Complications of facial autologous fat grafting

Abstract

Autologous fat grafting is a commonly performed procedure for facial volume augmentation and rejuvenation. While overall complication rates in the literature are low, adverse events related to fat grafting can range from minor to systemic and severe. It is crucial that the surgeon be aware of these potential complications, counsel patients appropriately, and take the necessary steps to mitigate these risks. Local graft site complications include contour irregularity, over- or under-volumization, prolonged edema and ecchymosis, fat necrosis, granuloma formation, and infection. Similar complications can also be seen at the donor sites, including contour irregularity, prolonged induration or erythema, infection, and skin pigmentation changes. Finally, the most severe complications, resulting from fat embolism due to intravascular injection, can result in vision loss or stroke. In this review, risk factors for adverse events, surgical techniques to mitigate risk, and potential treatment options for complications of autologous fat grafting are reviewed.

Keywords

Autologous fat grafting complications / volumetric facial rejuvenation

References

[1] Coleman SR.The anatomy of the aging face: volume loss and changes in 3-dimensional topography.Aesthet Surg J2006;26:S4-9

[2] Donofrio LM.Fat distribution: a morphologic study of the aging face.Dermatol Surg2000;26:1107-12

[3] Ilankovan V.Anatomy of ageing face.Br J Oral Maxillofac Surg2014;52:195-202.

[4] Wan D,Rohrich R.The clinical importance of the fat compartments in midfacial aging.Plast Reconstr Surg Glob Open2013;1:e92 PMCID:PMC4174112

[5] Neuber F. Fettransplantation Berich uber die Verhandlungen der Deutschen Gesellscaft fur Chirurgie. Available from: https://www.scirp.org/reference/referencespapers?referenceid=1812808 [Last accessed on 18 Jan 2024]

[6] Illouz YG.The fat cell "graft": a new technique to fill depressions.Plast Reconstr Surg1986;78:122-3.

[7] Coleman SR.Facial recontouring with lipostructure.Clin Plast Surg1997;24:347-67.

[8] (ASPS) ASoPS. 2022 ASPS Procedural Statistics Release. Available from: https://www.plasticsurgery.org/documents/News/Statistics/2022/plastic-surgery-statistics-report-2022.pdf [Last accessed on 18 Jan 2024]

[9] (ISAPS) TISoAPS. ISAPS International Survey on Aesthetic/Cosmetic Procedures performed in 2022. Available from: https://www.isaps.org/discover/about-isaps/global-statistics/reports-and-press-releases/global-survey-2022-full-report-and-press-releases [Last accessed on 18 Jan 2024]

[10] Krastev TK,Hommes J,Mathijssen I.Efficacy and safety of autologous fat transfer in facial reconstructive surgery: a systematic review and meta-analysis.JAMA Facial Plast Surg2018;20:351-60 PMCID:PMC5876814

[11] Boureaux E,Bannani S.Eyelid fat grafting: indications, operative technique and complications; a systematic review.J Craniomaxillofac Surg2016;44:374-80

[12] Tuin AJ,Spijkervet FKL,Jansma J.Volumetric effect and patient satisfaction after facial fat grafting.Plast Reconstr Surg2022;150:307e-18e

[13] Gornitsky J,Alnaif N,Gilardino MS.A systematic review of the effectiveness and complications of fat grafting in the facial region.JPRAS Open2019;19:87-97 PMCID:PMC7061561

[14] Schiraldi L,Meuli J.Facial fat grafting (FFG): worth the risk? A systematic review of complications and critical appraisal.J Clin Med2022;11:4708 PMCID:PMC9410081

[15] Dhooghe NS,Depypere B.Fat embolism after autologous facial fat grafting.Aesthet Surg J2022;42:231-8

[16] Moellhoff N,Frank K.Arterial embolism after facial fat grafting: a systematic literature review.Aesthetic Plast Surg2023;47:2771-87 PMCID:PMC10784353

[17] Cuzalina A.Complications in fat grafting.Atlas Oral Maxillofac Surg Clin North Am2018;26:77-80

[18] Lazzeri D,Figus M,Pantaloni M.Blindness following cosmetic injections of the face.Plast Reconstr Surg2012;129:995-1012

[19] Maamari RN,Holds JB.Complications associated with fat grafting to the lower eyelid.Facial Plast Surg Clin North Am2019;27:435-41

[20] Wang K,Dang J.Severe vascular complications caused by facial autologous fat grafting: a critical review.Ann Plast Surg2021;86:S208-19

[21] Yoshimura K.Complications of fat grafting: how they occur and how to find, avoid, and treat them.Clin Plast Surg2015;42:383-8, ix

