BACKGROUND: For decades, facial fat grafting is used in clinical practice for volume restoration. The main challenge of this technique is the variable volume retention. Over the past years, studies reported the addition of supplements to augment the fat graft to increase volume retention.
OBJECTIVES: The aim of this systematic review was to investigate which supplements increase volume retention in facial fat grafting as assessed with volumetric outcomes and patient satisfaction.
METHODS: Central, MEDLINE, EMBASE, Web of Science Core Collection and Google Scholar were searched until 30th of November 2020. Only studies assessing volume after facial fat grafting with supplementation in human subjects were included. Outcomes of interest were volume or patient satisfaction. Quality of the studies was assessed using the Effective Public Health Practice Project tool.
RESULTS: After duplicates were removed 3724 studies were screened by title and abstract. After reading 95 full-text articles, 27 studies were eligible and included for comparison. Supplementation comprised of platelet rich plasma (PRP), platelet rich fibrin, adipose tissue-derived stromal cells or bone marrow-derived stromal cells, cellular or tissue stromal vascular fraction (SVF) or nanofat. In 13 out of 22 studies the supplemented group showed improved volumetric retention and 5 out of 16 studies showed greater satisfaction. The scientific quality of the studies was rated as weak for 20 of 27 studies, moderate for 6 of 27 studies and strong for 1 study.
CONCLUSIONS: Our results show that it remains unclear if additives contribute to facial fat graft retention while there is a need to standardize methodology.