Guided SEFFI and CaHA: A Transformative Approach to Regenerative Facial Rejuvenation

Significance 

Facial aging is a complex process that happens for a bunch of reasons. On one hand, there are internal factors like your genes and hormonal shifts that come with time. On the other hand, external influences, such as exposure to UV rays, pollution, and certain lifestyle habits, also speed up the process. Together, these factors lead to a gradual decline in skin elasticity, loss of facial volume, and a breakdown in structural support. This results in visible signs of aging—things like wrinkles, sagging, and hollowed-out areas in key parts of the face. Indeed, some options, like fillers made from hyaluronic acid or calcium hydroxylapatite (CaHA), can restore volume right away, but they do not do much to promote long-term skin improvement. Then there is fat grafting, which uses stem cell-rich tissue from your own body, but it can be tricky to perform and sometimes comes with uneven results. Finding a way to combine these biological and material-based treatments into one seamless, less invasive solution is something that still needs work. Recently, new research paper published in Journal of Clinical Medicine and conducted by international experts: Dr. Fabrizio Melfa from the Mediaging Clinic Center, Dr. Alec McCarthy from the Merz Aesthetics, Dr. Shino Bay Aguilera from the Shino Bay Cosmetic Dermatology & Laser Institute, Dr. Jani van Loghem from the UMA Academy, and Professor Alessandro Gennai from the Studio Gennai in Italy, the researchers tested a new approach by combining Guided Superficial Enhanced Fluid Fat Injection (SEFFI) with CaHA for facial rejuvenation. Their idea was to use SEFFI to harvest fat loaded with regenerative cells and pair it with CaHA for both immediate and long-term results. This method aims to tackle both skin quality and volume loss in one treatment, offering a more comprehensive solution to the challenges of facial aging.

The study involved 158 participants, most of whom were women aged between 40 and 65. To ensure accurate results, the researchers chose individuals who had not undergone any cosmetic procedures in the recent past. They used tools like the Global Aesthetic Improvement Scale (GAIS) and advanced 3D imaging to carefully track changes in the skin’s appearance and facial volume over time. These methods allowed them to assess even subtle improvements, providing a comprehensive view of how the treatment worked. The authors’ process began with the collection of adipose tissue, or fat, from the patients using guided SEFFI technique which is minimally invasive and it specifically targets superficial fat layers to extract tissue rich in regenerative cells. The harvested fat was handled very gently to preserve its natural properties. Afterward, it was prepared into clusters of specific sizes, ready for injection. These fat clusters were then carefully placed into the upper layers of the face to help restore volume and improve texture. At the same time, CaHA was injected into deeper layers of the skin, where it could stimulate the production of collagen and elastin while also adding volume. The amount and concentration of CaHA were adjusted depending on the needs of each area of the face. In this study the AA used  CaHA diluted  with saline solution  with ratio  1:1 or 1:2. The authors’ results were encouraging and they found by 30 days after treatment, there were early signs of improvement in skin texture and volume, although the changes at this stage were not dramatic. However, by the 90-day mark, the effects were much more noticeable. Patients’ skin appeared smoother and more radiant, wrinkles were less pronounced, and the natural contours of their faces were restored. These changes were not only visible to the naked eye but were also reflected in the GAIS scores. At 150 days, the improvements either remained stable or became even more pronounced which demonstrate the long-lasting nature of the treatment. According to the authors, the procedure was well-received by the participants with very minor side effects, such as mild swelling or bruising at the injection sites, resolved quickly within a week. Importantly, no significant complications occurred, highlighting the safety of this approach.