[22] Mortada H,Alhamoud MA.Ophthalmic complications following facial autologous fat graft injection: a systematic review and meta-analysis.Aesthetic Plast Surg2022;46:3013-35

[23] Cook T,Shorr N.Facial recontouring with autogenous fat.Facial Plast Surg2004;20:145-7

[24] Zeltzer AA,Verpaele AM.Sharp-needle intradermal fat grafting (SNIF).Aesthet Surg J2012;32:554-61

[25] Marten TJ.Fat grafting in facial rejuvenation.Clin Plast Surg2015;42:219-52

[26] Qian H,Zhang M.Massive cerebral infarction following facial injection of autologous fat: a case report and review of the literature.Front Hum Neurosci2021;15:610945 PMCID:PMC7900534

[27] Danesh-Meyer HV,Sergott RC.Case reports and small case series: ocular and cerebral ischemia following facial injection of autologous fat.Arch Ophthalmol2001;119:777-8

[28] Egido JA,Marcos A.Middle cerebral artery embolism and unilateral visual loss after autologous fat injection into the glabellar area.Stroke1993;24:615-6

[29] Evans BGA,Saint-Cyr MH.How fat grafting works.Plast Reconstr Surg Glob Open2020;8:e2705 PMCID:PMC7413772

[30] Canizares O Jr,Allen RJ Jr.The effect of processing technique on fat graft survival.Plast Reconstr Surg2017;140:933-43

[31] Allen RJ Jr,Scharf C.Grading lipoaspirate: is there an optimal density for fat grafting?.Plast Reconstr Surg2013;131:38-45

[32] Coleman SR.Structural fat grafting.Aesthet Surg J1998;18:386-8

[33] Ferraro GA,Tirino V.Effects of a new centrifugation method on adipose cell viability for autologous fat grafting.Aesthetic Plast Surg2011;35:341-8

[34] Pulsfort AK,Pallua N.The effect of centrifugal forces on viability of adipocytes in centrifuged lipoaspirates.Ann Plast Surg2011;66:292-5

[35] Asilian A,Iraji R.Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat.J Res Med Sci2014;19:556-61 PMCID:PMC4155712

[36] Hoareau L,Girard AC.Effect of centrifugation and washing on adipose graft viability: a new method to improve graft efficiency.J Plast Reconstr Aesthet Surg2013;66:712-9

[37] Kurita M,Shigeura T.Influences of centrifugation on cells and tissues in liposuction aspirates: optimized centrifugation for lipotransfer and cell isolation.Plast Reconstr Surg2008;121:1033-41

[38] Rigotti G,Galiè M.Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.Plast Reconstr Surg2007;119:1409-22

[39] Ross RJ,Mutimer KL.Autologous fat grafting: current state of the art and critical review.Ann Plast Surg2014;73:352-7

[40] Demirel O,Bozkurt M.The effect of centrifuge duration on fat graft survival.Indian J Plast Surg2023;56:53-61 PMCID:PMC10049827

[41] Son D,Yeo H,Han K.The effect of centrifugation condition on mature adipocytes and adipose stem cell viability.Ann Plast Surg2014;72:589-93

[42] Rohrich RJ,Brown SA.In search of improved fat transfer viability: a quantitative analysis of the role of centrifugation and harvest site.Plast Reconstr Surg2004;113:391-5; discussion 396

[43] Gupta R,Taylor SM,Hong P.In search of the optimal processing technique for fat grafting.J Craniofac Surg2015;26:94-9

[44] Zielins ER,Longaker MT.Autologous fat grafting: the science behind the surgery.Aesthet Surg J2016;36:488-96 PMCID:PMC5006291

[45] Fisher C,Schafer ME,Marra KG.Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation.Plast Reconstr Surg2013;132:351-61

[46] Pfaff M,Zellner E.Processing technique for lipofilling influences adipose-derived stem cell concentration and cell viability in lipoaspirate.Aesthetic Plast Surg2014;38:224-9

[47] Smith J,Wolosewick J.Use of human serum albumin to improve retention of autologous fat transplant.Plast Reconstr Surg2002;109:814-6

[48] Kaminski MV.Fat autograph retention: use of albumin to correct physiologic perturbation caused by klein solution.AJCS2007;24:123-34.

