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Fat is a connective tissue derived from the mesoderm. The fat tissue within the human body is also called the “adipose organ”. Mainly, fat is located within the subcutaneous regions, underneath the skin. Other locations of fat tissue are found within the abdominal cavity (around the intestines and organs). Fat or adipose tissue has important functions within the body and secretes molecules and hormones that are crucial for a good functioning of the human body. It is richly vascularized and a very dynamic tissue. Fat consists of two compartments or fractions: the adipocytes or fat cells and the stomal-vascular fraction (SVF). The SVF contains a heterogenous population of cells and stem cells, the so-called adipose derived stem cells (ADSC). Those stem cells can be used for tissue engineering applications or regenerative medicine applications. The concentration of stem cells within adipose tissue is far higher compared to bone marrow.


Lipofilling is not a new technique. Essentially, lipofilling transplants fat tissue from one location in the human body to another location. In the 19th century surgeons resected fat tissue and implanted it elsewhere to treat soft tissue deficiencies. In the 20th century the technique of liposuction was introduced. Liposuction removes fat with small cannulas and the fat becomes liquified. This liquified fat is called “lipo-aspirate”. Surgeons had the idee to inject this lipoaspirate to reconstruct tissue or to augment tissues. The lipofilling technique was born. In the beginning the results were poor because of cyst formation and the disappearance of the injected fat, a process called resorption. Better insights in the behavior of injected fat and ongoing research introduced new clinical approaches and the results became better. However, the main disadvantage of fat grafting or lipofilling is the unpredictable resorption rate which ranges from 20 to 80%.


Resorption is a natural biological phenomenon. To survive cells depend on blood vessels. Those blood vessels transport oxygen and nutrients to the cells. When cells are transplanted from one place in the body to another place this blood flow is interrupted. The transplanted cells need to survive through a process called “plasmatic imbibition”. This means that they “drink” fluids from their environment. After 24 hours new blood vessels will start to sprout from preexisting blood vessels and they direct towards the transplanted cells. Those new blood vessels will eventually reach the transplanted cell population and transport new nutrients and oxygen. When the transplanted cells are revascularized too late they will die (cell necrosis). The death cells will disappear and this is called resorption. The resorption rate in transplanted fat tissue is unpredictable and depends on many factors (lifestyle, smoking, age, …).

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Subcutaneous fat contains stem cells. They are called the adipose derived stem cells (ADSCs). The number of stem cells within subcutaneous fat tissue is larger compared to bone marrow. This population of stem cells is very attractive because they are easily available (underneath the skin) and abundant. They can be used for tissue engineering purposes or in regenerative medicine. The presence of stem cells within fat tissue has a beneficial effect when lipofilling is performed. We noticed an improvement of the tissue quality in places where fat grafting has been performed.



Three essential steps are involved in the fat grafting technique:

  • liposuction
  • processing
  • injection