T. Votruba1,2, J. Holoubek3, B. Lipovy1
1 Department of Burns Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic2 Department of Plastic Surgery, České Budějovice Hospital, České Budějovice, Czech Republic3 Department of Traumatology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Summary
Autologous fat grafting (AFG) is a widely used technique in both reconstructive and aesthetic plastic surgery. Despite its clinical popularity, the main limitation remains the unpredictable viability of the transplanted volume, which ranges between 18–80%. This variability reflects a complex interplay of biological processes and technical factors, placing AFG at the interface between a relatively simple surgical procedure and a challenging tissue engineering problem. The primary cause of volume loss is early ischemia. A cascade of inflammatory responses, oxidative stress, cyst formation, and fibrosis results in variable degrees of volume reduction. Current research on improving AFG outcomes focuses on two main areas. One aim is to be technical factors related to harvesting, processing, and application of the fat. The second area, which is the subject of this review, examines the possibilities of increasing the survival of autologous fat grafts by applying biotechnological procedures. In the center of these procedures are neovascularization, mechanical and structural support to the graft, and promoting regeneration of adipose tissue rather than just survival of transplanted cells. Graft enrichment using stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs), both autologous populations from lipoaspirate, enhances angiogenesis, adipogenesis, and immune modulation. Preclinical data show improved vascularization and graft retention, but clinical outcomes vary. ADSC-derived exosomes offer a cell free alternative with strong proangiogenic and anti-inflammatory effects. Growth factors, including vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF2), or transforming growth factor-b (TGF-b) – can be delivered directly or via platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), though results remain inconsistent. Hydrogels, scaffolds, acellular adipose matrix (AAM), molecular interventions, and preconditioning strategies show big promise but lack standardized clinical evidence so far. Despite promising preclinical results, clinical application faces several challenges and obstacles. Future research should focus on rational combinations of therapies and strategies and further development of biomaterials. Improving the survival of autologous fat grafts requires a multidisciplinary approach combining refined surgical techniques with targeted biotechnological interventions.
Key words
autologous fat graft – lipotransfer – adipose-derived stem cell – growth factor – exosomes – angiogenesis – hydrogel
Votruba T, Holoubek J, Lipovy B. Cutting-edge biotechnological strategies to enhance autologous fat graft survival. Acta Chir Plast 2026; 68 (1–2): 14–18.