The back of the hand, a part of the body just as difficult to conceal one's age as the face. A clinical case report on the application of the 'Stromal-Enhanced Lipograft (SEL)' technique to the back of the hand, which involves concentrating fat with stem cells for transplantation.
SC301 Clinic · Stem Cell Research Series 3th Week of June · Single Paper Based · Pure SVF Direct Transplantation
Original paper information:
Sterodimas A, Boriani F, Nicaretta B, Pereira LH.
“Hand rejuvenation by stromal enriched lipograft”
Journal of Plastic, Reconstructive & Aesthetic Surgery (JPRAS). 2018;71(10):1507–1517.
doi: 10.1016/j.bjps.2018.07.029. PMID: 30139666.
Affiliation: Department of Plastic Surgery, IASO General Hospital (Greece) / Gruppioni Hospital (Italy) / LH Clinic (Brazil)
Content Transparency Notice
This paper is on PubMed 'Letter (Clinical Letter)' Since it is listed in a specific format, unlike general clinical research papers, the structured abstract (exact number of patients, follow-up period, statistical figures) is not disclosed. In this article Written based solely on officially verifiable facts (author, affiliation, journal of publication, definition and principles of the SEL technique, and the rationale behind the conclusions stated in the paper).We did not arbitrarily create specific, unverified figures or statistics.
It is easy to take care of your face but forget the back of your hands.
What is the body part that most honestly reveals one's age? Many people think of the face, but in reality, people Guessing age by looking at the back of the handThere are studies suggesting that it is possible. While the face is often consistently cared for through makeup, skincare, and procedures, the backs of the hands are a relatively neglected area in terms of care.
subcutaneous fat reduction
The subcutaneous fat layer on the back of the hand thins, and veins and tendons become prominently visible.
loss of skin elasticity
The skin thins and wrinkles become more prominent due to a decrease in collagen and elastin.
색소 변화
Pigmented spots (commonly known as 'age spots') are prone to appear on the back of the hands due to accumulated UV exposure.
Highlighting skeletal contours
The contours of the bones and joints on the back of the hand are more prominent than usual due to soft tissue volume loss.
To respond to these changes, plastic surgery and dermatology clinics have utilized various methods such as fillers and autologous fat grafting. The authors of this paper go a step further, 'SEL (Stromal Enriched Lipograft)', a standard fat graft enhanced with stem cells (SVF)We reported a case where a proprietary technique called [name] was applied to the back of the hand.
What is SEL (Stromal Enriched Lipograft)?
The author group of this paper (Sterodimas, Pereira et al.) has developed a proprietary technique that has been applied to various areas, including facial, breast, and body contour correction. SEL (Stromal-Enriched Lipograft)I applied it to the back of my hand.
The core concept of SEL is clear — Converting stem cell-deficient fat grafts into stem cell-rich fat graftsis to do
Fat extracted from conventional fat grafting (lipoaspirates) has a relatively low concentration of stem cells. SEL is a technique that aims for more effective grafting results with a smaller amount of fat by increasing the concentration of stem cells (SVF) within this fat through a mechanical processing process.
SEL processing process
STEP 1
fat harvesting
Autologous adipose tissue aspiration
STEP 2
mechanical processing
SVF concentration using a dedicated machine
STEP 3
Particle formation
Processed into milli, micro, and nano fats
STEP 4
Hand transplant
Inject with particle size suitable for the depth
Mechanical Treatment Instead of Enzymes — Why This Method Was Chosen
SEL is like collagenase Physical processing using dedicated machinery without the use of enzymesWe use a method to concentrate SVF. Compared to enzymatic treatment, this is highly likely to qualify as 'minimum manipulation' in terms of regulation, and has the practical advantage of allowing for immediate processing and transplantation on the day of the procedure.
