By Alexander Zuriarrain, MD

Nanofat grafting is a breakthrough process for halting and reversing structural changes in skin primarily due to aging and sun damage. Especially notable are the technique’s applications in facial and neck rejuvenation procedures and improved contouring of breasts and buttocks.

Nanofat is derived from a patient’s own adipose tissue, usually harvested from the abdomen, flanks, or inner thigh. The tissue is processed in a way that removes unwanted fluids, as well as the larger, mature fat cells. What remains is a biocompatible product naturally rich in tiny particles of regenerative mesenchymal stem cells from a patient’s own body, nearly as viable as the original tissue.

A Brief History

Also known as “micro-fat,” nanofat is the result of extensive research by plastic surgeons Patrick Tonnard, MD, and Alexis Verpaele, MD, PhD. The mechanical means to create the material outside of the laboratory and make it available for general clinical use was developed by Tulip Medical Products in partnership with the researchers. It can be readily injected into the patient’s dermis or subcutaneous tissue using small, 27-gauge or 30-gauge needles under local anesthesia.

Smaller needle sizes offer the surgeon much more injection control to achieve finer cosmetic results, including removal of folds and wrinkles, smoothing of fine lines and creases around the lip, brow lifts, and restoration of volume to the mid-face and cheeks. For the lip, injections are made into the most superficial level to avoid labial arteries and the orbicularis oris muscle. Fat injections in the forehead and brow can be subcutaneous or delivered intramuscularly or sub-muscularly.

Nanofat grafting can be effectively combined with other techniques like lipofilling to augment and contour breasts, creating a more natural appearance following breast reconstruction, or to manage post-surgical breast scarring, particularly unavoidable scars after breast-reduction surgery, as described in a 2021 Journal of Plastic Surgery and Hand Surgery study.

For enhancements of the buttocks, nanofat grafting also offers surgeons a greater margin of safety. If fat is inserted too deeply and enters the more prominent blood vessels of the buttocks region, it can cause embolisms.

Other possible complications—most of them minor—due to nanofat grafting include bruising and edema, infection, blistering, pain at the donor site, and keloid formation. Because of the additional control the technique grants surgeons, under-corrections or overcorrections of appearance, uneven contouring, and tissue deformities are less common.

Clinical experience suggests nanofat integrates well into host tissues and promotes tissue vascularity and elastin and collagen density, enhancing topography of skin that has thinned and lost structure and volume due to aging, sun damage, or trauma. Many plastic surgeons refer to the “striking quality and texture of skin” following nanofat grafting and praise the substance’s long-lasting effects compared to the temporary nature of dermal fillers.

Authors of a study in a March 2022 edition of the Aesthetic Surgery Journal reported demonstrating—for the first time—“progressive improvement” in mid-facial skin volume 19 months after fat-grafting treatment, “regardless of the amount of fat injected.”

With its regenerative qualities, nanofat has shown potential for wound healing, scar revision, and even enhancement of hair growth in patients experiencing initial stages of alopecia. It also appears more beneficial than plasma-rich platelets, which contain lesser amounts of growth factors and do not regenerate elastin and collagen in the skin, according to a Faces + article.

In a 2021 article published in the World Journal of Stem Cells, scientists write, “Considering [nanofat’s] wide reconstructive and regenerative potential, the applications of nanofat can be extrapolated to various disciplines,” including regrowth of burned tissue and regeneration of diseased joint cartilage, ligaments, and tendons.

The technology that now allows clinicians to more effectively “disaggregate fat tissue into small fat particles (nanofat)” by mechanical means was presented in a 2019 study published in Plastic and Reconstructive Surgery. In the report, researchers wrote, “Mechanical disaggregation of adipose tissue is becoming more popular than enzymatically dissociated stromal vascular fraction for its use in surgical treatments and clinical applications.”

Advantages of Nanofat Grafting

There are many reasons for this popularity from a physician’s perspective. Nanofat from mechanical disruption requires “10 times less fat tissue as starting material compared with enzymatic isolation,” according to the report. Mechanically derived material also is more cost-effective and easier to use “because of the substantial reduction in material harvesting and processing.”

It is also important to note the positive psychological effect of nanofat grafting. An article in the National Library of Medicine emphasizes the importance of appearance, especially that of the face, which authors say “defines a person’s identity…An attractive face promotes self-esteem, trust, approachability, and success. Autologous fat grafting for facial rejuvenation represents a powerful tool in the plastic surgeon’s armamentarium when creating a youthful and attractive appearance.”

To this, we can all agree.

Alexander Zuriarrain, MD, FACS, is a board-certified plastic surgeon and owner of Zuri Plastic Surgery in Miami. Listen to a podcast PSP did with him here.

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