Cell-supplemented autologous fat grafting: a review from bench to bedside

Autologous fat grafting is routinely used in plastic and reconstructive surgery to improve contour deformities and appearance. However, retention of fat over time is inconsistent and unpredictable. Cell-assisted lipostransfer (CAL), the practice of using stem cell-containing portions of adipose to enrich fat grafts, has been found to be a promising area of research to increase not only the retention of volume but also increase collagen production, enhance angiogenesis, and direct the overall repair, remodeling, and regeneration of the recipient site. CAL, therefore, has a multitude of clinical applications, ranging from oncologic reconstruction following radiation to facial rejuvenation, among others. In this paper, we provide a comprehensive review of the current state of cell-supplemented fat transfer and discuss our understanding of cellular interactions in enriched fat grafts, techniques to improve the viability of fat, clinical translation of CAL, regulatory oversight, and future directions.