Principles and Applications of Fat Grafting in Plastic Surgery

Abstract

Autologous fat transplantation has become increasingly popular in recent years. Its biocompatable properties and availability made it a widely used treatment modality for soft tissue augmentation and volume replacement in both reconstructive and aesthetic plastic surgery. Multiple protocols and clinical applications have been described in the literature, with wide variations in the harvesting, processing, and injection techniques. In this review, the authors will discuss the basic principles and clinical applications of fat grafting in plastic and reconstructive surgery. The article will then conclude with a discussion of fat grafting limitations as well as potential future applications, giving the reader a well-rounded understanding of autologous fat transfer.

Keywords: adipose derived stem cells; autologous fat transfer; fat grafting; lipofilling; regeneration; volume augmentation.

Fig. 1

Only microdroplets with radii less than 1.6 mm will completely revascularize and survive.

Fig. 2

Sprinkle micrograft delivery is performed to maximize graft-to-recipient interface.

Fig. 3

Stoichiometry of fat grafting principle as described by Khory et al in 2017. To create a surviving graft–recipient complex, a unit graft (G) has to interact with a capillary recipient site (R). If only four recipient sites (4R) are available, adding 10 grafts (10G) will at best result in four surviving grafts (4RG) and six necrotic grafts, with 40% graft survival rate. By carefully adding the maximum amount of grafts a recipient site can tolerate, the procedure will yield 100%graft survival.