Combining fatgrafting, microneedling and fractional radiofrequency (RF) microneedling: a novel approach to autologous regenerative treatment

Permanent dermal fillers such as polyalkylimide gel (PAIG) are associated with delayed inflammatory and immunologic complications, particularly following subsequent aesthetic interventions. We report the case of a 59-year-old woman with a history of PAIG cheek augmentation who presented with age-related facial volume loss, skin laxity, and photodamage. To minimize the risk of foreign-body reaction, a regenerative strategy using exclusively autologous tissue was selected. Treatment consisted of facial microfat grafting combined with microneedling, and fractional radiofrequency (RF) microneedling followed by stromal vascular fraction (SVF) injections of the neck, deliberately avoiding regions containing PAIG. Clinical follow-up at 14, 90, and 240 days demonstrated improvement in facial volume, skin quality, and neck laxity, with high patient-reported satisfaction and no adverse events. This case illustrates a cautious, individualized regenerative approach in a patient with permanent filler history, emphasizing safety, anatomical restraint, and realistic interpretation of outcomes.