Stem cells, mature adipocytes, and extracellular matrix: What does each contribute to fat graft survival?

For almost 100 years, fat tissue has been used as soft tissue filler for volume restoration. Fat grafting represents today a major tool in both reconstructive and aesthetic surgery. The discovery of adipose-derived stem cells (ASCs) opened new perspectives in basic science, experimental, and clinical plastic surgery. After fat grafting, the overlying skin gains in terms of thickness and quality. The authors have found that fat tissue can be used for two effects - volume restoration and tissue regeneration. Although the survival of adipose tissue has already been documented in different ways, the major drawback is the unpredictable resorption rates. For both clinical applications of the adipose tissue, an important issue to understand these processes and to solve the aforementioned. The authors discuss the role of cells, extracellular matrix, and biological factors in fat grafting which determine volumetric, regenerative, and bioengineering possibilities.