Autologous fat grafting AFG is used both in aesthetic and
reconstructive surgery. Neuber described fat transfer in retractile
scarring and published successful outcomes (1). In recent decades this
technique has been used increasingly since the development of modern
liposuction techniques in the 1980s by Illouz (2, 3). The technique of
harvesting and processing, expanded applications and fat transfer is now
commonly used in the head/face and neck. Coleman provided a
comprehensive description of techniques in the 1990s, and in recent
years the scientific basis of the regenerative effects of fat grafts is
progressing (4).
Adipose tissue has notable plasticity and has endocrine function. This
type of tissue consists of different cell types; adipocytes, connective
tissue, nerve tissue, stromal vascular cells and immune cells, and
adipose-derived stem cells ASCs . The latter have the potential to
differentiate into numerous cell lines (5). These can be endothelial
cells, vascular complexes, and stromal cells. ASCs are involved in
biologic pathways of inflammation and tumour environment. ASCs have been
ascertained to promote angiogenesis and further showed an elevated
pro-oncologic behaviour in xenografts (5, 6). The applications also have
expanded beyond physical ‘contouring and space filling’ to regenerative
medicine applications that address radiation injury, abnormal scarring,
improving aged skin and managing varieties of skin injury such as
burns(2, 7).
The safety of autologous fat grafting is largely accepted, but attitudes
differ where and the anatomical region to be treated has previously been
ablated for cancer(8).
Unlike breast surgery, it is not clear what current attitudes and trends
are in facial fat grafting in the post-cancer treatment patient, for
example post radiation injury, contour defect, or chronic neck
lymphedema. We aimed to try ascertaining certain attitudes in this
respect and whether these attitudes are reflected in the evidence base
for these procedures. We also recognize there are no English or German
published guidance, healthcare system based or otherwise, to guide the
treating teams.