Page 12 - Read Online

Braswell et al. Plast Aesthet Res 2024;11:46 https://dx.doi.org/10.20517/2347-9264.2023.136 Page 7 of 10

DISCUSSION
While autologous fat grafting with PRP has steadily been gaining popularity due to its availability,
regenerative effects, and potential to improve graft survival, the current literature remains somewhat
divided regarding the technique’s efficacy and long-term results. This study examined a variety of cases that
employed adipose grafting with PRP to gain further insight into the safety of this procedure as well as its
potential benefits.

Unlike other specialties, plastic surgery has a distinct disadvantage when it comes to measuring objective
outcomes. The combination of both art and science that makes plastic surgery unique also poses a challenge
in terms of quantifying results . While we were able to quantitatively analyze complication rates in this
[28]
study, the somewhat subjective cosmetic outcomes are difficult to numerically objectify. We used pre-
operative and postoperative photographs, physician notes, and physician-documented patient satisfaction to
determine successful cosmetic outcomes. These cases each individually revealed promising results, as visual
improvement was noted in the context of volume replacement and/or scarring deformities following the
procedure. Along with obvious visual advancements, both the physician and the patients documented
satisfaction with the results of the procedure. While this reported documentation is qualitative in nature, it
allows us to explore the subjective aspects of both the patient and physician experience, which are crucial to
address in the effort to improve care.

When analyzing the cases and outcomes entirely objectively, we see that the complication rate was minimal,
with only one major complication presenting from the 50 fat grafting with PRP procedures. While the exact
complication rate of autologous fat grafting without PRP varies in the literature, our overall 2.0%
complication rate was in line with the reported 2.27% complication rate associated with facial fat grafting
and the 2.1% complication rate related to fat grafting of the breast [29,30] . Various complications have been
reported in the context of adipose grafting, including infection, calcification, fat necrosis, and fat
[31]
embolism . The only complication experienced by our cohort consisted of one case of cellulitis in a patient
who underwent fat grafting of the breast. To our knowledge, this is the first study analyzing fat grafting with
PRP in the context of multiple, vastly different indications each in diverse anatomic location. Our
retrospective review found PRP to be overall safe and effective in the context of facelifts, hypertrophic scars
treatments, keloid excisions, buttock augmentation, HIV facial atrophy treatments, breast implant removals,
and structural fat grafting for the nose.

Focusing specifically on scar improvement, autologous fat grafting has emerged as a technique able to
[32]
essentially reverse fibrotic changes in the skin by restoring skin texture and pliability . Multiple studies,
including some with level-I evidence, have analyzed the beneficial effects of fat grafting alone and fat
grafting with PRP in the context of radiation-induced skin alterations, scar tissue from trauma, and scar-
related conditions [20,21,33-35] . In this study, we looked at the potential benefit of fat grafting with PRP in burn
scars, hypertrophic scars, and scarring from hidradenitis suppurativa. All of the scar patients experienced an
improved appearance and texture of their scar as well as an increase in skin flexibility regardless of the
anatomic location of the scar.

PRP is a treatment method used in a wide spectrum of skin conditions for anti-inflammatory, healing, and
cosmetic purposes . When combined with the use of triamcinolone, improved scar height, pigmentation,
[36]
and pliability have been noted in comparison to those treated with triamcinolone alone . Fat grafting has
[37]
been proposed for the treatment of hypertrophic scarring, with histological analysis of hypertrophic scars
treated with autologous fat showing improved structural features [32,38] . Although evidence on the
effectiveness of fat grafting to treat hypertrophic scarring is low, a systematic review suggests that