A study of the reconstructive role of autologous fat graft and future application in regeneration

Abstract

Autologous fat graft was first reported for reconstruction of lower eyelid scar in literature in the 18th century. However, the result was unpredictable and varied amongst surgeons. Over the years, the techniques of harvesting, processing and injection have evolved and been standardized, such that recent results have become more reliable and the technique is now widely applied in clinical use. It can be used for reconstruction as well as aesthetic purpose. It can correct craniofacial depression, breast contour defects, cleft deformities and scars. Facial rejuvenation and breast augmentation can also be achieved. The surgery is simple and the recovery time is short. Compared to autologous tissue flap or implant reconstruction, fat grafting has minimal donor morbidities and long-term complication. Fine contouring of the defect is also feasible and this is difficult to achieve with flap or implant. The drawback of fat graft is that repeated procedures are sometimes needed. Thus, the treatment period can be prolonged. During period of 2005 to 2015, fat grafting was applied to treat patients with craniofacial depression, breast contour defects, cleft deformities and scars at Queen Mary Hospital. The demographic data, outcome and morbidities were studied. The result was satisfactory in most patients and there were minimal operative morbidities. Fat graft was also showed to be more than a filler in the study. It improved skin texture, soft tissue quality and fibrous contracture. These could be explained by the regenerative effect of fat graft. Adipose derived stem cells were demonstrated in the fat graft. These cells could differentiate into different kinds of cells in the body and also helped facilitate tissue regeneration. Adipose derived stem cells can be isolated from fat graft by enzymatic dissociation in the form of mixture with endothelial cells, pericytes and some blood cells. The procedure is expensive and time consuming. There is also stringent government regulation on its use. A simplified isolation process can facilitate its clinical use. Application of fat graft in regeneration will attract attention in the coming future. More applications of fat grafting and adipose derived stem cells are going to be explored.