Autologous fat grafting: Latest insights

Abstract

A recent rise in the use of autologous fat transfer for soft tissue augmentation has paralleled the increasing popularity of liposuction body contouring. This creates a readily available and inexpensive product for lipografting, which is the application of lipoaspirated material. Consistent scientific proof about the long-term viability of the transferred fat is not available. Clinically, there is a reabsorption rate which has been reported to range from 20 to 90%. Results can be unpredictable with overcorrection and regular need for additional interventions. In this review, adipogenesis physiology and the adipogenic cascade from adipose-derived stem cells to adult adipocytes is extensively described to determine various procedures involved in the fat grafting technique. Variables in structure and physiology, adipose tissue harvesting- and processing techniques, and the preservation of fat grafts are taken into account to collect reproducible scientific data to establish standard in vitro and in vivo models for experimental fat grafting. Adequate histological staining for fat tissue, immunohistochemistry and viability assays should be universally used in experiments to be able to produce comparative results. By analysis of the applied methods and comparison to similar experiments, a conclusion concerning the ideal technique to improve clinical outcome is proposed.

Keywords: ASC; CAL; Cell; Fat grafting; Lipofilling; Lipotransfer; White adipose tissue engineering.

Fig. 1

a: typical ASC culture. Cells are spindle shaped, and rapidly expanding. b: culture in adipogenic medium results in a more rounded shape and accumulation of lipid droplets in the cytoplasma, characteristics of adipocytes. c: Lentiviral transduction of green fluorescent protein allows for easy tracking of ASC's in 3D gel constructs. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

a: contour deformation and contracted scar after sacrococcygeal cyst removal at young age. b: restored contours after 2 sessions of lipofilling. c: mammary hypotrophy in a healthy young female patient. d: result after 1 session of lipofilling to the breast.

Fig. 3

A: Status of a breast after tumorectomy and radiotherapy resulting in ischemic changes in the skin and retraction of the scar. B: Results after 2 sessions of lipofilling.