Adipose tissue is an abundant source of mesenchymal stem cells. The use of transplantation of preadipocytes and adipocytes to restore the volume of tissues has added a lot to the value of fat transplantation strategies. These cells are more advantageous as a cell source than mature adipocytes. They are capable of both proliferating to obtain larger cell numbers and of differentiating to obtain the tissue of interest. This study aims to compare the results of traditional fat injection and

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... ed adipose derived mesenchymal stem cells injection enriched with platelet rich fibrin matrix in augmentation and rejuvenation of the distal leg. Patients and Methods: The study was conducted on 14 patients who had fat injection of the leg. They were divided into 2 groups: 7 cases by traditional fat injection and 7 cases by injection of (PRFM) with the adipose derived mesenchymal stem cells. Post-operative assessment at 3, 6, 18 months were done subjectively. Patients in group 11 were subjected to monthly injection of platelet rich plasma. The final results in each patient were evaluated according to the comparison of pre-and post-operative photos and measurements of circumference for the degree of improvement by the patients. Three populations including the patient herself, a surgeon not involved in the procedure and nurse were subjected to standardized questionnaire. Results: All patients were treated bilaterally, they knoticed that the use of fat grafting not only provided a volumetric effect but also improved the quality of skin. They felt their skin is thicker, firmer with less wrinkles and pigmentation and less need for moisturizers. Conclusion: Mixing fat containing activated mesenchymal stem cells with platelet rich fibrin matrix gave better long lasting results than traditional fat injection as regarding both volume and skin quality.