Dr. Patricia Gutiérrez Ontalvilla — Medical Doctor, plastic, reconstructive, and aesthetic surgeon. Scientific researcher specializing in lichen sclerosus and regenerative cells. President of the Nixarian Foundation. National Secretary for Spain at ISAPS. Creator of the Liquenia Protocol.
Reviewed: May 2026 | Published on liquenia.es
Direct answer. Nanofat, SVF (stromal vascular fraction), and lipofilling — also called lipotransfer — are three distinct products obtained from the patient’s own fat. Lipofilling is unprocessed lipoaspirate; it is used only to add volume to the labia majora. Nanofat is emulsified and microfiltered fat, rich in regenerative factors, but without the capacity to provide volume. SVF is the concentrate of regenerative cells obtained exclusively by mechanical digestion: enzymatic digestion with collagenase is prohibited for direct use in patients. Only the combination of nanofat + SVF, applied together, constitutes the Liquenia-SVF protocol for the treatment of lichen sclerosus and vulvar lichen planus.
If you have lichen sclerosus and have started looking for information on regenerative cells, lipotransfer, or regenerative medicine, you have almost certainly come across three words —lipofilling, nanofat, SVF— sometimes used as synonyms and sometimes combined in ways that, clinically, do not make much sense. The confusion is understandable: all three are obtained from the same fat and in the same surgical procedure. But they are distinct products, with different compositions and different functions within the treatment.
In this article, I explain, without unnecessary technical jargon, what each is, what it contains, how it is obtained, and what it is used for within the Liquenia-SVF protocol. And, above all, I explain why the way SVF is obtained is not a minor detail: it is the point where scientifically proven protocols are separated from those that are not.
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Lipofilling or Lipotransfer: The Lipoaspirate As Is
Lipofilling — also called lipotransfer or fat grafting — consists of infiltrating the lipoaspirate obtained during liposuction without isolating any specific component. Beyond a basic wash to remove blood and debris, the fat is infiltrated directly. If you want to delve deeper into the technical principles of lipotransfer and its applications, you can consult lipotransferencia.net, our ecosystem’s specialized resource on the subject.
What does this lipoaspirate contain? Fundamentally adipocytes —the fat cells themselves— and a very small amount of regenerative cells. The concentration of regenerative cells is relatively low because no isolation or concentration process has been performed.
In the Liquenia-SVF protocol, lipotransfer has a very specific and limited function: to provide volume to the labia majora when atrophy exists. Nothing more. It does not treat lichen sclerosus. It does not act on inflammation, does not reverse fibrosis, nor does it modulate the autoimmune response. For that, the other two components are needed.
Nanofat: Emulsified Fat That Regenerates Without Adding Volume
Nanofat is a step beyond lipofilling. The aspirated fat is mechanically emulsified by repeatedly passing it between syringes, through successive filters of different sizes, until particles smaller than 0.5 mm are obtained. The result is a fluid, almost liquid suspension, which no longer has the consistency to provide volume —the adipocytes have been destroyed in the process— but is rich in all other biologically active components of the fat.
Nanofat contains stromal fraction, growth factors, regenerative cells, and anti-inflammatory mediators in an injectable format for the most superficial layers of the skin. It is the component that acts directly on the tissue damaged by lichen: it improves the texture, coloration, and elasticity of the vulvar mucosa.
Nanofat acts on damaged skin, improving its texture, coloration, and resistance. It is the fraction that reaches the dermis and prepares the ground for the deep action of SVF.
Dr. Patricia Gutiérrez Ontalvilla
But nanofat alone is not enough to treat lichen sclerosus. Without the concentration of regenerative cells provided by SVF, the regenerative effect is partial. That is why the Liquenia-SVF protocol always combines them.
SVF: the concentrate of regenerative cells. And only by mechanical digestion
The stromal vascular fraction (SVF) is the cell concentrate obtained from fat through a digestion and separation process. It contains adipose-derived mesenchymal stem cells (ADSCs), pericytes, endothelial cells, growth factors, and exosomes. In volume, it is small —2 to 3 cc— but in cell content, it is the most potent of the three components.
