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Roll, Spin, Wash, or Filter? Processing of Lipoaspirate for Autologous Fat Grafting: An Updated, Evidence-Based Review of the Literature

Cleveland, Emily C. M.D.; Albano, Nicholas J. B.A.; Hazen, Alexes M.D.

Plastic and Reconstructive Surgery: October 2015 - Volume 136 - Issue 4 - p 706–713
doi: 10.1097/PRS.0000000000001581
Cosmetic: Original Article
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Background: The use of autologous adipose tissue harvested through liposuction techniques for soft-tissue augmentation has become commonplace among cosmetic and reconstructive surgeons alike. Despite its longstanding use in the plastic surgery community, substantial controversy remains regarding the optimal method of processing harvested lipoaspirate before grafting. This evidence-based review builds on prior examinations of the literature to evaluate both established and novel methods for lipoaspirate processing.

Methods: A comprehensive, systematic review of the literature was conducted using Ovid MEDLINE in January of 2015 to identify all relevant publications subsequent to the most recent review on this topic. Randomized controlled trials, clinical trials, and comparative studies comparing at least two of the following techniques were included: decanting, cotton gauze (Telfa) rolling, centrifugation, washing, filtration, and stromal vascular fraction isolation.

Results: Nine articles comparing various methods of processing human fat for autologous grafting were selected based on inclusion and exclusion criteria. Five compared established processing techniques (i.e., decanting, cotton gauze rolling, centrifugation, and washing) and four publications evaluated newer proprietary technologies, including washing, filtration, and/or methods to isolate stromal vascular fraction.

Conclusions: The authors failed to find compelling evidence to advocate a single technique as the superior method for processing lipoaspirate in preparation for autologous fat grafting. A paucity of high-quality data continues to limit the clinician’s ability to determine the optimal method for purifying harvested adipose tissue. Novel automated technologies hold promise, particularly for large-volume fat grafting; however, extensive additional research is required to understand their true utility and efficiency in clinical settings.

New York, N.Y.

From New York University Institute of Reconstructive Plastic Surgery.

Received for publication February 13, 2015; accepted March 10, 2015.

Disclosure: The authors report no relevant financial or commercial disclosures related to this current work. This particular research received no internal or external grant funding.

Alexes Hazen, M.D., New York University Institute of Reconstructive Plastic Surgery, 305 East 33rd Street, New York, N.Y. 10016,

©2015American Society of Plastic Surgeons