Autologous Fat Grafting: The Science Behind the Surgery

Abstract

An invaluable part of the plastic surgeon's technical arsenal for soft tissue contouring, fat grafting continues to be plagued by unpredictable outcomes, resulting in either reoperation and/or patient dissatisfaction. Thus, extensive research has been conducted into the effects of adipose tissue procurement, processing, and placement on fat graft quality at both the cellular level and in terms of overall volume retention. Herein, we present an overview of the vast body of literature in these areas, with additional discussion of cell-assisted lipotransfer as a therapy to improve volume retention, and on the controversial use of autologous fat in the setting of prior irradiation.

Facial skin rejuvenation by autologous dermal microfat transfer in photoaged patients: Clinical evaluation and skin surface digital profilometry analysis

“…15 In addition, the absence of a standardized, objective, non-invasive method to evaluate the outcomes of fat transplant makes it difficult to compare results obtained following different procedures or the effects of similar methods on different patients. 16,17 .…”

Fructose 1,6-Bisphosphate as a Protective Agent for Experimental Fat Grafting

“…Fat grafting has been regarded as a promising biomaterial for soft‐tissue reconstruction, because it is readily available; easily obtainable, with low donor‐site morbidity; repeatable; inexpensive; versatile; and biocompatible . However, although fat graft provides good results in the early period, it may disappoint the patient and surgeon in the long term because of its reported resorption rate of 10%–90% . Strategies to reduce the reabsorbed proportion of fat have evolved, and they focus on the surgical technique, donor‐site selection, supplementation of stromal vascular fraction or ASCs, and the addition of growth factors.…”

“…Tan et al have recently shown that the indolamine hormone melatonin promotes survival of fat grafts via reducing inflammation . However, loss of transplanted graft is the result of hypoxia and a lack of nutrients because of ischemia when the implanted tissue does not become fully vascularized to support the metabolic needs of the tissue in the required timeframe. Reducing fat‐graft desorption is still an area that needs further improvement, we may consider to find more efficient agent to enhance survival of the substitute graft under ischemia condition.…”

Lull pgm system: A suitable technique to improve the regenerative potential of autologous fat grafting

“…The most problematic issue is that this decline over time is not foreseeable because it depends on several variables. These include the choice of donor site infiltration, the harvesting technique, the diameter of the cannula, the magnitude of negative pressure utilized, the processing method of the harvested tissue, the reinjection procedure, the content in ADSCs, and the amount and integrity of mature adipocytes …”

“…These include the choice of donor site infiltration, the harvesting technique, the diameter of the cannula, the magnitude of negative pressure utilized, the processing method of the harvested tissue, the reinjection procedure, the content in ADSCs, and the amount and integrity of mature adipocytes. 1 The processing of the collected material is one of the most important topics to be investigated. 10 This issue is still under debate and a unique agreement has not been reached yet.…”