Background: Rectus abdominis fat grafting (RAFG) has emerged as a valuable adjunct to liposuction and abdominoplasty to enhance muscular definition and abdominal contour. Despite its growing popularity, evidence regarding safety, standardization, and outcomes remains limited. This study described a standardized protocol for ultrasound-guided or direct-vision RAFG and evaluated clinical results, complications, and patient satisfaction. Methods: A retrospective review was conducted on 182 consecutive patients who underwent liposuction or abdominoplasty with intramuscular fat grafting to the rectus abdominis between 2022 and 2024. Fat was injected under high-frequency ultrasound guidance or direct vision during abdominoplasty. Demographics, operative time, graft volumes per metamere, complications, and pre- and postoperative BODY-Q abdomen scores were analyzed. Results: The cohort included 182 patients with a mean age of 37.2 years and a mean body mass index of 26.4 kg/m 2 . The average fat graft volume per patient was 85 mL, distributed across 4 metameres (15, 20, 20, and 30 mL). Complications directly related to the grafting procedure occurred in 2 patients (1.09%): 1 surgical-site infection and 1 fat necrosis. No cases of fat embolism were observed. Mean BODY-Q satisfaction scores improved from 12.5 to 26.2 on a 28-point scale. Conclusions: RAFG using ultrasound guidance or direct visualization with a metameric, small-volume protocol is a safe, reproducible technique that enhances abdominal definition. Its low complication rate and significant improvement in patient satisfaction support its inclusion in contemporary body contouring practices.
Páez et al. (Sun,) studied this question.