In my clinical experience, these cells produce the maximum therapeutic effect in lichen sclerosus. What I explain to my patients in consultation is that SVF is what modulates the autoimmune response, reduces inflammation, reverses stromal fibrosis, and stimulates the formation of new blood vessels. And it is not a statement based on clinical intuition: it is confirmed by biopsies from the study I published in 2025 in the Aesthetic Surgery Journal, showing a significant reduction in stromal hyalinization, a decrease in CD3+ T lymphocyte infiltrate, and an increase in microvascular density.
⚠️ Mechanical digestion vs. enzymatic digestion: a difference that is not optional.
Enzymatic digestion with collagenase is prohibited for direct use in patients. In Europe and under FDA regulations in the United States, SVF obtained with collagenase cannot be applied in consultation or in a conventional operating room.
In the Liquenia-SVF protocol, SVF is obtained exclusively through mechanical digestion with the LipoCube device, which performs microfragmentation of adipose tissue followed by low-speed centrifugation to isolate the stromal vascular pellet. This process preserves cell integrity and complies with current minimal manipulation regulations.
If, in any context, you are offered a “regenerative cell therapy for lichen” without specifying that the SVF is obtained by mechanical digestion, that is a question you should ask. The method of obtaining it is not a technicality: it determines whether the treatment is legal, safe, and reproducible.
Comparative Table: Lipofilling, Nanofat, and SVF at a Glance
| Lipofilling (lipotransfer) | Nanofat | SVF | |
|---|---|---|---|
| What it is | Aspirated fat as is, unprocessed beyond basic washing | Emulsified and microfiltered fat: particles <0.5 mm, no volumetric capacity | Cell concentrate obtained from fat by mechanical digestion: 2-3 cc rich in regenerative cells |
| What it contains | Adipocytes (fat cells) | Stromal fraction, growth factors, regenerative cells. No viable adipocytes | Mesenchymal stem cells (ADSCs), pericytes, endothelial cells, growth factors, exosomes |
| How it is obtained | Lipoaspiration + washing | Lipoaspiration + mechanical emulsification through successive filters | Lipoaspiration + mechanical digestion (LipoCube). NEVER by collagenase |
| Function in Liquenia-SVF | Volume in labia majora. Does not treat lichen | Dermal regeneration of affected vulvar tissue | Deep tissue regeneration: anti-inflammation, immunoregulation, angiogenesis |
| Does it treat lichen on its own? | No | Only in combination with SVF | Only in combination with nanofat |
How They Work Together in the Liquenia-SVF Protocol
In a single session, the protocol combines the three components sequentially. We apply it as follows:
- Lipofilling (microfat) in labia majora: only in patients with documented atrophy. Restores lost volume.
- Nanofat in vulvar and perianal area: infiltrated into the superficial dermis and subdermal layer of the labia minora, clitoral hood, fourchette, and perianal area. Regenerates texture and prepares the tissue.
- SVF: concentrate of regenerative cells that acts deeply. It modulates the autoimmune response, reverses fibrosis, and stimulates angiogenesis.
All three components are obtained from the patient’s own lipoaspirate in the same surgical procedure. Liposuction is performed in the infraumbilical area or on the inner thighs under general anesthesia. The entire process lasts between 60 and 90 minutes. You can find more details about regenerative cell sessions in the corresponding section.
This is also why the protocol cannot be “replicated” by simply adding fat or PRP. Without the mechanical digestion process to isolate SVF, there is not enough concentration of regenerative cells to produce the histological changes documented in our biopsies. This is exactly the difference I explain in this other article about PRP, myths, and the Liquenia protocol.
What About Vulvar Lichen Planus?
The biological basis of the protocol —regenerative cells with anti-inflammatory and immunomodulatory properties derived from the patient’s own adipose tissue— is also relevant for vulvar lichen planus. The autoimmune mechanisms underlying both dermatoses share elements. The candidacy assessment for lichen planus, as for lichen sclerosus, is always performed individually during consultation.
