CLINICAL AND SURGICAL FOUNDATIONS OF REGENERATIVE MEDICINE WITH AUTOLOGOUS FAT

Abstract

Autologous fat grafting is both a reconstructive operation and a biologically active tissue transfer. Its clinical value depends on the survival of transplanted adipose parcels, the response of the recipient bed, and the behavior of stromal, vascular, extracellular-matrix, and immune components that accompany mature adipocytes. This narrative review examines the biological basis, surgical technique, indications, safety, evidence quality, and regulatory boundaries of regenerative medicine using autologous fat. PubMed/MEDLINE, major professional statements, and regulatory guidance were reviewed through September 2026, prioritizing mechanistic studies, consensus documents, randomized trials, systematic reviews, meta-analyses, and large clinical series. Conventional fat grafting is distinguished from microfat, nanofat, microfragmented adipose tissue, stromal vascular fraction, cell-assisted lipotransfer, and culture-expanded adipose-derived stromal cell products. Graft survival is governed by diffusion before revascularization, recipient-site vascularity, parcel size, atraumatic harvest and processing, and the avoidance of excessive local pressure. No single donor site or processing system is universally superior. Clinically, the strongest and most established uses are restoration of soft-tissue volume and contour in breast and craniofacial reconstruction, with additional but heterogeneous evidence for radiated tissue, scars, burns, chronic wounds, and selected functional disorders. Musculoskeletal injections and fresh adipose treatment of fistulas remain emerging and should not be presented as established stem-cell therapies. Complications range from undercorrection, oil cysts, fat necrosis, infection, and contour irregularity to rare catastrophic vascular events, including blindness, stroke, and pulmonary fat embolism. Safe practice requires precise anatomical planning, low-pressure delivery of small aliquots during cannula withdrawal, strict subcutaneous placement in gluteal grafting with real-time ultrasound, staged treatment when recipient capacity is limited, and coordinated oncologic surveillance in breast reconstruction. Manipulated cellular products may trigger substantially different regulatory requirements from conventional structural fat transfer. Autologous fat is therefore best understood as a living surgical graft with regenerative potential—not as a uniform drug or an unqualified source of stem cells.