Uses by fat particle size
Millifat
For deep layer transplantation
Used for large particle, deep volume supplementation
Microfat
For intermediate layer transplantation
Intermediate particles, reconstruction of the lower dermal layer
Nanofat
For surface grafting
Very small particles, for improving skin texture
This classification system is a characteristic of the SEL technique, and the principle is to select and use the appropriate particle size based on the graft depth. This distinction in particle size can be particularly meaningful in areas with thin skin and structures of varying depths (skin, dermis, subcutaneous fat, and above tendons), such as the back of the hand.
Facts confirmed regarding this paper
What is the 'Letter' format, and why is it important?
The 'Letter' of an academic journal is rather than large-scale clinical trials A format for rapidly sharing application examples of new techniques or initial observation results with the academic community.Although it does not possess the same statistical rigor as a full-scale randomized controlled trial, it holds value in that an experienced research team rapidly shares early clinical experience in a new application site with the academic community. However, due to the nature of this format, specific patient numbers or numerical data available externally are limited for this paper.
Who is this research team — The development process of the SEL technique
The authors of this paper are a research team that has consistently applied and reported on SEL techniques to various parts of the body. Through other papers published by the same author group, one can examine the context of how SEL techniques have evolved.
①
2011
Sterodimas et al. Comparison of Autologous Fat Graft vs. ADSC-Enhanced Fat GraftPublished the research in the Aesthetic Surgery Journal — the early foundation of the SEL concept.
②
2013
Published a report on the application of the SEL technique to Rhinoplasty Refinement — extending application to micro-areas of the face.
③
2018 (This paper)
Apply the SEL technique to the back of the handReported a case to JPRAS — expanding the application area from the face and breasts to the hands.
4
After 2020 years
Continued expansion and reporting of SEL application through facial complex lifting (Blepharoplasty + Minilift + SEL), breast implant combination, etc.
These footprints are this research team A professional group that has systematically expanded the application of consistent techniques (SEL) to various body parts, rather than a one-off attempt.It demonstrates that... The application to the back of the hand can also be understood as an extension of this accumulated experience.
The Purpose of the Conclusions Presented in This Paper
Purpose of verifiable conclusions
The authors report clinical experience applying the SEL technique to hand rejuvenation, A cosmetic technique using stem cell (SVF)-enhanced fat grafting to improve signs of aging on the back of the hands (decreased subcutaneous fat, protruding veins and tendons, reduced skin elasticity).It presented the possibility of applicability as.
According to the MeSH classification, this paper falls under the categories of 'Cosmetic Techniques' and 'Rejuvenation,' which suggests that SEL was applied for the purpose of external and cosmetic improvement of the back of the hand.
In subsequent papers published by the same research team regarding other body parts (face, breast), SEL It is a safe and acceptable method with high patient satisfaction and a low complication rate....has repeatedly presented evaluations. However, this is the research team's evaluation of the SEL technique as a whole, and the specific figures listed in the paper itself cannot be confirmed from the published abstract alone.
Why is SVF-enhanced fat grafting meaningful on the back of the hand?
Compared to the face, the skin on the back of the hand is thinner, has a naturally smaller subcutaneous fat layer, and is an area subject to significant daily movement and friction. Considering these anatomical characteristics, the reasons why SVF can contribute to hand transplantation can be considered as follows.
Specialities of back of the hand fat grafting
The back of the hand is more than the face An environment where the subcutaneous fat layer is thin and there is a lot of movement, making it difficult for transplanted fat to survive.It is known that in the field of general fat grafting, the principle that SVF promotes angiogenesis to increase the survival rate of transplanted fat (such as CAL and the temple study discussed in other posts of this series) is well known, and it is presumed that the background for introducing SEL to the back of the hand is that this principle can be applied even in challenging grafting environments like the back of the hand.
The message conveyed by this paper
A research team that has been applying the SEL (Stromal Enriched Lipograft) technique to various body parts, including the face and breasts, Reported to the academic community clinical experience applying the same SVF-enhanced fat grafting technique to the rejuvenation of the back of the hand.I did.
