Facial aesthetic fat graft retention rates after filtration, centrifugation, or sedimentation processing techniques measured using three-dimensional surface imaging devices

Abstract

Objective: How to increase the long-term retention rate of autologous fat grafting has been widely discussed. This study aimed to evaluate long-term fat graft retention rates for the most widely used fat processing methods in the area of facial esthetic surgery, including centrifugation, filtration, and sedimentation, using three-dimensional (3D) imaging. Data Sources: PubMed, Embase, Wiley/Cochrane Library, and Web of Science databases were comprehensively searched from inception to July 2018 according to the guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Study Selection: Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, follow-up devices, fat grafting techniques, and clinical outcomes. Patient cohorts were pooled, and fat graft retention rates were calculated. Complications were summarized according to different clinical characteristics. Results: Of 77 articles, 10 clinical studies met the inclusion criteria and reported quantified measurement outcomes with 3D imaging which provide precise volumetric data with approximately 2% standard deviation compared to real volumes. Data of 515 patients were included. Fat grafting retention varied from 21% to 82%. We found filtration and centrifugation techniques could result in better retention outcomes. However, retention varied within each processing technique, with no significant difference among the 3 techniques. Twenty-two complications were reported among 515 patients, including donor-site hematoma (1 case), mild post-operative erythema (2 cases), mild volumetric asymmetries (2 cases), chronic edema (2 cases), overcorrection (2 cases), skin irregularity (6 cases), and headache or dysesthesia (7 cases). Conclusions: Filtration and centrifugation techniques may result in better fat grafting retention outcomes than gravity sedimentation; however, more accurate statistical evidence is needed. Controversies continue to exist with respect to the performance of the different fat-processing techniques in fat graft retention.

Autologous fat graft assisted by stromal vascular fraction improves facial skin quality: A randomized controlled trial

“…1 Autologous fat grafting is widely utilized for reconstructive and esthetic purposes, such as increasing the quality of skin, softening scar tissue, filling a soft-tissue defect, and increasing the projection of body parts, 2 , 3 because it is easily available, biocompatible, natural looking, and non-immunogenic. 4 However, the major obstacle of using fat grafts is the unpredictable and often low graft survival rate, which represents a significant burden for patients, surgeons, and healthcare systems, leading to multiple supplemental surgeries and increased treatment-associated costs. 5 Inadequate tissue vascularization is the main cause of low graft survival.…”

Comparison of Results After Facial Fat Grafting with Filtered and Washed Fat Versus Centrifuged Fat

“…There was a mean score of 7.13 ± 1.81 in the filtered and washed group in our study, while it was 7.7 ± 0.6 and 8.0 ± 1.0, respectively, in the study conducted by Botti et al, 9 Both our study and Botti et al, agreed that there was no difference between the two preparation techniques. Asilian et al, 14 also concluded that there was no difference between the two methods when it came to patient satisfaction; 87.5% and 94% for centrifuged grafts and filtered/washed grafts (p= 0.468), respectively, a conclusion that was shared by the systematic review conducted by Wang et al 15 Conversely, Fulton et al, actively proposed centrifugation as a safe and effective means for preparing the fat graft and reported very good results with the process but did not compare it to any other processing technique. 16 El Sayed et al, stated that traumatic injury to blood vessels during graft harvesting results in extravasation of blood cells into the graft, which may induce an inflammatory reaction at the recipient site; such blood components may not be removed by filtration, and the centrifugation process was thus proposed as the go-to fat graft processing technique.…”

Volumetric Effect and Patient Satisfaction after Facial Fat Grafting

“…The overall visible volumetric effect up to 1 year after grafting observed in our study matches the observed overall effect in previous studies using three-dimensional stereophotogrammetry. 7,10,[12][13][14]21 A one-to-one comparison of the observed effects in the various studies is difficult to perform because of differences in injected volumes, fat grafting techniques, and different evaluated regions between the studies. Notwithstanding these differences in design of the studies, similar effects were reported in general.…”

“…Since the introduction of three-dimensional stereophotogrammetry in the clinical setting, this technique has evolved to be the leading tool for assessing visible volumetric effects as a function of time. 4,[7][8][9] Most clinical studies used three-dimensional stereophotogrammetry to assess the overall visible volumetric effect (i.e., the volumetric effect of the total face). 10,11 Occasionally, attempts have been made to assess local effects too, by manually selecting large, not strictly predefined areas on three-dimensional images.…”