Current state of the art in fat grafting: paradigm shift in surgical techniques and refinements in cleft and craniofacial reconstruction

Purpose of reviewThe purpose of this review is to provide an update on current practice and trends in fat graft surgery. The present review covers postoperative fat graft survival and phases, recipient bed and fat tissue enrichment issues, the spectrum of clinical applications in the cleft-craniofacial field, surgical techniques, and predictive factors for different outcomes.Recent findingsCurrent investigations have led to a better understanding of fat graft survival and postoperative clinical progress. Fat grafting has been successfully adopted in a broad spectrum of cleft-related, craniofacial contour-related, burn-related, and radiation-related indications. Many variations on harvesting, processing, and delivery techniques and the use of recipient-site preconditioning and cell-enriched methods to increase the efficiency of fat grafting have been described, but little consensus exists about which technique is optimal. The development of predictors for fat grafting-related outcomes can aid multidisciplinary teams in providing better preoperative counseling, selecting the most suitable candidates for treatment, and establishing patient-specific postoperative care profiles.SummaryThe addition of modern fat graft surgery to the surgeon's toolbox revolutionized the delivery of surgical cleft and craniofacial care. Further investigation is necessary to assist surgeons in selecting the best candidates and optimal techniques.