Fat grafting was first reported in 1893. For many decades fat was introduced into the recipient areas as a large block of tissue, most of which failed to survive. A significant improvement was initiated in the early 1990’s with the introduction of micrografting. The increased retention of the fat is attributed to insertion of multiple tiny beads which allows more surface area on the fat for oxygenation and metabolite exchange. Fat is commonly harvested from different sites including the abdomen, inner thighs, knee pads or flank area. The incision site is 2-3mm and requires a single stitch for closure. The tissue removed is then placed in a sterile centrifuge, and then the stem cell rich fat is decanted. The fat is then inset through a 1-2mm slit, and laid down in a series of passes. In most cases the incision does not require any stitches, and can be covered by makeup after a few days.
Depending on the location and volume, the procedure is carried out either under local anesthetic, or in larger cases under intravenous sedation. The major issue with all injectable techniques including hyaluronic acid fillers as well as fat, is retention. Three dimensional studies reveals a decrease in the first 6-9 months, followed by a volume rebound towards the second year. These studies reveal that patients younger than 55 have a retention at 2 years of about 53%, and patients older than 55 have about a 31% retention. Therefore, some patients request touch up procedures.