Biology and Fundamentals of Lipofilling: Current Standings on Graft Survival, Regenerative Potential and Safety

L ipofilling is the removal of fat by liposuction, which is then injected into the desired region of the body for volume enhancement. However, the technique is not new and more than 125 years ago the alleged potential of living fat cells as fillers was explored. Lipofilling has regained popularity in recent decades. Prior to 1966 there was criticism of the scientific knowledge and personal experience of clinicians advocating lipofilling. An expanding knowledge of adipocyte survival and standardisation of the lipofilling method contributed to the predictability of fat graft take and has expanded its applications. Despite these developments lipofilling is still labeled as ‘experimental’ including by the senior authors’ own national board (De Nederlandse Vereniging voor Plastische Chirurgie, NVPC). The use of living fat cells as a graft is therefore labeled as ‘special medical treatment’ and is not recognised as a valid treatment option. The American Society of Plastic Surgeons (ASPS) fat graft task force agrees that lipofilling for aesthetic breast augmentation is not recommended for reconstruction but is very promising and clinically relevant. More level one and two evidence-based research is required. The scientific interest in lipofilling received a great boost by the discovery of the pre-adipocyte stem cell in HIERONYMUS P. J. D. STEVENS is Bergman Clinics Den Haag, Binckhorstlaan 149, 2516 BA, Den Haag; Joep C.N. Willemsen, MD, Bergman Clinics Den Haag, Binckhorstlaan 149, 2516 BA, Den Haag,