Current practice in autologous fat transplantation: suggested clinical guidelines based on a review of recent literature.

After more than a century of use, fat grafting is firmly entrenched in the skill set of plastic surgeons. While macrofat grafting is relatively predictable and reliable, microfat grafting by injection is still in the stages of technical evolution. Review of the current literature suggests that revascularization may take up to 21 days to reach the center of a microfat graft. We recommend harvesting by excision (or gentle aspiration), processing by short and gentle centrifuge to separate the layers, and reinjection of the lower layer via a fine cannula (for example, 17 gauge for the face) and a 1-mL syringe with multiple passes, injecting only a tiny amount with each pass as the needle is withdrawn, to obtain the most reliable clinical outcome.