How is it Different from Bone Marrow BMAC? — Explanation from Medical Staff Who Have Researched and Performed Fat-Regenerative Medicine Since 2009
Author: Ahn Jae-seok | Director, seoul chungdam dr ahnapa clinic
Research and treatment of fat-derived regenerative therapy and stem cell fat transfer in Gangnam since 2009
Clinical experience with over 15,000 stem cell fat transfer proceduresThis content has been created in compliance with relevant laws including the Medical Law.
Treatment effects and recovery processes may vary depending on individual joint conditions, age, and underlying diseases. The suitability of the procedure is determined after consultation with a specialist.
Why is 'Fat' Recently Drawing Attention in Knee Stem Cell Treatment?
This is one of the most frequently asked questions by knee osteoarthritis patients recently.
"What is the difference between bone marrow stem cells and fat stem cells?"
Both use the patient's own tissue for autologous regenerative therapy, but the starting point for obtaining stem cells is different.
BMAC involves harvesting and concentrating bone marrow from the pelvic bone.
In contrast, fat-derived SVF involves harvesting adipose tissue from the abdomen, flanks, and thighs, then separating the Stromal Vascular Fraction (SVF) from within it for use.
The biggest reason adipose tissue receives particular attention in regenerative medicine is simple.
Because it is tissue that can be harvested relatively easily from our body while being rich in cells involved in regeneration.
Multiple studies report that adipose tissue is a source with much higher density of mesenchymal stromal/stem cells compared to bone marrow, and some studies report that the amount of cells obtainable from adipose tissue is tens to hundreds of times higher than bone marrow. However, the exact numbers vary greatly depending on harvesting and separation methods.
What is Fat-Derived Stem Cell SVF?
The precise medical technology name is
'Autologous Fat-Derived Stromal Vascular Fraction (SVF)'
.
SVF is not simply extraction of one type of stem cell.
In addition to fat cells, adipose tissue contains
-
Fat-derived stromal and stem cells
-
Vascular endothelial cells
-
Pericytes
-
Immune-related cells
-
Various regeneration-related cells
.
The portion containing this group of cells is SVF, or stromal vascular fraction.
Therefore,
"Extracting only stem cells from fat and injecting them"
is less accurate than
"Separating and using SVF containing multiple cells involved in regeneration from autologous fat for treatment"
.
Fat-Derived SVF Knee Injection is a Ministry of Health and Welfare New Medical Technology
Autologous fat-derived SVF intra-articular injection is now more than a mere experimental concept.
The Ministry of Health and Welfare announced in 2024
'Intra-articular injection of autologous fat-derived stromal vascular fraction for knee osteoarthritis'
as new medical technology.
The target population is patients with Kellgren-Lawrence (KL) grade 2~3 knee osteoarthritis, and the purpose is to improve joint function and relieve pain.
Therefore, for appropriate patients, it is one of the non-surgical treatment options to consider before surgery.
Why Have I Focused on 'Fat' Since Long Ago?
I have been clinically applying fat-derived stem cells and fat regenerative medicine in Gangnam since 2009.
The starting point was fat transfer to the face.
Moving beyond conventional fat transfer that simply fills volume, I have performed stem cell fat transfer that utilizes the characteristics of regeneration-related cells within adipose tissue, and have accumulated over 15,000 clinical experiences with stem cell fat transfer to date.
Through long-term direct harvesting, separation, and transplantation of fat, the greatest advantage of adipose tissue I confirmed is
"Fat is not merely an energy storage tissue but a storage depot of abundant regenerative cells"
.
Currently in regenerative medicine, adipose tissue is also valued as an important autologous cell source due to its good accessibility, the ability to obtain large quantities, and abundance of mesenchymal stromal/stem cells.
The Greatest Difference Between Fat-Derived SVF and Autologous Bone Marrow BMAC
To explain the core difference between these two treatments simply:
| Comparison | Fat-Derived SVF | Autologous Bone Marrow BMAC |
|---|---|---|
| Cell source | Autologous adipose tissue | Autologous bone marrow |
| Harvesting site | Abdomen, flanks, thighs, etc. | Mainly iliac crest of pelvis |
| Mesenchymal stromal/stem cell supply | Relatively very abundant | Relatively limited |
| Composition | Fat-derived stromal and stem cells and various cells | Bone marrow cells, platelets, growth factors, etc. |
| Obtainable tissue volume | Relatively abundant | Relatively limited |
| Knee new medical technology | Recognized | Recognized |
| Representative target | KL 2~3 | KL 2~3 or patients meeting ICRS criteria |
Why Do More Stem Cells Exist in Fat Than in Bone Marrow?
One of the key cells discussed in regenerative medicine is the Mesenchymal Stromal Cell (MSC).
While it exists in bone marrow, its proportion is not high.
In particular, there are studies showing that the number and proliferative capacity of mesenchymal stromal cells obtainable from bone marrow may decrease with age.
