Resumen

Objectives: 1. present history of fat grafting 2. discuss outcomes following Coleman approach 3. present studies showing outcomes after newer modifications in fat processing 4. present studies and an anatomic and regenerative procedure associated with nearly 80% improvement in facial volume14-19 months after treatment Introduction: Fat grafting has been around since the late 1800's. In 1986, Coleman introduced a standardized technique and this has been the gold standard for many years to follow. However, new developments in fat graft processing, injection, placement and regenerative effects have occurred since that time and newer anatomic and regenerative approaches appear to be generating substantially better outcomes. Materials / method: We reviewed the objective outcome studies in fat grafting over the past 5 years and present our findings of anatomic and regenerative fat grafting from several studies as a means of comparison. Results: With the exception of two studies from our clinic, none has shown nearly 80% improvement in mid-facial volume after facial fat grafting using the Coleman technique. Whether centrifugation, decanting or filtration are used, the outcomes were not improved and generally only 20-35% of fat was evident by volume estimation 1-2 years later. Conclusion: Much has happened in the field of regenerative surgery since 1986. New advances in regenerative and anatomic fat grafting appear to produce the best outcomes in patient under 55 years of age. Patients over 55 years of age have more senescent cells and although fat grafting is still effective, longer term outcomes show only 20-30% volume improvement nearly 2 years after treatment.