Advancing Fat Graft Survival: From Adipose-Derived Stem Cell Mechanisms to Next-Generation Regenerative Strategies

Autologous fat grafting is popular in reconstructive and aesthetic surgery but faces challenges due to unpredictable graft resorption. Two cell-based approaches, stromal vascular fraction (SVF) and culture-expanded adipose-derived stem/stromal cells (ADSCs), have been developed to improve fat retention. Meta-analyses indicate that expanded ADSCs offer significantly better outcomes than SVF, due to their ability to support graft survival through growth factor secretion, immunomodulation, and other mechanisms. The review covers clinical evidence for ADSC- and SVF-enriched fat grafting across various applications, evaluates adjunctive strategies like platelet-rich plasma and exosome-based therapies, and highlights ongoing challenges such as the need for standardized preparation methods and safety assessments.