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Comment & Response
October 24, 2019

A Practical Precaution Relevant to Facial Injections

Author Affiliations
  • 1Department of Plastic Surgery, University of California, Irvine
  • 2Alastin Skin Care Inc, Carlsbad, California
JAMA Facial Plast Surg. Published online October 24, 2019. doi:https://doi.org/10.1001/jamafacial.2019.1055

To the Editor We read with interest the case report by Sebaratnam et al.1 Recently a new type of white adipose tissue (WAT), dermal WAT (dWAT), has been identified and is recognized as playing a role in skin processes such as hair follicle growth, thermoregulation, wound healing, and signal transmission.2 This layer lies in the reticular dermis encasing mature hair follicles.3 In addition this fat compartment is associated with specific adipose stem cell phenotypes (CD24+), distinctly different from subcutaneous WAT, suggesting unique functions of this fat depot.2 Dermal WAT is organized in cone-like structures (often identified in deeper skin graft donor areas) and is particularly associated with scarring when exposed at that depth.4 Importantly, dWAT appears to have a unique relationship with the hair follicle and dynamic reciprocity is seen between these 2 anatomic regions through WNT signaling pathway and its major mediator cadherin-associated protein β 1 (CTNNB1 or β-catenin).5 Research of this signaling has revealed that dWAT is directly stimulated in unison with anagen and regresses through telogen.5 This is a logical relationship when one considers the evolutionary function both regions serve in relation to thermoregulation.