30/10/2019 A Practical Precaution Relevant to Facial Injections | JAMA Facial Plastic Surgery | JAMA Network

Comment & Response

October 24, 2019

A Practical Precaution Relevant to Facial

Injections
Alan D. Widgerow, MBBCh, MMed1,2

Author Affiliations
JAMA Facial Plast Surg. Published online October 24, 2019. doi: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.2This
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.5This
is a logical relationship when one considers the evolutionary function both regions serve in relation to
thermoregulation.

https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2753334 1/1