Strategic application of multilayer fat grafting in facial rejuvenation: a retrospective study

Backgrounds: Facial aging is characterized by complex volumetric changes involving soft tissue atrophy and skeletal remodeling. Autologous fat grafting has evolved as a primary technique, though unpredictable graft retention remains a challenge. Objective: The study aims to provide the strategic application of differentially processed adipose products by matching material properties to anatomical requirements. Methods: This retrospective study analyzed 105 patients undergoing facial fat grafting for age-related contour deformities. Adipose products, including high-density fat (HDF), adipose matrix complex (AMC), and stromal vascular fraction gel (SVF-gel), were injected into specific anatomical layers. Outcome assessments included clinical evaluation and standardized photographic documentation, Visual Analog scale, and Global Aesthetic Improvement Scale. Results: All patients achieved significant aesthetic improvement with no major complications. Early side effects resolved spontaneously within 3 weeks. Sixteen patients required secondary procedures due to partial volume absorption. SVF-gel demonstrated efficacy in periorbital rejuvenation and skin quality enhancement, while HDF and AMC provided stable structural support in deeper facial regions. Patient-reported satisfaction scores were 5.26 ± 1.84 preoperatively and 8.01 ± 1.09 postoperatively. Observer assessments using the Global Aesthetic Improvement Scale (GAIS, -1 to 3) yielded a postoperative score of 1.88 ± 0.65. Conclusions: The targeted application of processed adipose products based on their biological properties and recipient site requirements enables effective, multilayer facial restoration. This approach addresses both volumetric deficits and skin quality concerns, offering a comprehensive solution for facial rejuvenation.