Injectable Human Acellular Adipose Matrix with Crosslinked Hyaluronic Acid and Carboxymethyl Cellulose Gels for Soft Tissue Augmentation.

BACKGROUND: Fillers have become a viable treatment option for addressing volume deficits, whether for aesthetic purposes or due to trauma or congenital deformities. While most fillers effectively maintain volume, promoting adipogenesis remains a significant challenge. This study investigated a biomaterial designed to maintain volume both in the short and long term while promoting adipose tissue formation, focusing on the biological properties of a human acellular adipose matrix (AAM) combined with crosslinked hyaluronic acid (HA) and carboxymethyl cellulose (CMC) gels. METHODS: The AAM was prepared through delipidation and decellularization and evaluated for residual fat and cells. To assess its performance, the AAM was compared with conventional collagen scaffolds for the proliferation and adipogenic differentiation of human adipose-derived stem cells(hADSCs) in vitro. An injectable AAM filler was developed by combining AAM with crosslinked HA and CMC gels for the desired rheological properties. Over 12 weeks, the AAM filler, conventional HA filler, and adipose tissue were compared in a nude mice model, assessing volume retention, cell incorporation, and adipogenesis. RESULTS: The AAM showed effective fat and cell removal and promoted the viability and adipogenic differentiation of hADSCs in vitro. The AAM filler exhibited six times higher viscosity than HA filler. It also outperformed both HA filler and adipose tissue in volume retention and cell incorporation, and new adipose tissue formation. CONCLUSIONS: These results suggest that AAM filler is a promising biomaterial for soft tissue augmentation, particularly in applications requiring volume retention and adipogenesis.