In contrast, fat can be obtained in relatively large quantities from adult bodies.
Related reviews introduce studies reporting that the number of mesenchymal lineage cells obtainable from adipose tissue is approximately 40 to 500 times higher than bone marrow. However, this number varies greatly depending on tissue volume, harvesting method, separation method, and cell definition, so it should not be accepted as the same multiple for all procedures.
This is one reason I regard fat as important from a regenerative medicine perspective.
Then Is the Treatment Effect of Fat-Derived SVF Necessarily Much Better Than BMAC?
It is important to speak precisely here.
The amount of regeneration-related cells that can be obtained from adipose tissue may be much more abundant than bone marrow.
But
"Because there are more cells, the treatment effect for knee osteoarthritis is definitely necessarily much better than BMAC"
cannot be determined based solely on current medical evidence.
In studies directly comparing BMAC and fat-derived cell therapy, both groups showed improvement in pain and function, but some studies showed no clear clinical superiority between the two treatments.
Recent large-scale comparative studies also failed to demonstrate clear superiority between BMAC and SVF and other orthobiologic treatments in pain and function at one year.
Therefore, I explain it this way:
The clear advantage of fat-derived SVF is 'abundant cell supply source'.
And in actual treatment selection, we must evaluate not only cell numbers but also
-
Patient age
-
Degree of arthritis progression
-
Extent of cartilage damage
-
Lower limb alignment
-
Meniscal condition
-
Synovitis
-
Previous treatment effect
.
PRP is Not Stem Cell Treatment
There is one aspect patients most commonly confuse.
PRP is not stem cell treatment.
PRP is Platelet-Rich Plasma, in other words platelet-rich plasma.
Patient's own blood is harvested, then centrifuged to concentrate the platelet-rich portion for use.
The main therapeutic components are
Platelets + growth factors secreted from platelets
.
Stem cells are not harvested for treatment.
Therefore,
PRP = stem cell injection
advertising or explaining it this way is not medically accurate.
Accurately Comparing SVF, BMAC, and PRP
| Category | Fat-Derived SVF | Bone Marrow-Derived BMAC | PRP |
|---|---|---|---|
| Raw material | Own fat | Own bone marrow | Own blood |
| Stromal/stem cells | Abundantly included | Included but relatively limited | Not stem cell treatment |
| Growth factors | Included | Included | Included |
| Harvesting | Liposuction method | Bone marrow aspiration | Blood draw |
| New medical technology | Knee osteoarthritis recognized | Knee osteoarthritis recognized | Separate technology |
| Core features | Abundant cell source | Bone marrow-based treatment with long research history | Platelet and growth factor-centered |
Not All 'Fat Stem Cell Treatments' Are the Same Treatment
Searching for fat stem cells on the internet returns various forms of treatment mixed together.
But
SVF
and
cultured fat-derived mesenchymal stem cells
are not the same thing.
SVF is a cell fraction containing multiple cells together separated from the patient's adipose tissue, and cultured cell therapy is a different concept involving separate culturing and proliferation processes.
Therefore, when selecting a hospital, rather than simply looking at numbers of
"how many stem cells are injected"
it is important to confirm
what technology is used, whether it meets the indications for new medical technology, and whether it is suitable for the patient's condition
.
The Difference of seoul chungdam dr ahnapa clinic is 'Long Experience Handling Fat'
Fat-derived regenerative therapy is not a field where identical experience is immediately created just by purchasing equipment.
Since 2009, I have in Gangnam
continuously researched and clinically applied fat harvesting → fat separation → fat transfer → fat-derived regenerative therapy
.
In particular, through over 15,000 stem cell fat transfer experiences, I have long dealt with harvesting and processing of adipose tissue, and tissue graft and response.
At seoul chungdam dr ahnapa clinic, based on this experience in fat regenerative medicine, for knee osteoarthritis we do not simply 'administer stem cell injection' but rather
evaluate the patient's joint condition first and determine whether fat-derived SVF is suitable for the patient
think this process is important.
seoul chungdam dr ahnapa clinic's Knee SVF Treatment Approach
STEP 1. Confirm Accurate Joint Arthritis Stage
Through X-ray and if necessary MRI, we evaluate
-
KL grade
-
Cartilage damage
-
Meniscus
-
Synovial condition
-
Joint space
-
Lower limb alignment
.
STEP 2. Confirm SVF New Medical Technology Indications
Not all knee osteoarthritis patients are recommended SVF.
We confirm whether they fall under KL grade 2~3, the main target of current new medical technology.
STEP 3. Autologous Fat Harvesting
Fat necessary for treatment is harvested from the patient's abdomen, flanks, thighs, etc.
STEP 4. SVF Separation from Fat
The stromal vascular fraction is separated from harvested adipose tissue.
This includes fat-derived stromal and stem cells as well as various regeneration-related cells.
STEP 5. Intra-Articular Knee Injection
Depending on the patient's condition and treatment plan, accurate location is confirmed for intra-articular treatment.
