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Systemic sclerosis is a devastating condition that can drastically alter the quality of life for patients affected by this condition. Functional limitations are enormous around the mouth and the hands. A severe decrease in the range of motion can reduce hand function tremendously for these patients.
Going back many years ago, when Coleman started reporting positive outcomes with the injection of fat into scar tissue, it occurred to me that this type of improvement could be possible in scleroderma. We tested this hypothesis and demonstrated histologic change following fat injection after fibrosis was induced in animals, with total reversal of sclerotic changes. These data have not been published yet. Subsequently, we started recruiting patients; however, fortunately, this condition is rare and recruitment has been extremely slow for our team. Today, we have only recruited three patients over 4 years. All three patients had facial involvement, one had hand and face, and one had linear changes in the left side of the face and lower extremity. All three patients demonstrated significant positive change in the quality of skin, contour, color, and elasticity of skin, and range of motion. Obviously, the number of cases, even when one adds up our experience with these authors, is too small for any scientific conclusion. Yet, the collective uniform positive changes are very exciting and should not be ignored.
We are grateful to Dr. Blezien and colleagues for sharing this information with us. I concur that larger patient samples or even better, a randomized study, would lend more scientific support to these independent findings. However, these observations are gratifying enough to suggest that colleagues might offer fat injection to these desperate patients for two reasons. First, it is likely to work. Second, it is not an invasive procedure.
Conflict of interest
The author serves as board member/CEO of Innovative Medical Equipment (IME).
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Guyuron, B. Discussion of the Article “Effects of Fat Grafting Containing Stem Cells in Microstomia and Microcheilia Derived from Systemic Sclerosis” by Dr. Blezien and Colleagues. Aesth Plast Surg 44, 239 (2020) doi:10.1007/s00266-017-0938-4