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Braswell et al. Plast Aesthet Res 2024;11:46 https://dx.doi.org/10.20517/2347-9264.2023.136 Page 3 of 10

METHODS
A single institution, Institutional Review Board (IRB)-approved (IRB-300006012) retrospective chart
review was conducted on 40 patients who underwent a total of 50 fat grafting/PRP procedures by one
provider from October 2019 to October 2022. Data collection included patient demographics as well
as both major and minor postoperative complications. Patients were followed at all subsequent
appointments following the procedure to assess results and monitor complications.

The majority of cases were grafted with a fat/PRP ratio of 0.8 fat/0.2 PRP (20% PRP) or 0.9 fat/0.1 PRP (10%
PRP), depending on body location and pathology. The PRP was prepared using a centrifuge in the operating
room. All fat was processed using a washing and filtration technique. Tumescent was infiltrated into the
donor sites, and the fat was harvested using a standard liposuction technique. Fat was harvested from the
abdomen, thighs, and/or flanks using an enclosed power-assisted system or Toomey syringes with 3.7 or
3.0 mm cannulas. A 0.9 mm Tulip single port injection cannula with 1ml syringes was used for injections
into the face, neck, and smaller areas of scarring. For breast and buttocks, a 3.7 cannula or Tuohy needle
was used. An 18-gauge needle for injection into hypertrophic scars was utilized. Multiple 10 mL syringes
were used for larger areas such as breasts, buttocks, hypertrophic scarring, burns, and keloids. Sixty mL
Toomey syringes were used with the 3.7 or 4.6 cannula for buttocks. The majority of harvested fat was
washed with saline, strained, placed in syringes, and emulsified. For cases where minimal fat was harvested,
the fat was processed by being rolled onto Telfa after being washed with saline. The correct ratio of PRP was
then added to the prepared fat prior to injection.

For the cases involving hypertrophic scarring, 5-fluorouracil (5-FU) and triamcinolone were also injected in
addition to the PRP. For each session, the patient was put under general anesthesia and abdominal fat was
harvested through liposuction. Aspirated fat was washed, emulsified, and mixed at a ratio of 0.8 fat to 0.2
PRP. This was injected into areas of hypertrophic scarring using an 18-gauge needle. Following the fat
grafting, 5-FU (45 mg/0.9 mL with triamcinolone 1 mg/0.1 mL) and triamcinolone (40 mg/mL) were
injected into the same sites of hypertrophy.

RESULTS
The cohort consisted of 12 males and 28 females with an average age of 52 years (range 18-79). The analyzed
cases included 13 burn scars, 6 hypertrophic scars, 1 case of scarring from hidradenitis suppurativa, 13 cases
for facial aesthetics, 2 procedures for human immunodeficiency virus (HIV) facial atrophy, 6 cases for
breast aesthetics, 4 keloid excisions, 4 cosmetic buttock fat grafts, and 1 nose fat graft. The average amount
of fat and PRP grafted in each case is depicted in Table 1.

All cases analyzed involved fat grafting with the addition of PRP. Results showed obvious improvement in
the appearance of prior scars, excellent volume replacement, and overall favorable cosmetic results for
patients. A review of all 50 cases showed a 2.0% complication rate, with only one complication of cellulitis
occurring in a fat graft breast patient. There were no cases of embolization.

The patient in Figure 1 is a 68-year-old man who sustained a large chemical burn spanning his right
scapular region, right shoulder, and right axilla after falling backward onto flooring covered with a chemical
tile stripper. The burn measured 33 cm × 34 cm. He underwent debridement in the burn unit at the time of
the incident and then presented to the clinic four months later for revision of his hypertrophic and keloid
scarring. This patient has received 3 treatments over an 8-month period of adipose grafting with PRP, along
with injections of Kenalog and 5-FU, to the affected areas. For each operation, the patient’s abdomen and
flanks were infiltrated with tumescent and adipose tissue was harvested using a 3.7 mm liposuction cannula.