Procedure, applications, and outcomes of autologous fat grafting

Francesco Simonacci, Nicolò Bertozzi, Michele Pio Grieco, Eugenio Grignaffini, Edoardo Raposio, Francesco Simonacci, Nicolò Bertozzi, Michele Pio Grieco, Eugenio Grignaffini, Edoardo Raposio

Abstract

Objective: To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications.

Patients and methods: Literature review of publications concerning autologous fat grafting.

Results: Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The "wet" method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification.

Conclusions: Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

Keywords: Applications; Autologous fat grafting; Outcomes; Procedure.

Figures

Fig. 1
Fig. 1
Lipoaspirate after centrifugation. From top to bottom: First layer of lipids, second layer of fatty tissue, and third layer of blood and local anaesthetics.
Fig. 2
Fig. 2
Adipose-derived stem cells (ASCs). Pellet of ASCs at the bottom of the tube.
Fig. 3
Fig. 3
a. Autologous fat grafting in secondary breast reconstruction. 39 years old patient subjected to mastectomy and recostruction with implants. Before treatment with lipofilling. b. 39 years old patient subjected to mastectomy and recostruction with implants. After treatment with lipofilling at the level of the scar of right breast.
Fig. 4
Fig. 4
a. Autologous fat grafting of burn scars. 25 years old patient with a burn scar with a retracted and hypertrophic burn scar. Before treatment with lipofilling. b. 25 years old patient with a burn scar with a retracted and hypertrophic burn scar. After treatment with lipofilling.

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