Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force

Sir: We read with interest the article entitled “Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force” (Plast Reconstr Surg. 2009;124:272–280). We would like to congratulate Dr. Gutowski and the ASPS Fat Graft Task Force for their publication, providing a systematic, evidence-based review about fat grafting for aesthetic and reconstructive purposes. This study offers a graded summary of the evidence about indications, techniques, patient selection, and complications. Concerning the listed “current and potential applications” of autologous fat grafting, we would add some reconstructive indications, which we showed in recent articles (evidence level, IV to V). After the first case series published in February of 2008, we verified the safety and effectiveness of scar remodeling by fat graft in more than 250 patients, including outcomes of burn, trauma, radiation damage, chronic ulceration, and peripheral nerve entrapment.1–5 We found that the procedure is suitable in each body area in cicatricial areas at least 12 months after injury. We observed a significant improvement in texture, color, softness, quality of skin and subcutaneous tissue, and functional motility and pain. Histologic examination after treatment showed patterns of neoangiogenesis and regularization in collagen deposition. Patients were satisfied with the procedure and the results. The role of lipostructure and biological mechanisms in regenerative surgery are discussed. An active role and differentiation of adult mesenchymal stem cells from the stromal fraction of transplanted fat have been suggested, but it is unclear which is the relative role of the molecular components and surrounding microenvironment in modulating cicatricial remodeling. In our experience and after this evidence,1–5 the application of autologous fat transplantation to mature scar treatment should be included in its current indications, providing new perspectives of reconstructive and regenerative surgery. Federico Villani, M.D. Fabio Caviggioli, M.D. Silvia Giannasi, M.D. Marco Klinger, M.D. Francesco Klinger, M.D. Cattedra di Chirurgia Plastica Università degli Studi di Milano U.O. Chirurgia Plastica 2 IRCCS Istituto Clinico Humanitas Rozzano, Milan, Italy