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The Future of Facial Fat Grafting

Brooker, Jack E., MD*; Rubin, J. Peter, MD*,†,‡; Marra, Kacey G., PhD*,†,‡

Journal of Craniofacial Surgery: May 2019 - Volume 30 - Issue 3 - p 644–651
doi: 10.1097/SCS.0000000000005274
Original Articles

Fat grafting was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion. Significant improvements in reliability have been made in the last 2 decades and there is a large body of literature pertaining to extraction, processing and injection methods to obtain more lasting effects. However, volume loss and graft resorption remain a major challenge in the long term and lead to unpredictability in results. Enriching adipose graft with stromal vascular fraction, ex vivo cultured adipose stem cells and platelet-derived growth factor among others is one method under active investigation which may assist graft survival through a range of mechanisms including increased angiogenesis. Breaking adipose graft into smaller fragments such that engrafted cells have greater access to donor-site oxygenation and nutrition is another method which in theory may promote survival. Presently, adipose grafting in the face is usually for the addition of volume to fill defects. However, the stem-cell containing fraction of adipose grafting (stromal vascular fraction) appears to exert a rejuvenating effect on overlying skin and soft tissue when administered alone. The application of these low-volume injections represents a significant shift in thinking away from mere volume expansion. These techniques have been tested in a range of animal models and some human studies. In this review, the authors provide a broad overview of present research and highlight both limitations in previous research and current areas of investigation.

*Department of Plastic Surgery

Department of Plastic Surgery, Department of Bioengineering, McGowan Institute of Regenerative Medicine

Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.

Address correspondence and reprint requests to Kacey G. Marra, PhD, Biomedical Science Tower, 200 Lothrop Street, Pittsburgh, PA 15213; E-mail:

Received 29 August, 2018

Accepted 22 September, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.