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Some things to consider when deciding between liposuction versus bone marrow aspirate for obtaining stem cells.

To date, there are no randomized, clinical controlled studies comparing liposuction derived stem cell therapy versus bone marrow aspirate stem cell therapy for any musculoskeletal disease or injury.

When deciding between the two elective procedures then one must consider the procedures and the risks.

Adipose Derived Stem Cells:

Adipose tissue is obtained via liposuction or lipoaspiration.  A tumescent liposuction is performed by injecting a large solution of saline, lidocaine, and epinephrine (1 to 3 liters) into the subcutaneous fat layer of your abdomen or buttock to make the fat swollen and firm (tumescent) and then after a 30 minutes of percolating, a cannula is inserted and with slow to and fro motion (think of carving a turkey or playing the violin) the fat is damaged and sucked out.

The lipoaspirate then has to be processed to obtain the stem cells, which can be processed mechanically (think of making butter with marbles) or enzymatically via digestion and addition of chemicals.  Reference link.

Here is one depiction of a mechanical method at Research Gate:

Here is a depiction of an enzymatic process, Bio-Protocol, visit link to see the list of 29 reagents and materials and the 27 steps involved.  You do not want any of these reagents in your body as they are harmful and not studied for human use.

Cell yields from mechanical methods are contaminated, highly variable, and extremely low in nucleated cell counts, with counts as low as 10,000 to 240,000 per ml.  This is the method used by New York and other New Jersey regenerative institutes as enzymatically processing adipose tissue for stem cell use is not approved in the U.S.  

It is illegal because the addition of chemicals to your adipose tissue make your fat a drug and drugs have to be rigorously studied and regulated to make sure they are safe for human use.  And those chemicals used to process your fat, that eat away your fat, that are toxic if touched by your skin, will be injected back into your tendons and joints without oversight or testing.  To bypass this problem, companies have come up with mechanical methods of separating out your stem cells from your fat but these methods are highly variable, inefficient, and produce fat fluid that are low in stem cell counts and highly contaminated.  These are the methods you are paying thousands of dollars for in other regenerative institutes.

Compare these numbers to Dr. Silberman's method which yields an average of 37 million nucleated cells per ml from bone marrow aspirate, with the addition of no additives, chemicals, or enzymes. Reference link.

What are the risks of liposuction?

Complications of liposuction include disfiguration, infection including deadly necrotizing fasciitis, abdominal wall injury, bowel herniation, bowel perforation, bleeding, hematoma, seroma, lymphedema, pulmonary embolism, deep vein thrombosis, lidocaine toxicity and cardiac events, and pulmonary edema.  Reference link.

The mortality rate of liposuction performed by cosmetic surgeons is estimated to be 1 out of 5224 procedures, or an estimated 20 out of 100,000 procedures.  The fatality rate of U.S. motor vehicle accidents is 16.4 deaths per 100,000 motor vehicle accidents.   Reference link.

In another study, a 21.7% minor complication rate and a .38% major complication rate are reported.   Minor complications include palpable and visible permanent deformity, seromas (fluid collections), hyperpigmentation of the skin, cutaneous slough, and   infection.  

Bone Marrow Aspiration Derived Stem Cells:
Bone marrow aspiration using a marrow cellution needle that Dr. Silberman uses involves numbing the iliac bone, insertion of the needle, removal of 10cc of bone marrow aspirate, 5cc for one joint, and then injecting the bone marrow aspirate directly back into the injured or diseased location.  Direct from your body, back in to you body.

Are bone marrow aspirations painful?  Perception of pain is different for everybody but for most, as we collect more data, pain appears to be at its worst a level of 4 out of 10 while for some it is a 1 of 10, and that is not from the needl going in which is not felt due to local lidocaine, but discomfort from the negative pressure of aspirating the stem cells from a closed space.

Bone marrow aspirations are not painful.  I repeat bone marrow aspirations are not painful.  If a bone marrow aspiration is painful it is usually due to one of the following: insufficient amount of local anesthetic, incorrect placement of local anesthetic, and incorrect placement of the bone marrow needle in a site on the bone NOT anesthetized.   If the correct amount of anesthetic is used, usually 10cc of lidocaine directed and infiltrated along the lining of the iliac crest, and the bone marrow needle is placed in the same location as where the local anesthetic was directed, one would expect to experience mild discomfort to no pain at all, which is the experience of the author’s
patients.  Dr. Silberman teaches attending physicians, fellows, residents, and medical students.

What are the risks of bone marrow aspiration?
In a study of 19,259 bone marrow procedures (13,147 bone marrow aspirations plus a bone marrow biopsy, which are NOT done for musculoskeletal stem cell procedures, and 6,112 bone marrow aspirations alone), 16 adverse events occurred, representing a rate of 0.08% of all procedures.  Bleeding occurred in 11, infection in 2, persistent pain in 2, and a serous leak in 1 who suffered from cancer and kidney disease.  Out of the 11 who had bleeding, 10 of them had one or more risk factors for bleeding, which included myeloproliferative disorder (bone marrow cancer), aspirin treatment, Coumadin treatment, platelet disease, renal impairment, disseminated intravascular coagulation.   And out of the 11 bleeding events, 10 occurred in those who had a bone marrow
aspiration AND a bone marrow biopsy (removal of bone core that I repeat again, is not done in musculoskeletal aspiration for stem cell procedures).  The risk of bleeding then appears to be .005 % for a bone marrow aspiration performed on a hematology patient with cancer or suspected cancer with no evident risk factors for bleeding.  And the risk of infection appears to be .01%.   Reference: Bain, Bone Marrow Biopsy Morbidity: review
of 2003, J Clin Pathol. 2005 Apr; 58(4): 406–408.

Compare that to the risk of a serious complication from a total knee replacement which is reported to be about 2%, with the 30 day risk of mortality following a total knee replacement 0.25%.  An estimated 25X higher risk for adverse event in a total knee replacement exists compared to a bone marrow aspiration.

And the complication risk of shoulder arthroscopy is estimated to be 5 to 10%.
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