[49] Sasaki GH.The safety and efficacy of cell-assisted fat grafting to traditional fat grafting in the anterior mid-face: an indirect assessment by 3D imaging.Aesthetic Plast Surg2015;39:833-46

[50] Serra-Mestre JM,Martinez L,D'Andrea F.Platelet-rich plasma mixed-fat grafting: a reasonable prosurvival strategy for fat grafts?.Aesthetic Plast Surg2014;38:1041-9

[51] Zuk PA,Ashjian P.Human adipose tissue is a source of multipotent stem cells.Mol Biol Cell2002;13:4279-95 PMCID:PMC138633

[52] Debuc B,Cras A.Improving autologous fat grafting in regenerative surgery through stem cell-assisted lipotransfer.Stem Cell Rev Rep2023;19:1726-54

[53] Koh KS,Kim H.Clinical application of human adipose tissue-derived mesenchymal stem cells in progressive hemifacial atrophy (Parry-Romberg disease) with microfat grafting techniques using 3-dimensional computed tomography and 3-dimensional camera.Ann Plast Surg2012;69:331-7.

[54] Kølle ST,Taudorf M.Ex vivo-expanded autologous adipose tissue-derived stromal cells ensure enhanced fat graft retention in breast augmentation: A randomized controlled clinical trial.Stem Cells Transl Med2020;9:1277-86 PMCID:PMC7581442

[55] Zimmerlin L,Rubin JP,Landreneau RJ.Regenerative therapy and cancer: in vitro and in vivo studies of the interaction between adipose-derived stem cells and breast cancer cells from clinical isolates.Tissue Eng Part A2011;17:93-106 PMCID:PMC3011910

[56] Goldman JJ,Fang XH,Baynosa RC.Tumescent liposuction without lidocaine.Plast Reconstr Surg Glob Open2016;4:e829 PMCID:PMC5010320

[57] Cucchiani R.The effects of fat harvesting and preparation, air exposure, obesity, and stem cell enrichment on adipocyte viability prior to graft transplantation.Aesthet Surg J2016;36:1164-73

[58] Kim YW,Choi RJ,Cheon YW.Insulin promotes adipose-derived stem cell differentiation after fat grafting.Plast Reconstr Surg2018;142:927-38

[59] Olaru I,Tamaş C.The significance of erythropoietin and insulin administration on survival of fat tissue after autologous fat transplantation in Wistar rats. An experimental study.Rom J Morphol Embryol2020;61:1143-51 PMCID:PMC8343588

[60] Lu F,Gao J.Improvement of the survival of human autologous fat transplantation by using VEGF-transfected adipose-derived stem cells.Plast Reconstr Surg2009;124:1437-46

[61] Hong DK,Lee JH.Sudden visual loss and multiple cerebral infarction after autologous fat injection into the glabella.Dermatol Surg2014;40:485-7

[62] Sert G,Zırh EB.Photobiomodulation with polychromatic light (600-1200 nm) improves fat graft survival by increasing adipocyte viability, neovascularization, and reducing inflammation in a rat model.Lasers Surg Med2022;54:268-80

[63] Kim SE,Kim TG,Chung KJ.Fat graft survival after recipient site pretreatment with fractional carbon dioxide laser.Ann Plast Surg2017;79:552-7

[64] Kaur S,Gusenoff J.The general registry of autologous fat transfer: concept, design, and analysis of fat grafting complications.Plast Reconstr Surg2022;149:1118e-29e PMCID:PMC9547580

[65] Kim IA,Groth MJ.The downside of fat: avoiding and treating complications.Facial Plast Surg2016;32:556-9

[66] Butterwick KJ,Hsu JW.Autologous fat transfer: an in-depth look at varying concepts and techniques.Facial Plast Surg Clin North Am2007;15:99-111, viii

[67] Gause TM 2nd,Sivak WN,Rubin JP.Particle size in fat graft retention: a review on the impact of harvesting technique in lipofilling surgical outcomes.Adipocyte2014;3:273-9 PMCID:PMC4550681

[68] Mashiko T.How does fat survive and remodel after grafting?.Clin Plast Surg2015;42:181-90

[69] Anderson L,Trinh K.Facial hypertrophy as a complication of weight gain in autologous fat graft patients: considerations and recommendations.Aesthet Surg J2023;43:NP738-47

[70] Duhoux A,Lantieri L.Complications of fat grafts growth after weight gain: report of a severe diplopia.J Plast Reconstr Aesthet Surg2013;66:987-90

[71] Nakra T. Utilizing Microliposuction for Deprojection in Patients withOverfill. presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Annual Fall Scientific Symposium

[72] Douglas RS,Shorr N.Lumps and bumps: late postsurgical inflammatory and infectious lesions.Plast Reconstr Surg2003;112:1923-8

[73] Fang HA,Pigg R.The safety of fat grafting: an institutional retrospective review.Ann Plast Surg2022;88:S473-7 PMCID:PMC9893916

[74] Homer NA,Epstein A,Nakra T.Autologous fat transfer harvest-site complications: incidence, risk factors, and management.Ophthalmic Plast Reconstr Surg2022;38:65-7