of 14.60 ± 6.24 ml was injected in the overall facial area, median 16 (range 27-3) ml. The average interval between procedures was 5.30 ± 2.04 months, with a median of 6 (range 3-6.91) months. At the time of inclusion, patients were diagnosed with scleroderma disease on an average 14.7 ± 7.35 years.

Conclusions: Fat grafting for facial systemic sclerosis is effective and safe. The definitive durability of the effect is still unclear, and the optimal number of treatments must be determined to define a precise evidence-based protocol. The body of evidence is highly fragmented, with disagreement in the surgical technique used and outcome assessment, making results from different studies often not comparable. The level of evidence is overall low or very low, and the risk of bias of published studies is overall medium to high. RCTs are urgently needed.