Trends in Fat Grafting: A 10-Year Analysis of the Major Plastic Surgery Journals

PURPOSE:  

Fat grafting has attained rapid popularity for both reconstructive and aesthetic purposes. Clinical research has explored the advantages of adipose stem cells beyond the traditional boundaries to incorporate into all areas of the body. However, despite rising international interest in the regenerative outcomes, no methodological and technical standardization exists. Rather, the efficacy of fat grafting extends far beyond the clinical results, with intermediate steps, such as harvesting, processing, donor and recipient sites, critically influencing the final outcome. This study analyzes the literature on fat grafting techniques during the experimental and clinical stages to provide a comparative platform.

METHODS:  

A systematic review of 22,274 articles conducted for the years 2006 to 2015 of major plastic surgery journals (PRS, JPRAS, APS, ASJ, Annals, PRS Go, etc.) yielded 719 articles, which were further narrowed by predetermined inclusion criteria, resulting in 667 related publications. Two-tailed t-tests and Chi-squared tests with the Cochran-Armitage Trend Test evaluation were performed using JMP software. The five most-cited articles related to fat-grafting from each journal were reviewed during our study period to serve as a comparative platform.

RESULTS:

Total number of articles per year increased significantly throughout the 10-year span (p<0.0001) from 13 in 2006 to 118 in 2015. PRS (p<0.0001), JPRAS (p<0.0015), Annals (p<0.0013), and APS (p<0.015) all showed significant increases over time. Basic science (p<0.04), animal (p<0.01), and human (p<0.01) studies all increased significantly throughout the study period. Level of evidence for human studies increased throughout the years, with significant increase for levels 2 (p<0.01), 3 (p<0.01), and 4 (p<0.001). Of the papers regarding clinical outcomes, 50.17% of the papers focused on reconstruction, 39.69% focused on aesthetics, and 10.24% emphasized both. A total of 113 articles studied fat-grafting to the breast, 96 on head and neck, 39 on entire body, 12 on gluteus, 12 on upper extremities, 8 on trunk, 7 on lower extremities, 3 on the abdomen, and 3 on perineum.

CONCLUSIONS/SIGNIFICANCE:  

As fat grafting becomes increasingly widespread in clinical practice, there is discordance in the standardization of methods and an absence of basic science and clinical evidence in certain procedural aspects. Nevertheless, the applications and future of adipose stem cell research remains promising.

Analysis of the 5 most-cited articles revealed a consensus in that early fat grafting practice showed great potential mixed with practical uncertainties. The authors state that recent technological advances have led to a resurgence in fat grafting literature, and the possibility that the technique can achieve its full potential.

We hope that this review will provide some insight in the evolution of fat grafting, and emphasize the facets that can undergo further investigation.