Abstract:
Introduction: Autologous fat transfer (AFT) is widely applied in facial rejuvenation due to its
biocompatibility and capacity to restore age-related volume loss. Although patient satisfaction remains
high, long-term predictability is limited by graft survival, with traditional techniques demonstrating
approximately 50–60% volume retention at one year. To improve these outcomes, stromal vascular
fraction (SVF) – enriched grafting, also referred to as cell-assisted lipotransfer (CAL), incorporates
adipose-derived stem cells (ADSCs) in order to enhance tissue integration, angiogenesis and
regenerative capacity. This paper analyzes the biological mechanisms and clinical outcomes of ADSCenriched autologous fat grafting in facial rejuvenation.
Material and Methods: A structured literature review was performed focusing on publications from
2015 to 2025. Thirty-five records were identified through searches in PubMed, HINARI and Google
Scholar using combinations of the terms “autologous fat grafting”, “adipose-derived stem cells”,
“stromal vascular fraction”, “cell-assisted lipotransfer” and “facial rejuvenation”. After screening titles
and abstracts, full-text articles were evaluated according to predefined inclusion criteria and eighteen
publications met the eligibility criteria.
Results: ADSC enrichment improves graft performance through multiple mechanisms. These include
stimulation of angiogenesis via increased secretion of vascular endothelial growth factor and fibroblast
growth factor, reduction of oxidative stress and modulation of inflammatory pathways that facilitate
tissue regeneration. Enhanced neovascularization improves oxygenation during the critical early
ischemic phase, thereby supporting graft survival. Reported retention rates for CAL reached up to 88%,
compared with 50–60% in conventional AFT, 6 months post-procedure. Patient satisfaction increased
from approximately 81% with traditional grafting to 91.1% following ADSC enrichment. Histological
findings demonstrated increased collagen and elastin deposition, improved dermal thickness and
enhanced vascularization. While complications were not eliminated, they appeared reduced.
Traditional AFT is associated with fat resorption, necrosis and infection, whereas CAL primarily
reported lower incidence of these events and rare vascular embolism.
Conclusions: ADSC-enriched fat grafting enhances angiogenesis, dermal remodeling, and long-term
volume stability compared with conventional techniques. Standardization of protocols and larger
controlled studies remain necessary to define optimal clinical guidelines and confirm long-term safety
and efficacy.