An important note. Vulvar lichen sclerosus is a chronic inflammatory disease of autoimmune origin. According to the guidelines of the International Society for the Study of Vulvovaginal Disease (ISSVD 2022), there is currently no curative treatment. The Liquenia-SVF protocol produces tissue regeneration documented by biopsy and significant improvement in symptoms, but continued clinical follow-up is still necessary.
Download the scientific guide to the Liquenia-SVF protocol
Data, biopsies, and frequently asked questions in a downloadable PDF.
Frequently asked questions
Is lipotransfer the same as lipofilling?
Yes. Lipotransfer, lipofilling, and fat grafting are three ways of referring to the same procedure: the transfer of autologous fat obtained by liposuction and reinjected into another area of the body without additional processing. In the Liquenia-SVF protocol, it is used only to provide volume to the labia majora when there is atrophy; it does not act on lichen sclerosus.
Are nanofat and SVF the same as PRP?
No. PRP (platelet-rich plasma) is obtained from blood, not fat. It contains platelet growth factors but NOT regenerative cells. Nanofat and SVF are obtained from adipose tissue and contain mesenchymal stem cells, pericytes, and endothelial cells, in addition to growth factors. They are distinct components, with distinct mechanisms of action.
Can I have only nanofat without SVF?
Technically, yes. In fact, the first Liquenia clinical trial (2022) combined nanofat with PRP, without SVF, with good results. The protocol evolved to nanofat + SVF because the isolation of the cell concentrate by mechanical digestion increases the concentration of regenerative cells and improves histological results. Today, the standard at the Nixarian Institute is always nanofat + SVF.
What is mechanical digestion and why is it important?
Mechanical digestion is the process by which adipose tissue is fragmented using a specific device —in this case, the LipoCube— without using enzymes or chemical agents. The result is a concentrate of stromal vascular cells that complies with the “minimal manipulation” regulations and can be legally used in a conventional operating room. Enzymatic digestion with collagenase, however, is prohibited for direct use in patients.
Why is lipofilling not used more to treat lichen sclerosus?
Because lipofilling —lipoaspirate without isolation or concentration— does not have the necessary concentration of regenerative cells to produce the histological changes documented in biopsy. It provides volume, useful for atrophy of the labia majora, but does not act on autoimmune inflammation or reverse fibrosis. For this, SVF isolated by mechanical digestion is needed.
Is the Liquenia-SVF protocol scientifically endorsed?
Yes. The results are published in Aesthetic Surgery Journal by Oxford University Press (2025, DOI: 10.1093/asj/sjaf148) and in Aesthetic Plastic Surgery (2022, DOI: 10.1007/s00266-021-02718-1). I am the first author of the ISAPS clinical practice guideline on regenerative management of vulvar lichen sclerosus (2025, DOI: 10.1007/s00266-025-05459-7), published by Springer.
References
- Gutiérrez-Ontalvilla P et al. Mechanical Stromal Vascular Fraction and Nanofat for Vulvar Lichen Sclerosus. Aesthetic Surgery Journal. Oxford University Press, 2025. DOI: 10.1093/asj/sjaf148
- Gutiérrez-Ontalvilla P et al. The Use of Autologous Adipose-Derived Stromal Vascular Fraction (SVF) and PRP for Vulvar Lichen Sclerosus. Aesthetic Plastic Surgery, 2022. DOI: 10.1007/s00266-021-02718-1
- Gutiérrez-Ontalvilla P et al. ISAPS Clinical Practice Guideline on Regenerative Management of Vulvar Lichen Sclerosus. Aesthetic Plastic Surgery, 2025. DOI: 10.1007/s00266-025-05459-7
- ISSVD. 2022 Clinical Practice Guidelines on Vulvar Lichen Sclerosus.
Dr. Patricia Gutiérrez Ontalvilla is a medical doctor and a plastic, reconstructive, and aesthetic surgeon, specializing in vulvar lichen sclerosus and regenerative medicine. She is President of the Nixarian Foundation, National Secretary for Spain at ISAPS, and creator of the Liquenia-SVF Protocol. She has published in Aesthetic Surgery Journal (Oxford University Press) and is the first author of the ISAPS 2025 clinical guideline on regenerative management of vulvar lichen sclerosus.
