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Strategic Sequences in Fat Graft Survival

Guo, Jimmy; Widgerow, Alan D. MBBCh, MMed, FCS, FACS; Banyard, Derek MD, MBA; Toranto, Jason MD; Wirth, Garrett A. MD, MS, FACS; Paydar, Keyianoosh MD, FACS; Tocco-Tussardi, Ilaria MD; Evans, Gregory R.D. MD, FACS

doi: 10.1097/SAP.0000000000000416
Review Article

Although lipotransfer, or fat grafting, is a commonly used procedure in aesthetic and reconstructive surgery, there is still variability in graft survival and neoadipogenesis from one procedure to the next. A better understanding of the sequential molecular events occurring with grafting would allow us to strategize methods to improve the regenerative potency of the grafted tissue. These steps begin with an autophagic process, followed by the inclusion of stromal vascular fraction and matrix components. By tailoring and modifying each of these steps for a particular type of aesthetic or reconstructive procedure, strategic sequencing represents a dynamic approach to lipotransfer with the aim of maximizing adipocyte viability and growth. In the implementation of the strategic sequence, it remains important to consider the clinical viability of each step and its compliance with the US Food and Drug Administration regulations. This review highlights the basic science behind clinically translatable approaches to supplementing various fat grafting procedures.

From the Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, Orange, CA.

Received June 12, 2014, and accepted for publication, after revision, November 11, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Alan D. Widgerow, MBBCh, MMed, FCS, FACS, Department of Plastic Surgery, Center for Tissue Engineering, University of California, Irvine, 101 S City Dr, Orange, CA 92868. E-mail:

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