STEP 6. Post-Procedure Rehabilitation and Posture/Strength Management
Treatment does not end with stem cell therapy.
Strength in the quadriceps and gluteal muscles, knee alignment, gait, weight, and other mechanical stresses continuously applied to the knee must be managed together.
These Patients Can Consider Fat-Derived SVF Consultation
✓ Knee pain has persisted for several months or longer
✓ Pain recurs despite conservative treatments like medication and physical therapy
✓ X-ray shows KL 2~3 osteoarthritis diagnosis
✓ MRI confirms cartilage damage
✓ You've heard it is not yet severe enough for artificial joint surgery
✓ You want to review non-surgical treatments first if possible
✓ You want to know which treatment between BMAC and fat-derived SVF is suitable for you
Conversely, in severe end-stage arthritis of KL 4 or severe O-shaped deformity, SVF alone may not be sufficient.
Most Frequently Asked Questions About Fat-Derived SVF
Q1. Do fat stem cells have more cells than bone marrow stem cells?
Generally yes.
Adipose tissue is known as a source richer in mesenchymal stromal/stem cells than bone marrow.
Depending on the study, the cell yield from fat is reported to be tens to hundreds of times higher than bone marrow, but the exact numbers vary depending on harvesting and separation methods.
Q2. Then is fat stem cell treatment unconditionally more effective than bone marrow?
Current evidence does not permit such a definitive conclusion.
The advantage of fat is outstanding cell supply volume and tissue accessibility, but in actual knee osteoarthritis clinical trials, there were studies where the effectiveness difference between fat-derived treatment and BMAC was not clear.
Therefore, selection appropriate to the patient's condition is important.
Q3. Are PRP and fat stem cells the same treatment?
No.
PRP is platelet treatment and not stem cell treatment.
SVF contains multiple cells including fat-derived stromal and stem cells, while the central components of PRP are platelets and growth factors.
Q4. Is SVF a formally recognized treatment?
Autologous fat-derived stromal vascular fraction intra-articular injection for use in knee osteoarthritis was recognized as new medical technology by the Ministry of Health and Welfare.
The main target is KL grade 2~3 knee osteoarthritis.
Q5. If I receive fat stem cell injection, will worn cartilage regenerate like new?
That cannot be guaranteed.
According to current new medical technology, the treatment purpose is pain relief and joint function improvement.
Describing cartilage as completely regenerating to normal condition exceeds current medical evidence.
The Reason for Researching and Performing on Fat Since 2009
During long periods of performing fat transfer, I have not viewed fat merely as tissue for creating volume.
Fat is living tissue containing diverse cells with regenerative capacity.
Starting fat-derived stem cell research and practice in Gangnam in 2009, and subsequently performing over 15,000 stem cell fat transfer procedures, I have accumulated experience in regenerative therapy using fat.
Now, as fat-derived SVF is recognized as new medical technology in knee osteoarthritis, the scope of regenerative medical applications of fat is expanding from skin and fat transfer to the joint region.
If You Are Considering Fat-Derived Stem Cell SVF Knee Treatment in Dasan, Namyangju
The first question you should ask is not
"How many stem cells are injected?"
Instead,
"What stage is my knee osteoarthritis?"
"Is my pain really caused by cartilage damage?"
"Do I meet the indications for SVF new medical technology?"
should be confirmed.
After that, you should decide which of fat-derived SVF, bone marrow-derived BMAC, PRP, conventional injection therapy, or exercise/rehabilitation therapy is most appropriate.
At seoul chungdam dr ahnapa clinic, an anesthesiology and pain medicine specialist directly evaluates the patient's knee condition, and based on the clinical experience in fat regenerative medicine continuing since 2009, we provide consultation on the suitability of fat-derived SVF treatment.
Summarizing the Key Points
Fat-derived SVF is a knee osteoarthritis new medical technology recognized by the Ministry of Health and Welfare.
Compared to bone marrow, fat has the advantage of being able to abundantly obtain mesenchymal stromal and stem cells.
BMAC is treatment obtained from bone marrow, and SVF is treatment obtained from fat.
PRP is not stem cell treatment.
And most importantly,
choosing treatment "suited to my knee condition" over "treatment with many cells" is key.
seoul chungdam dr ahnapa clinic
Dasan New City, Namyangju-si, Gyeonggi-do
Knee osteoarthritis · Non-surgical pain treatment · Autologous fat-derived SVF consultation
If you are looking into non-surgical treatment for knee osteoarthritis in northern Gyeonggi such as Dasan, Guri, Byeolnae, Uijeongbu, Yangju, and Pocheon, please first confirm your current joint condition and treatment indications.
Medical Precautions
All medical procedures including SVF and BMAC may cause side effects such as pain, bleeding, and infection depending on the individual. Treatment results may vary depending on individual joint condition. Recognition of new medical technology does not guarantee efficacy or cartilage regeneration in all patients, and the decision to perform specific procedures is made after consultation and imaging tests.