Macrofat Vs Microfat in Reconstructive Surgery: Comparative Analysis Based on a Case Report
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Abstract
Autologous fat grafting has become a fundamental tool in reconstructive and aesthetic surgery due to its biocompatibility, availability, and regenerative potential. Among its different modalities, macrofat and microfat have gained relevance because of their distinct biological properties and clinical applications. Macrofat is primarily used for structural volume restoration in deep planes, whereas microfat, due to its smaller particle size and higher stromal vascular fraction content, is more suitable for superficial applications and improvement of skin quality.
We present the case of a 58-year-old female patient with moderate facial aging characterized by volume loss in the midface, deep nasolabial folds, and skin quality deterioration. She underwent autologous fat grafting combining macrofat and microfat techniques. Macrofat was applied in deep planes to restore facial contour and structural support, particularly in the malar region, nasolabial folds, and mandibular line. Microfat was injected in superficial planes in the perioral and infraorbital regions to enhance skin texture and fine wrinkles.
Postoperative follow-up at 2, 6, and 12 weeks demonstrated satisfactory integration of the graft, with significant improvement in facial volume, contour, and skin quality, without complications such as fat necrosis, infection, or irregularities. The results remained stable at 3 months, with high patient satisfaction.
This case highlights the importance of a combined approach using macrofat and microfat to address both structural and superficial components of facial aging. The appropriate selection of technique, processing method, and injection plane is essential to optimize outcomes and achieve natural, long-lasting results in reconstructive facial surgery.
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References
I. Coleman, S. R. (1995). Long-term survival of fat transplants: Controlled demonstrations. Aesthetic Plastic Surgery, 19(5), 421–425.
https://doi.org/10.1007/BF00453875
II. Coleman, S. R. (2006). Structural fat grafting: More than a permanent filler. Plastic and Reconstructive Surgery, 118(3 Suppl), 108S–120S.
https://doi.org/10.1097/01.prs.0000234610.81672.e7
III. Tonnard, P., Verpaele, A., Peeters, G., Hamdi, M., Cornelissen, M., & Declercq, H. (2013). Nanofat grafting: Basic research and clinical applications. Plastic and Reconstructive Surgery, 132(4), 1017–1026. https://doi.org/10.1097/PRS.0b013e31829fe1b0
IV. Rigotti, G., Marchi, A., Galiè, M., Baroni, G., Benati, D., Krampera, M., Pasini, A., Sbarbati, A., & Bassetto, F. (2007). Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant. Plastic and Reconstructive Surgery, 119(5), 1409–1422.
https://doi.org/10.1097/01.prs.0000256047.47909.71
V. Yoshimura, K., Sato, K., Aoi, N., Kurita, M., Hirohi, T., & Harii, K. (2008). Cell-assisted lipotransfer for cosmetic breast augmentation. Plastic and Reconstructive Surgery, 121(6), 1930–1939. https://doi.org/10.1097/PRS.0b013e31817151c6
VI. Gentile, P., De Angelis, B., Pasin, M., Cervelli, V., & Curcio, C. B. (2019). Adipose-derived stromal vascular fraction cells and platelet-rich plasma: Basic and clinical evaluation for cell-based therapies. Journal of Craniofacial Surgery, 30(2), 516–520. https://doi.org/10.1097/SCS.0000000000005045
VII. Khouri, R. K., Khouri, R. E., Rigotti, G., Cardoso, E., Biggs, T. M., & Perez, M. A. (2014). Aesthetic applications of Brava-assisted megavolume fat grafting. Plastic and Reconstructive Surgery, 133(4), 796–807. https://doi.org/10.1097/PRS.0000000000000025
VIII. Pu, L. L. Q. (2016). Mechanisms of fat graft survival. Annals of Plastic Surgery, 77(Suppl 1),
S84–S86. https://doi.org/10.1097/SAP.0000000000000799
IX. Zhu, M., Zhou, Z., Chen, Y., Schreiber, R., Ransom, J. T., Fraser, J. K., & Hedrick, M. H. (2010). Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Annals of Plastic Surgery, 64(2), 222–228. https://doi.org/10.1097/SAP.0b013e31819ae05c
X. Rohrich, R. J., Sorokin, E. S., & Brown, S. A. (2004). In search of improved fat transfer viability: A quantitative analysis of the role of centrifugation and harvest site. Plastic and Reconstructive Surgery, 113(1), 391–395.
https://doi.org/10.1097/01.PRS.0000097293.56504.00
XI. Mojallal, A., Lequeux, C., Shipkov, C., Duclos, A., Braye, F., & Damour, O. (2009). Improvement of skin quality after fat grafting: Clinical observation and an animal study. Plastic and Reconstructive Surgery, 124(3), 765–774.
https://doi.org/10.1097/PRS.0b013e3181b17b8f
XII. Kølle, S. F. T., Fischer-Nielsen, A., Mathiasen, A. B., Elberg, J. J., Oliveri, R. S., Glovinski, P. V., Kastrup, J., & Kirchhoff, M. (2013). Enrichment of autologous fat grafts with adipose-derived stem cells improves graft survival. Plastic and Reconstructive Surgery, 132(3), 507–515.
https://doi.org/10.1097/PRS.0b013e31829ace83
XIII. Strong, A. L., Cederna, P. S., Rubin, J. P., Coleman, S. R., & Levi, B. (2015). The current state of fat grafting: A review of harvesting, processing, and injection techniques. Plastic and Reconstructive Surgery, 136(4), 897–912.
https://doi.org/10.1097/PRS.0000000000001590
XIV. Pallua, N., & Wolter, T. P. (2010). Lipofilling and adipose-derived stem cell therapy in reconstructive surgery. Plastic and Reconstructive Surgery, 125(1), 178–188. https://doi.org/10.1097/PRS.0b013e3181c2a6b5
XV. Gentile, P., Garcovich, S., Bielli, A., Scioli, M. G., Orlandi, A., & Cervelli, V. (2015). The use of adipose-derived stem cells in plastic surgery: Review of current clinical applications. Journal of Clinical Medicine, 4(3), 455–470.