Autologous Fat Grafting in Facial Cosmetic Surgery: A National Survey

Autologous fat grafting (AFG) is a popular modality for restoring facial volume deficits using the patients' own lipoaspirate. Fat grafting offers the potential for permanent augmentation but carries the downside of an unpredictable reabsorption rate. There is a lack of data on the current practice patterns of facial plastic surgeons with regard to techniques for harvesting, processing, and delivering autologous fat. Understanding current trends is critical to the planning of relevant and useful clinical research with the goal of improving AFG outcomes.

This study was approved by an institutional review board. In January 2020, a web-based anonymous survey consisting of a 16-item questionnaire was sent to all 1,096 actively practicing and fellowship-trained members of the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS). Two reminder e-mails were sent at 2-week intervals.

A total of 164 surveys were completed, with a 15% survey response rate. The majority of respondents practice in the United States (95.6%). Most respondents have more than 10 years of experience after fellowship (67.5%) and devote at least 70.0% of their practice to cosmetic procedures (69.6%).

Most respondents incorporate fat grafting into facial rejuvenation procedures: 36.0% use AFG often or always, 35.4% sometimes, 18.0% rarely, and 10.6% never use AFG. Of those who utilize AFG, the mean number of transfers performed annually was 25.3 (range: 1–100; standard deviation: 24.1). Survey responses regarding AFG harvesting and injection techniques are shown in [Table 1]. The majority of surgeons harvest fat using a blunt cannula and syringe (70%) followed by the Coleman technique (15.7%). The most common cannula sizes used for harvesting are 2 or 3 mm (70.1%). Fat is injected using a cannula by 95.4% of respondents and with a needle by 4.6%. The preferred gauges for injection are 18 gauge (38.7%) and 21 gauge (30.7%). Most surgeons limit the interval between harvest and injection to under 30 minutes (70.2%). The average volume of fat used to augment different facial subunits is shown in [Fig. 1] and ranges from 1.5 mL in the tear trough to 4.0 mL in the malar region. The most utilized processing techniques are shown in [Fig. 2] and include centrifugation (39.3%), washing (20.7%), and decantation (18.6%). The majority of surgeons (81.2%) aim to overcorrect defects to some degree, most commonly between 10 and 20% (53.1%).

Table 1 Autologous fat grafting techniques used by survey participants

	Number of respondents (%)
Preferred fat harvesting technique
Manual aspiration with blunt cannula and syringe	98 (70.0%)
Coleman technique	22 (15.7%)
Power-assisted aspiration	10 (7.2%)
Excision	3 (2.1%)
Other	7 (5.0%)
Average time between harvesting and injection
0–30 min	94 (70.2%)
31–60 min	29 (21.6%)
61–90 min	8 (6%)
> 91 min	3 (2.2%)
Injection cannula/needle size
14 gauge	6 (4.8%)
16 gauge	24 (19.4%)
18 gauge	48 (38.7%)
21 gauge	38 (30.7%)
23 gauge	8 (6.5%)

Fig. 1 Mean milliliters of autologous fat injected into unilateral facial subsites. Whisker bars indicate standard deviation, and X indicates mean.

Fig. 2 Preferred fat grafting processing techniques of survey respondents.

Most surgeons expect fat reabsorption; 43% estimate that 41 to 60% of fat remains beyond 1 year followed by 28.9% who expect approximately 61 to 80% of fat to remain. A modest percentage of surgeons reported having experiencing complications including contour deformity (19.6%), hematoma (5.5%), infection (3.8%), and lipocalcification (2.4%).

Our survey demonstrates that the majority of facial plastic surgeons utilize AFG for facial rejuvenation. There are strong trends in preference for harvesting with manual aspiration, processing through centrifugation, and delivering fat using 21 gauge or smaller blunt cannulas. Our study was limited by the modest response rate and associated potential for self-selection bias. Future research is needed to directly compare different harvesting and processing methods to determine if one offers superior outcomes.

Publication History

Article published online:
12 April 2021