Purpose. Autologous fat transfer is thought to be a common plastic surgical procedure; however, some studies have reported unpredictable results. Even simple variations in techniques are thought to make a significant difference in overall longevity and graft take. Despite the apparent interest in autologous fat transfer, there is no consensus as to the best technique or the level of success in the results. The purpose of the present study was to determine the national trends in techniques for harvest, preparation and application of autologous fat, as well as the success perceived by practitioners for each particular procedure.

Methods. Comprehensive surveys were sent to 650 randomly selected members of the American Society for Aesthetic Plastic Surgery. The survey consisted of thirty questions aimed at determining whether autologous fat transfer is a commonly performed procedure in the surgeon's practice, and if so, the specific methods involved, and the subjective perception of short and long term results. 508 (78%) of physicians returned the survey via mail or facsimile. The completed questionnaires were entered into a database and used to calculate percentages.

Results. Of the 508 surgeons surveyed, 43% perform less than 10 fat transfers annually, 34% perform between 10 and 30, and 23% perform more than 30. Autologous fat transfer is performed as an isolated procedure by 57% of respondents, compared to the 43% who combine it with other facial rejuvenation procedures. The most common harvest technique is with a microcannula (54%), followed by a standard liposuction cannula (27%), syringe with large bore needle (20%), and direct excision (4%). A majority of respondents (75%) treat the harvested fat graft with centrifugation, washing with saline, or a combination. The most common sites for graft injection are: nasolabial folds, lips, and nasojugal region. Ninety-three percent believe there is some graft loss 6 months after injection and accordingly, 89% believe it is necessary to overcorrect the defect. The short-term patient satisfaction with the procedure is felt to be good to excellent by most (84%), while the long-term patient satisfaction is perceived by most (80%) to be fair to good.

Conclusion. Although autologous fat transfer is a relatively common procedure, few are performing it in high volume. Techniques for harvest, preparation, and injection are rather standard, with few physicians deviating from methods commonly encountered in the literature. Although basic science investigations have not been convincing with regard to long-term fat survival, most physicians believe that at least some graft survival is clinically evident. The results suggest that most patients are pleased with the short-term results of the procedure despite a lower rate of long-term patient satisfaction.