Particle size in fat graft retention: A review on the impact of harvesting technique in lipofilling surgical outcomes

Abstract

Fat grafting popularity continues to rise among plastic surgeons. As a soft tissue filler, adipose tissue had many desirable attributes: it is easy to obtain, autologous, and may reintegrate into recipient sites. However, fat grafting is clinically plagued by unpredictable resorption rates, thus there is much interest in optimizing the procedure of fat grafting for consistent graft volumes. Fat harvesting, a part of fat transfer surgery, involves the removal of adipose tissue from the donor site. Different harvest procedures, such as whole fat excision or liposuction cannulas, result in a range of fat particle volumes, which may play a role in the cellular stability of grafts. The ideal harvesting technique and fat particle diameter is not currently known. This study aims to review the literature on the impact of fat particle size and clinical fat grafting outcomes, to present overarching conclusions, and to provide future directions for study. Current evidence supports excisional methods and larger bore cannulas to minimize cellular damage, preserve the native architecture, and maximize the number of cells within fat particles.

Keywords: adipocyte viability; clinical translation; fat grafting; fat particle; lipo harvesting; liposuction.

Figure 1.

During the first 3 months of tissue remodeling, adipocytes have 3 different fates depending upon their microenvironment and proximity to the surface of the fat particle. Adipocytes in the outermost layer are able to obtain sufficient nutrients through diffusion and survive. Mature adipocytes within the middle layer are unable to withstand the hypoxic conditions, however stem cells are able to survive and proliferate when blood supply is reestablished. All cells within the core die independent of maturity and eventually undergo cicatrization or form oil cysts.