Structural fat grafts: the ideal filler?

In the search for injectable subcutaneous fillers, fat harvested, transferred, and placed in the manner previously described has most of the characteristics of an ideal filler. It is biocompatible, versatile, stable, long-lasting, and natural-appearing. The key to successful fat grafting lies in the technique. Harvesting, refinement, and transfer of subcutaneous tissue to provide pure, intact parcels of fat are essential for successful fat grafting. The surgeon also must infiltrate the refined fat parcels into the recipient site so that they survive predictably and uniformly, become integrated into the host tissues, and accomplish the desired structural alteration. The key to attaining these goals is the placement of minuscule amounts of fatty tissue with each withdrawal of the infiltrating cannula. This maneuver maximizes the surface area of contact between the newly transplanted tissues and the recipient tissues. Applying this technique to enact structural volume alteration of the face can result in subtle or striking improvements in the appearance of patients. The ideal substance for soft-tissue augmentation still eludes physicians, but fat grafting through a blunt cannula seems to be the safest of all of the fillers used; in the hands of an experienced surgeon, it can provide long-lasting, natural-appearing structural changes.