Autologous Fat Grafting and Regenerative Medicine in Plastic Surgery

Autologous fat grafting has evolved from a volumetric filler technique into a biologically active strategy within regenerative plastic surgery. The clinical appeal of adipose tissue derives from its biocompatibility, availability, pliability, and capacity to restore contour while delivering a stromal and extracellular matrix-rich microenvironment. Contemporary evidence suggests that the regenerative effect of fat grafting is mediated not only by adipocyte survival but also by stromal vascular fraction cells, adipose-derived stem/stromal cells, extracellular matrix components, microvascular fragments, and paracrine signaling. These mechanisms are increasingly relevant in facial rejuvenation, scar remodeling, burn sequelae, chronic wounds, irradiated tissues, breast reconstruction, and selected aesthetic indications. Nevertheless, clinical outcomes remain limited by variable graft retention, heterogeneity in harvesting and processing methods, inconsistent terminology, regulatory constraints, and incomplete standardization of outcome assessment. This narrative review synthesizes recent literature on autologous fat grafting and adipose-derived regenerative therapies in plastic surgery, with emphasis on mechanistic rationale, processing strategies, nanofat and stromal vascular fraction-based approaches, clinical applications, oncologic safety, and future directions. The review supports a balanced interpretation: fat grafting is a mature surgical technique with meaningful regenerative potential, but its translation into reproducible evidence-based protocols requires rigorous technical reporting, controlled clinical trials, validated imaging-based volumetric analysis, and long-term surveillance.