Successful Fat Grafting Research Articles

The science behind autologous fat grafting.

IntroductionAdipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation.Material and methodsThe purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable.ResultsA standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue.He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue.ConclusionAdipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles.Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.

Current Clinical Applications of Fat Grafting.

After reading this article, the participant should be able to: 1. Understand the theory and principles behind successful avascular fat transfer; 2. Apply these principles into techniques that yield safe and successful fat grafting operations; 3. Identify the well-established indications and limitations of the various fat grafting operations as well as the indications that require additional clinical and translational research. In this article, the authors summarize the established principles and techniques of fat grafting, discuss debated topics, and present both the well-established and the novel clinical applications of fat grafting.

Fat transfer techniques: general concepts.

Facial volume loss has become widely accepted as one of the contributing factors in global facial aging. Some have even suggested that bony, muscular, fatty, and dermal/epidermal changes are more integral in the aging process than gravitational influence. Although detractors of autologous fat transfer persist, facial autologous fat transfer has become widely utilized as one option for volume restoration. Various techniques in harvesting, processing, and injecting autologous fat have been debated at length without clear guidelines emerging to maximize outcomes. This article aims to present one surgeon's experience in successful fat grafting philosophy and technique. Areas covered will include preparation, harvesting, processing, and injection techniques. The injection techniques are organized by facial region and into the general philosophy and thinking regarding the facial region as well as the specific technique that has been utilized over 7 years and hundreds of successful procedures.

The Facial Autologous Muscular Injection (FAMI) Procedure: An Anatomically Targeted Deep Multiplane Autologous Fat-Grafting Technique Using Principles of Facial Fat Injection

As widely described in the medical literature, facial fat grafting has been limited to the subcutaneous plane, with only vague reference to the muscular plane and deeper tissues. Local infiltration, with or without general anesthesia, is commonly used. The challenges of maintaining volumetric correction, symmetry, and predictability have limited practitioners' confidence in obtaining a desirable result when fat grafting the face. The authors describe a technique for facial fat grafting that targets specific anatomic structures and tissue beds, in effect making the patient's underlying anatomy the template for rejuvenation. Engrafting the muscles of facial expression improves graft retention and therefore predictability and symmetry. The ability to target anatomic structures other than muscle lends itself to the prospect of greater therapeutic advances using adipose-derived stem cells (ADSCs). A set of principles guiding the technique intended to promote successful cellular engraftment is presented. Three illustrative cases are presented, each the result of a single session: two from a 10-year experience of 700 patients by the lead author and one by the corresponding author. The majority of cases (80-90%) needed only a single session for creation of permanent improvement in facial volumes and contours. The facial autologous muscular injection (FAMI) technique offers an anatomically based approach to facial fat grafting with greater predictability and efficiency than current techniques. The principles of the technique put forth apply equally to volumetric enhancements obtained through successful fat grafting and to the promise of ADSCs.

Structural Fat Grafts: The Ideal Filler?

In the search for injectable subcutaneous fillers, fat harvested, transferred, and placed in the manner previously described has most of the characteristics of an ideal filler. It is biocompatible, versatile, stable, long-lasting, and natural-appearing. The key to successful fat grafting lies in the technique. Harvesting, refinement, and transfer of subcutaneous tissue to provide pure, intact parcels of fat are essential for successful fat grafting. The surgeon also must infiltrate the refined fat parcels into the recipient site so that they survive predictably and uniformly, become integrated into the host tissues, and accomplish the desired structural alteration. The key to attaining these goals is the placement of minuscule amounts of fatty tissue with each withdrawal of the infiltrating cannula. This maneuver maximizes the surface area of contact between the newly transplanted tissues and the recipient tissues. Applying this technique to enact structural volume alteration of the face can result in subtle or striking improvements in the appearance of patients. The ideal substance for soft-tissue augmentation still eludes physicians, but fat grafting through a blunt cannula seems to be the safest of all of the fillers used; in the hands of an experienced surgeon, it can provide long-lasting, natural-appearing structural changes.

The current status of autologous fat grafting

The opinion of the majority of surgeons is fat grafting does not work. The fat cells do not survive transfer. Many have attempted the techniques only to become discouraged and abandon it. This article describes certain principles necessary for successful fat grafting: for harvesting use of a large-diameter syringe and needles, an atraumatic method of cleaning the fat cells, and an anaerobic method of storage. A method of autologous fat cell transfer including harvesting, processing, and injection of the fat is described. Long-term results are shown and limitations of the procedure are presented.

The current status of autologous fat grafting.

The opinion of the majority of surgeons is fat grafting does not work. The fat cells do not survive transfer. Many have attempted the techniques only to become discouraged and abandon it. This article describes certain principles necessary for successful fat grafting: for harvesting use of a large-diameter syringe and needles, an atraumatic method of cleaning the fat cells, and an anaerobic method of storage. A method of autologous fat cell transfer including harvesting, processing, and injection of the fat is described. Long-term results are shown and limitations of the procedure are presented.

Experience of injected fat grafting.

Eighteen months' experience with the injected fat grafting technique used in 208 patients to correct various problems such as buttocks (augmentation and reshaping), trochanteric depressions, breast augmentation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg's disease), nasolabial fold, upper outer breast quadrant, liposuction sequela, fingers and hands is presented. This method shows major advantages with few complications. Some technical details and recommendations for successful fat grafting are also presented.