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Page 2 of 10 Braswell et al. Plast Aesthet Res 2024;11:46 https://dx.doi.org/10.20517/2347-9264.2023.136

Conclusion: Patients who underwent autologous fat grafting with PRP had favorable volume replacement and
improvement in scarring deformity following the procedure. Fat grafting with PRP was found to be a safe and
reliable technique to address various volume and skin concerns.

Keywords: Adipose grafting, fat grafting, platelet-rich plasma

INTRODUCTION
Autologous fat grafting with enrichment has been gaining popularity in reconstructive and aesthetic plastic
surgery to correct soft-tissue volume loss and improve skin defects. Fat grafts themselves contain
regenerative mesenchymal stem cells, known as adipose-derived stem cells (ADSC), that can differentiate
into various cell lineages and secrete a plethora of cytokines and growth factors including vascular
endothelial growth factor (VEGF), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF),
[1,2]
and transforming growth factor-beta (TGF-β) . Together, these growth factors and cytokines provide a
diverse array of regenerative effects to the skin . It has been shown that during the wound healing process,
[3]
adipose-derived mesenchymal stem cells and their conditioned media stimulate collagen synthesis as well as
[4-6]
the migration of in vitro monolayer dermal fibroblasts in three-dimensional skin cultures .
Additionally, adipose transfer is nonimmunogenic, versatile, and easily harvestable with low donor-site
[7,8]
morbidity .

Despite this, fat graft retention is greatly varied in the medical literature, ranging from 10% to 90%, with fat
[8,9]
necrosis and subsequent graft resorption being significant problems . The exact mechanism of adipocyte
death in fat grafting is unknown, but it is hypothesized that ischemia is a major contributor .
[10]
Because fat graft survival has often been unpredictable, fat is often supplemented with platelet-rich plasma
(PRP) or other supplements . Bilkay et al. demonstrated that adding PRP to the fat graft reduced the
[11]
number of fat grafting treatments needed to obtain the desired outcome in calf augmentation compared to
[12]
the control fat without PRP . Gentile et al. also demonstrated the volume maintenance benefits of adding
PRP to fat grafting in the context of breast reconstruction .
[13]
PRP is a preparation of autologous plasma enriched with a platelet count above baseline that can be
obtained via a simple blood sample [14,15] . Platelets release many biologically active proteins that promote
tissue regeneration, angiogenesis, re-epithelization, and collagen formation. In the context of PRP as an
adjuvant to fat grafting, it is believed that the pro-angiogenic and anti-inflammatory components of PRP,
along with the potential proliferative effects that PRP can have on ADSCs, serve to improve the overall graft
outcome and survivability . Overall, PRP is thought to be a safe, cost-effective method to better fat graft
[16]
[9]
survival, decrease postoperative bruising and inflammation, and increase the ease of graft application .

In the literature, adipose grafting with PRP has been briefly analyzed in the context of wound healing [17-19] ,
scar treatment [20,21] , facial lipofilling [22-24] , gluteal augmentation , calf augmentation , and breast
[12]
[25]
reconstruction [26,27] . Initial results reveal variable superiority over other fat grafting techniques, but overall
positive short-term outcomes indicate potential efficacy that warrants additional exploration . This study
[16]
aimed to analyze fat grafting with PRP in the context of volume replacement and scar hypertrophy
improvement in a variety of different cases.