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Fat grafting is a technique in which harvested adipose tissue is injected underneath the skin to reconstruct traumatic, oncologic, or congenital defects. The technique may also be used for cosmetic purposes, particularly facial rejuvenation. The term "autologous fat grafting" refers to the same procedure when the fat is harvested from the person who will receive it, which is the most common clinical scenario. Autologous fat is considered by many to be the ideal filler material for facial rejuvenation, as it is 100% biocompatible, produces a soft and natural result, and is theoretically a permanent intervention. This activity reviews the utility of this procedure for facial rejuvenation and highlights the role of the interprofessional team in managing and improving care for patients who undergo autologous fat grafting. Objectives: Identify the indications and contraindications for autologous fat grafting in the face. Describe the equipment, personnel, preparation, and technique required to perform autologous fat grafting for facial rejuvenation. Review the potential complications of autologous fat grafting. Outline interprofessional team strategies for improving care coordination and communication to optimize outcomes from autologous fat grafting. Access free multiple choice questions on this topic.

Fat grafting is a technique in which harvested adipose tissue is injected underneath the skin for the reconstruction of traumatic, oncologic, or congenital defects. The technique may also be used for cosmetic purposes, particularly facial rejuvenation. The term "autologous fat grafting" refers to the same procedure when the fat is harvested from the person who will also receive it, which is the most common clinical scenario. Autologous fat is considered by many to be the ideal filler material for facial rejuvenation, as it is 100% biocompatible, produces a soft and natural result, and is theoretically a permanent intervention. This article focuses on the utility of this procedure for facial rejuvenation.[1]

Despite meticulous harvesting, processing, and grafting techniques, there exist several complications associated with fat grafting: Bruising, edema, and ecchymosis are the most common sequelae Overcorrection due to the transfer of excess fat Undercorrection due to transfer of an insufficient volume of fat or excessive resorption of grafted fat Pyogenic granulomas and cellulitis secondary to infection and/or prolonged inflammation Blistering Scarring Tissue bunching or palpable deformities from injections placed too superficially Contour irregularities and nodules or calcifications Pain at the donor site due to inadequate anesthesia Deformity at the donor site due to excessive or unequal fat harvesting or violation of a zone of adherence Blindness due to occlusion of the ophthalmic artery Stroke due to occlusion of the internal carotid artery Fat embolism Graft loss and bruising can be minimized by employing atraumatic technique, which minimizes hematoma formation. Cool compresses may be helpful in the first three days after treatment to reduce ecchymosis; excessive icing can lead to vasoconstriction and risk of graft loss. Vigorous activity should be avoided for two to three weeks after the procedure.[17] Blindness is a rare complication of fat grafting. High-pressure injection into the supratrochlear artery may cause the fat to reach the ophthalmic artery. Once the pressure is released, the fat can then embolize in an anterograde direction, and subsequent occlusion of the central retinal artery can cause blindness. Blindness resulting from fat grafting requires urgent intervention; the patient should immediately be transferred to the hospital. Timolol 0.5% drops, aspirin 325 mg, and acetazolamide 500 mg should be administered while awaiting transfer. In addition to blindness, fat embolism may cause stroke, including headaches, nausea, vomiting, dizziness, numbness, weakness, and vital sign instability.

Blindness is a rare complication of fat grafting. High-pressure injection into the supratrochlear artery may cause the fat to reach the ophthalmic artery. Once the pressure is released, the fat can then embolize in an anterograde direction, and subsequent occlusion of the central retinal artery can cause blindness. Blindness resulting from fat grafting requires urgent intervention; the patient should immediately be transferred to the hospital. Timolol 0.5% drops, aspirin 325 mg, and acetazolamide 500 mg should be administered while awaiting transfer. In addition to blindness, fat embolism may cause stroke, including headaches, nausea, vomiting, dizziness, numbness, weakness, and vital sign instability. Facial swelling and bruises are also quite common after fat grafting. It is important to distinguish expected edema from cellulitis, which presents with fever, warmth, erythema, and tenderness. In contrast to cellulitis, edema is self-limited but may be prolonged due to the rich vascularity of the face. Prolonged edema is treated with facial lymphatic massage, therapeutic ultrasound, explaining to the patient the protracted nature of symptoms, and offering reassurance. In cases of overcorrection with fat injections that do not resorb sufficiently, the excess volume may be addressed with deoxycholic acid injection.

Autologous fat grafting is a multi-stage process that includes evaluating recipient and donor areas and fat harvesting, processing, and reinjection. Oversights, errors, or omissions during any of these steps may adversely affect the outcome. Because each patient and procedure are unique, the physician must communicate specific equipment needs, such as cannulae and instrumentation for harvesting, processing, and transfer, to the operative team before the procedure. Nurses and other team members should be able to effectively communicate expectations for the procedure and possible complications with the patient. Any misconceptions or confusion on the part of the patient must be resolved prior to the procedure.[21] Imaging, if obtained, should be discussed with a radiologist to clarify any anatomical anomalies. This collaboration is essential for patients with histories of facial trauma or other pathology. When fat grafting is a part of complex surgery like facial reconstruction, cooperation with maxillofacial surgeons, orthopedic surgeons, orthodontists, and interventional radiologists may be necessary. [Level 5]

Using a compression garment is essential because the mobility of the grafted fat may cause volume loss. The patient should avoid massaging the grafted area in the early post-treatment phase, as doing so can shift the grafted fat. Applying a warm compress may improve blood flow to the grafted fat but will likely worsen edema. A cool compress may decrease swelling, but cold compresses should be avoided because of the risk of graft compromise. As part of the preprocedural counseling process, risks and warning signs of complications such as blindness, fat embolism, infection, and keloid formation should be discussed with the patient to facilitate early identification and intervention.