Role of stem cells for the regenerative procedures in aesthetic surgery. Today we are here with Prof. Alessandro Gennai, plastic and aesthetic surgeon, contract professor for minimally invasive techniques at the University of Camerino, member of AICPE (Italian Association of Plastic and Aesthetic Surgery) and EAFPS (European Academy of Facial Plastic Surgery) to talk about the role of stem cells for the regenerative procedures in aesthetic surgery. Prof. Gennai, could you explain to us what stem cells are? In the last few years we proved that in the adipose tissue there are more stem cells than in the bone marrow: these stem cells are named ADSCs (adipose derived stem cells) and they are in a fraction of the adipose tissue named stromal vascular fraction. Stem cells are like baby cells that have the capacity to transform into several different mature cells as epithelial cells (skin), adipocytes (fat), endothelial cells (vessels), chondrocytes (cartilages), osteocytes (bone), myocytes (muscle) and neurocytes. You are saying that potentially these kind of baby cells can regenerate and repair any kind of tissue? Yes they could! In effect these cells are said to be multipotential cells because they have the ability to transform into different kinds of mature cells; hence the interest for these stem cells is not only in the field of plastic and aesthetic surgery but also in orthopedics, cardiology, neurology etc It appears that you and your team standardized a particular procedure for tissue regeneration in aesthetic surgery using stem cells… My team and I have been studying the use of stem cells for regenerative purposes since 2012; we standardized the SEFFI technique (Superficial Enhanced Fluid Fat Injection). This technique addresses the regeneration of tissues and the restoration of volumes in facial rejuvenation. This injecting procedure is safe, simple, effective and long lasting; at the base of this procedure is the volumizing effect of the adipocytes and the volumizing effect of the ADSCs. This technique has aroused such a great international interest that we had the opportunity and honor to publish it in 2015 in two of the most relevant international scientific journals i.e. the Aesthetic Surgery Journal and JAMA Facial Plastic Surgery. In the meantime we have been studying another procedure aimed to inject adipocytes and ADSCs in very delicate areas such as the periocular and perioral areas: we named this technique MicroSEFFI (Micro Superficial Enhanced Fluid Fat Injection). MicroSEFFI too aroused great international interest and has been published on ASJ in 2016. From your words we get you give a great importance to tissue regeneration in the facial rejuvenation procedure.. This is the issue: in the last 30 years the only surgical rejuvenation procedure has been the face lift which is aimed to tight the skin but not rejuvenate the face. Extremely interesting is a survey where 100 patients were compared with their pictures when they were 20 years old: this survey proved that the most important effect in the aging face is the loss of volume, followed by the skin aging and the descent of tissue hold the third place. Moreover in my cases report of 500 facial rejuvenation procedures the average age of my patients is 45-50 years. In the light of these evidences I am deeply convinced that in order to achieve a natural facial rejuvenation it is mandatory to RESTORE the volume, then REGENERATE the skin and next REPOSITION the tissue. This is the reason why my facial rejuvenation procedure is called R3 (cubed). The R3 procedure has been published on AMJ in 2016. Could you explain this R3 procedure in more details? The R3 procedure involves the SEFFI and MicroSEFFI techniques to restore volume and regenerate the skin while MIVEL (Minimal Incisions Vertical Endoscopic Lifting) is my technique aimed to endoscopically reposition the tissue. Are you saying that you reposition the tissue of the face using an endoscopy procedure? Please explain it in more details. That is true. I don’t like removing and tightening the skin and I wish to reposition the deep tissue; I achieve this goal through small incisions along the hair line through which by use of a 4mm camera and small instruments I can release the deep tissues, reposition and fix them without any needs to tight and remove the skin. This technique of mine too has been published in one of the most relevant international scientific journals i.e. Ophthalmic Plastic and Reconstructive Surgery. Let’s step back to your SEFFI and MicroSEFFI techniques: which are the differences between these techniques and the micro and nano fat graft? In SEFFI and Micro SEFFI we don’t contemplate any manipulation of the tissue or using of devices in order to obtain the fluidity of the tissue: the fluidity of the tissue is extremely important for any micro nano fat graft and for SEFFI and MicroSEFFI as well. The fluidity of the tissue is mandatory in order to inject it into an extremely superficial layer so as to increase the regenerative effect and decrease the risk of irregularity and lumpiness. With SEFFI and MicroSEFFI we obtain this fluidity thanks to the use of a special micro cannula to harvest the tissue, while in the other micro and nano fat graft techniques, the fluidity is obtained by strong manipulation or devices which interfere in the quality of the tissue and in its regenerative capacity. In the lights of your answers and your scientific publications we can say that Italy is playing a prominent role in this field of research. Absolutely. This is confirmed by the publications and the great interest in our techniques at the international Congresses where I presented them. I am convinced that Italy is playing a fundamental role in the research of tissue regeneration using ADSCs.