What it means for a patient
- Fat grafting to the face is widely used, but at the time of this review there was no measured proof of how much fat survives.
- Patients reported satisfaction, and surgeons reported that some patients need a second procedure to refine the result.
- The methods listed (abdominal fat, blunt cannula, centrifuging, small injections in many passes) had only slight support in the evidence.
- This is a literature review. It does not report new patient data.
Why this paper matters
It set out the evidence behind each step of facial fat transfer and found that fat survival had not been measured. It called for 3D volume imaging to measure outcomes in a large group of patients.
Overview
Surgeons increasingly use a patient's own fat to add soft-tissue volume to the face, even though results are seen as unpredictable. The authors reviewed the literature and their own techniques. They covered eight steps: the donor site, aspiration method, local anesthesia, centrifugation and washing, exposure to cold and air, added growth factors, reinjection method, and how long fat grafts last.
Findings
- Clinical experience and basic science data showed a slight preference for fat taken from the abdomen.
- Collection with a "nontraumatic" blunt cannula was slightly preferred.
- Preparation by centrifugation, without washing or added growth factors, was slightly preferred.
- Immediate injection of small amounts of fat in multiple passes was slightly preferred.
- Quantitative evidence of fat survival in patients, and of predictable volume restoration, does not exist.
- Reports of patient satisfaction with the procedure do exist.
- Clinicians report that revision procedures are needed to optimize results.
- The literature fails to provide definitive evidence of fat survival.
- The authors propose a large clinical study using three-dimensional volume imaging.
Terms
- Autologous fat transfer: moving a patient's own fat from one body area to another.
- Facial recontouring: changing the shape of the face by adding or moving volume.
- Donor site: the area the fat is taken from.
- Aspiration: removing fat with suction through a cannula.
- Cannula: a thin tube used to remove or inject fat; a blunt cannula has a rounded tip.
- Centrifugation: spinning fat at high speed to separate it from fluid and oil.
- Growth factors: proteins that signal cells to grow or heal.
- Graft survival: the share of transferred fat that stays alive in its new location.
- Three-dimensional volumetric imaging: 3D scanning that measures changes in volume.