This international experts study stands out because it takes an innovative approach to tackling the challenges of facial aging. Instead of relying on just one method, it combines two powerful therapies—regenerative and biostimulatory—into a single, minimally invasive treatment. Facial aging is not just about appearances; it involves deep changes in the skin’s structure and the tissues beneath it. These changes can impact how people feel about themselves and even affect their overall quality of life. What this research does is offer a way to address these concerns by not only restoring lost volume but also encouraging the skin to regenerate itself over time. It fills a gap in existing treatments that often focus on quick fixes rather than long-term solutions.  The real magic of this approach comes from combining SVF from a patient’s own fat tissue with CaHA. SVF helps kickstart the skin’s natural ability to repair and regenerate, while CaHA provides immediate volume and stimulates collagen production. Together, they create a treatment that works on two levels: delivering results that patients can see right away while also promoting long-term improvements. This means fewer repeat treatments and a more natural look—something that many patients value, especially when they want to avoid major disruptions to their routines. We believe what makes this new study even more exciting is how accessible it could be. By avoiding invasive surgery, the protocol opens up the possibility of facial rejuvenation to people who might shy away from more traditional procedures. It taps into the body’s natural regenerative abilities, aligning with the growing interest in biologically based therapies. This combination of effectiveness and simplicity could change how aesthetic treatments are offered, making advanced options more widely available. Additionally, the research also sets the stage for further exploration. There is room to refine this approach by experimenting with different injection techniques or combining it with other regenerative treatments like platelet-rich plasma or exosomes. Longer-term studies could help us understand how far these benefits can go, particularly in improving skin quality over time. Beyond aesthetics, this work could have implications for other areas of medicine, like reconstructive surgery and wound healing, where regenerating tissue and restoring volume are just as important.

Guided SEFFI and CaHA: A Transformative Approach to Regenerative Facial Rejuvenation - Medicine Innovates

Guided SEFFI and CaHA: A Transformative Approach to Regenerative Facial Rejuvenation - Medicine Innovates

About the author

Alessandro Gennai
ORCID 0000-0003-4105-725X
www.gennaichirugia.it

Reconstructive and Aesthetic Plastic Surgeon

  • Graduated with honors in Medicine and Surgery in 1988 and specialized with honors in General Surgery in 1993 at the University of Modena.
  • Completed with honors the International School of Aesthetic Medicine at the Fatebenefratelli Foundation in Rome in 1994.
  • In 1999, pursued a private fellowship at the prestigious Isse Institute in Los Angeles, directed by Prof. Nicanor Isse, a pioneer and father of the endoscopic facial technique.
  • In the early 2000s, developed the endoscopic technique and was the creator of the M.I.V.E.L. technique (Minimal Incisions Vertical Endoscopic Lifting), published in 2013 in the prestigious American journal OPRS (Ophthalmic Plastic Reconstructive Surgery).
  • Furthered studies on the use of adipose-derived stem cells for tissue rejuvenation and regeneration; his studies and experience in the field of stem cells led to the creation of the S.E.F.F.I. (Superficial Enhanced Fluid Fat Injection) and MicroS.E.F.F.I. techniques in 2015 and 2016, respectively, published in some of the most prestigious American scientific journals such as ASJ (Aesthetic Surgery Journal), JAMA Facial Plastic Surgery, and CellR4.
  • In 2018, devised the N.A.L. (Neck Artificial Ligament) technique for surgical rejuvenation of the neck, published in the European Journal of Plastic Surgery and the Journal of Advanced Plastic Surgery Research.
  • Has been a speaker and lecturer at numerous national and international Congresses and Courses in the field of aesthetic surgery.
  • Published over 40 papers in national and international journals throughout his career.
  • Co-authored and authored 12 scientific texts.
  • Currently member AICPE (Italian Association of Plastic and Aesthetic Surgery), SICPRE (Italian Society of Plastic and Reconstructive Surgery) and SIME (Italian Society of Aesthetic Medicine).
  • Has served and currently serves as a Contract Professor at University Masters and Schools:
  • Second Level Master’s at the University of Camerino and the University of Turin
  • Second Level Master’s at Tor Vergata University, Rome
  • Second Level Master’s at the University of Pisa
  • Second Level Master’s at the University of Modena and Reggio
  • International School of Aesthetic Medicine (SIME) Rome
  • Since 2017, has been a member of the Educational Board of the European Academy of Facial Plastic Surgery (EAFPS).

Reference 

Melfa, Fabrizio, Alec McCarthy, Shino Bay Aguilera, Jani van Loghem, and Alessandro Gennai. 2024. “Guided SEFFI and CaHA: A Retrospective Observational Study of an Innovative Protocol for Regenerative Aesthetics” Journal of Clinical Medicine 13, no. 15: 4381. https://doi.org/10.3390/jcm13154381.

Go To Journal of Clinical Medicine