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.