This paper is in the form of a clinical letter and is not a large-scale clinical trial including full-scale statistical analysis, but The application scope of stem cell-enhanced fat grafting is expanding beyond the face to the hands.It is meaningful as an example demonstrating this.
This report suggests that SVF-enhanced fat grafting is worth considering as a cosmetic technique to improve signs of aging on the back of the hands, raising expectations for larger-scale follow-up research in this field.
Stories from SC301 Clinic
The backs of the hands are easily neglected in care, but they are surprisingly honest signals that reveal one's age. Although this paper is not a clinical trial containing large-scale statistical data, The proven principle of stem cell-enhanced fat grafting is being extended to the back of the hand.It shows the flow.
The principle that 'SVF helps transplanted fat survive,' confirmed in procedures covered in this series such as facial volume reconstruction (Paris-Romberg disease) and temporal fat grafting, is a general principle applicable to any part of the body.
SC301 Clinic adheres to the principle of honestly conveying verifiable evidence without exaggerating unverified figures. If you are interested in stem cell (SVF) therapy, we recommend visiting the clinic for an in-person consultation to receive accurate information tailored to your specific condition.
Questions (Q&A) regarding the paper
Q1. It is said that this paper differs in format from other clinical research papers. Is this a reliable basis?
A. This paper is published in the journal in the format of a 'Letter,' or clinical correspondence. Unlike standard clinical research papers that disclose structured abstracts containing precise patient numbers, follow-up periods, and statistical figures, the Letter format is a reporting style intended to rapidly share application cases of new techniques or initial observation results with the academic community. While it may not possess the same level of statistical rigor as large-scale randomized controlled trials, it holds its own academic value in that it allows experienced research teams to quickly share initial clinical experiences regarding new application sites. However, due to the nature of this format, there is a limitation in that specific patient numbers or numerical data cannot be verified solely through the published abstract. SC301 clearly recognizes these formal differences and adheres to the principle of honestly conveying only verifiable facts without exaggerating unverified figures. Even as a report in Letter format, it is considered a meaningful document in that it demonstrates the accumulated clinical experience of a research team that has consistently applied and developed the SEL technique across various body parts, including the face and breast.
Q2. How does the SEL (Stromal Enriched Lipograft) technique differ from standard fat grafting or stem cell (SVF) fat grafting?
A. SEL is a technique based on the clear concept of converting fat grafts lacking stem cells into fat grafts rich in stem cells. The fat extracted from conventional fat grafting—namely lipospirates—has a relatively low concentration of stem cells. SEL utilizes a method that increases the concentration of Stem Cell Viruses (SVF) within this fat through a physical processing process using specialized machinery. A key difference here is that SEL concentrates SVF solely through mechanical processing, without using enzymes such as collagenase. Compared to enzymatic treatment, this is highly likely to qualify as minimal manipulation from a regulatory perspective and leads to the practical advantage of enabling immediate processing and grafting on the same day of the procedure. Furthermore, SEL employs a system that classifies the processed fat into particle sizes—Milli-Fat, Micro-Fat, and Nano-Fat—allowing for selective use according to the graft depth. Large particles, Milli-Fat, are used for volume replenishment in the deep layers; medium particles, Micro-Fat, for reconstruction of the subdermal layer; and very small particles, Nano-Fat, for improving skin texture in the superficial layer. This classification of particle sizes is a unique feature of the SEL technique that is not commonly applied in conventional fat grafting.
Q3. Why is the back of the hand a more difficult area for fat grafting than the face?
A. The back of the hand has several anatomically challenging characteristics. First, the skin is thinner than that of the face, and the subcutaneous fat layer is naturally smaller. This means that the space available to receive the transplanted fat is limited. Second, it is an area subject to significant daily movement and friction. Since the hand is used all day long, it creates a physically unfavorable environment for transplanted fat to settle stably. Third, veins and tendons are located close to the skin, making it crucial to precisely control the depth of transplantation. Due to these characteristics, the back of the hand is known to be an environment where transplanted fat struggles to survive. In the field of general fat grafting, the principle that SVF promotes angiogenesis to increase the survival rate of transplanted fat is well-established through studies on the temples and facial areas. It is presumed that the introduction of SEL to the back of the hand stems from the belief that this principle can be applied equally to such a challenging transplantation environment. However, as this paper is in the form of a clinical letter, specific survival rate figures for the application to the back of the hand cannot be confirmed from the published abstract.
