Fat Grafting History and Uses

Marc T. Taylor, M.D. and the American Society of Plastic Surgery

Fat grafting is the surgical process by which fat is transferred from one area of the body to another area. Some physicians call the process fat transfer or fat injections. The surgical goal is to “fill” or augment an area with the fat. The technique involves removing the fat by gentle “mini-liposuction,” processing the fat, and then using special tiny cannulas to inject the purified fat into the area needing filling or augmentation. Fat grafting is an excellent way to improve and enhance the cosmetic appearance of the face, breast, hands, feet, hips, and buttocks. Also, medical studies and long term results have shown the therapeutic benefits of fat grafting in the healing of wounds and scars, as well as fat’s ability to repair damage to scar tissue and breast tissue following radiation treatment.

Fat Grafting Process

The process of fat grafting involves three steps:

1. extraction of the fat from the donor area with liposuction
2. decanting, centrifugation, and processing of the fat
3. reinjection of the purified fat into the area needing improvement

In the first step, fat is extracted from a donor area (I usually take it from the lower abdomen) by manual methods using tiny liposuction cannulas with small holes. The fat is then washed with saline and processed with decanting and centrifugation to separate debris, excess fluid, and dead cells from the viable adipose fat cells. In the final step, the fat is injected in tiny amounts as gently as possible with specially designed blunt cannulas or needles throughout the tissues of the recipient area. This is to ensure the fat develops a good blood supply. Although there are exceptions, normally 60-90% of the fat survives and is permanent.

Fat Grafting and Adipose Stem Cells

Fat grafts have increased in use not only for cosmetic purposes, but also because of their regenerative properties. The regenerative properties are due to the high concentration of mesenchymal stem cells (MSCs) resident in the fat tissue. In 2001, a group of Plastic Surgeons published a study describing the great potential for using fat cells in regenerative medicine. This was quite a revelation for the scientific community, as up until that time adult MSCs were predominantly thought of as a bone marrow product. As it turns out, adipose tissue is a much more prolific source of MSC’s than bone marrow. By volume, mesenchymal stem cells (MSCs) are actually 300-500 times more abundant in adipose tissue compared to bone marrow tissue. Coupled with the ease of extraction of adipose tissue (compared to bone marrow), this opened up a whole new chapter for the field of regenerative medicine. Since 2001, we have begun to learn how to unlock the regenerative potential of adipose tissue. Clinically, plastic surgeons are currently using fat grafts for treatments such as rejuvenating the skin, helping to reverse radiation tissue damage, and treating auto immune skin disorders. The future is great for the often times maligned fat cell!