Acharya Pawan, Mohammed Cara, Desai Arusha, Rojas Gomez Maria Camila, Sunil Gopika, Duran S Patricio Xavier, Kocaekiz Sami, Thottakurichi Abrar Ahmed, Munoz Ibzan Janier Gonzalez, Chavez-Alvarez Luis Antonio, Binny Vivasvat, Rai Manju
Surgery, Charing Cross Hospital, London, GBR.
Orthopaedic Surgery, Sangre Grande Hospital, Sangre Grande, TTO.
Cureus. 2025 Jul 22;17(7):e88493. doi: 10.7759/cureus.88493. eCollection 2025 Jul.
Autologous fat grafting (AFG) is increasingly utilized in aesthetic and reconstructive surgery owing to its biocompatibility, regenerative properties, and ease of harvest. However, inconsistent graft retention rates pose a persistent clinical challenge. This review explores contemporary advancements aimed at improving fat graft survival and volume retention. Biological enhancements, such as platelet-rich plasma (PRP), stromal vascular fraction (SVF), and adipose-derived stem cells (AdSCs), have demonstrated efficacy in promoting angiogenesis, reducing fibrosis, and improving graft integration. Emerging strategies, including vitamin E (VE) augmentation, compact fat grafting, and soluble molecule preconditioning with agents like deferoxamine (DFX) and vascular endothelial growth factor (VEGF), have shown promise in experimental and clinical models. The synergistic use of PRP and AdSCs yields higher growth factor expression, enhancing tissue viability. Innovations like Botulinum Toxin-A (BoNTA) for muscle immobilization, concentrated de-oiled fat (CDF), and biodegradable scaffolds further contribute to improved outcomes. Site-specific adaptations - for craniofacial, breast, and gluteal regions - demonstrate tailored approaches that enhance regional graft viability. Despite these advancements, standardization remains a barrier due to methodological heterogeneity in harvesting, processing, and application. Furthermore, while preliminary results from clinical trials are encouraging, long-term data and larger cohorts are required to validate safety and effectiveness. Future research should focus on optimizing stem cell enrichment protocols, biomaterial integration, and understanding molecular pathways that govern graft survival. Collectively, these evolving strategies represent a significant leap forward in maximizing the functional and aesthetic benefits of fat grafting, heralding a new era of regenerative plastic surgery.
由于自体脂肪移植（AFG）具有生物相容性、再生特性且易于获取，其在美容和重建手术中的应用日益广泛。然而，移植保留率不一致仍然是一个持续存在的临床挑战。本综述探讨了旨在提高脂肪移植存活率和体积保留率的当代进展。生物增强剂，如富血小板血浆（PRP）、基质血管成分（SVF）和脂肪来源干细胞（AdSCs），已证明在促进血管生成、减少纤维化和改善移植整合方面具有疗效。新兴策略，包括维生素E（VE）增强、致密脂肪移植以及用去铁胺（DFX）和血管内皮生长因子（VEGF）等试剂进行可溶性分子预处理，在实验和临床模型中已显示出前景。PRP和AdSCs的协同使用可产生更高的生长因子表达，增强组织活力。肉毒杆菌毒素A（BoNTA）用于肌肉固定、浓缩脱油脂肪（CDF）和可生物降解支架等创新进一步有助于改善结果。针对颅面部、乳房和臀部区域的特定部位适应性调整展示了增强区域移植活力的定制方法。尽管有这些进展，但由于采集、处理和应用方法的异质性，标准化仍然是一个障碍。此外，虽然临床试验的初步结果令人鼓舞，但需要长期数据和更大的队列来验证安全性和有效性。未来的研究应专注于优化干细胞富集方案、生物材料整合以及理解控制移植存活的分子途径。总体而言，这些不断发展的策略代表了在最大化脂肪移植的功能和美学益处方面的重大飞跃，预示着再生整形外科的新时代。