Q4. Specifically, what changes manifest as aging on the back of the hands, and why is it not as easy to care for as the face?
A. Aging on the back of the hands manifests in four changes. First is a decrease in subcutaneous fat, where the subcutaneous fat layer thins, causing veins and tendons to become more prominent. Second is a decline in skin elasticity; as collagen and elastin decrease, the skin thins and wrinkles become more pronounced. Third is pigmentation changes; as exposure to ultraviolet rays accumulates, pigment spots, commonly known as age spots, are prone to forming on the back of the hands. Fourth is the emphasis on skeletal contours; as soft tissue volume is lost, the contours of the bones and joints on the back of the hands appear more prominent than usual. Many studies have confirmed that people can estimate age by looking at the back of the hands, just as they do with the face. Nevertheless, the back of the hands are often neglected in care because, while the face is routinely cared for through makeup, skincare, and procedures, people often fail to meticulously apply even sunscreen to the back of their hands. To address these changes, plastic surgeons and dermatologists have utilized various methods such as fillers and autologous fat grafting; this paper goes a step further by reporting a case where the SEL technique, enhanced with SVF, was applied.
Q5. Was this research team's SEL technique applied to any body part other than the back of the hand? Is this a research team with reliable expertise?
A. The authors of this paper are a research team that has consistently applied and developed the SEL technique to various body parts. In 2011, Sterodimas et al. laid the initial foundation for the SEL concept by publishing a study comparing autologous fat grafting with ADSC-reinforced fat grafting. In 2013, they expanded the scope of application to the micro-face by publishing a report on the application of the SEL technique to rhinoplasty revisions. In 2018, through this paper, they reported a case of applying the SEL technique to the back of the hand, extending the application areas from the face and breasts to the hands. Since 2020, they have continuously expanded and reported on the application of SEL, including in combination facial lifting and procedures involving breast implants. This track record demonstrates that this research team is not a one-off endeavor, but a specialized group that has systematically expanded the application of consistent techniques to various body parts. In subsequent papers published by the same team regarding different body parts, they have repeatedly presented evaluations that SEL is a safe and acceptable method with high patient satisfaction and low complication rates. However, it is important to clearly distinguish that this is the research team's evaluation of the SEL technique as a whole, and that the specific figures stated in the paper itself cannot be verified solely from the published abstract.
Frequently Asked Questions
What is SEL (Stromal Enriched Lipograft)?
The author group of this paper (Sterodimas, Pereira, et al.) applied SEL (Stromal-Enriched Lipograft), a proprietary technique previously used on various body parts including the face, breasts, and body contours, to the back of the hand. The core concept of SEL is clear—it is to "convert stem cell-deficient fat grafts into stem cell-rich fat grafts."
Why is SVF-enhanced fat grafting meaningful on the back of the hand?
Compared to the face, the skin on the back of the hand is thinner, has a naturally smaller subcutaneous fat layer, and is an area subject to significant daily movement and friction. Considering these anatomical characteristics, the reasons why SVF can contribute to hand grafting can be considered as follows. The specificity of hand fat grafting: The back of the hand is known to be an environment where it is difficult for transplanted fat to survive due to its thinner subcutaneous fat layer and high movement compared to the face. In the field of general fat grafting, the principle that SVF promotes angiogenesis to increase the survival rate of transplanted fat (such as the CAL and temple studies discussed in other posts of this series) is well known. It is presumed that the background for introducing SEL to the back of the hand is that this principle can be applied even in a challenging grafting environment like the back of the hand.
