Fat grafting was first described in 1893 by Gustav Neuber, who transplanted adipose tissue from the arm to the orbit to correct depressed scars resulting from osteomyelitis. In 1895, Czerny reported excising a lipoma and grafting it into a breast defect. In 1900, Gersuny described paraffin injections, which became commonly performed for saddle nose defects secondary to syphilis. Paraffin injections initially gave amazing results, but infections and paraffinomas would follow, and paraffin could migrate causing pulmonary embolism. Holländer proposed the technique of fat injection, but there was a high rate of reabsorption. In 1912 his technique was to harvest adipose tissue from patients and mix it with fat from rams. This mixture was injected as a fluid at body temperature. Patients had a painful rash afterwards for two to three days but he reported a good outcome. In 1919, Lexer described fat grafting in 300 pages of his two volume textbook, to correct sequelae of facial trauma, hemifacial microsomia, microgenia, breast asymmetry, post-traumatic hand stiffness. He proposed the use of fat to restore gliding tissue around tendons in Dupuytren disease. In 1920, Gillies showed patients treated with fat grafting after facial injuries in his book. In 1926, Miller recommended fat amongst other fillers to correct nasolabial folds, crows feet and saddle noses. Fat grafting gradually fell from favour due to problems with reabsorption, cysts and fibrosis. In 1955, Peer demonstrated that about 50% of fat cells died after transplantation and were replaced with fibrous tissue. In the 1980s, liposuction became popular and fat grafting was rediscovered. Chajchir described favourable results in 1989, emphasising cautious handling of adipocytes, rinsing of the lipoaspirate to eliminate dead cells and grafting into a well-vascularised bed. In the 1990s Coleman systematised the procedure. Adipose-derived stem cells were discovered in 2001, which are capable of differentiating into other types of tissues of mesenchymal origin and this seems to account for the regenerative properties of fat grafts. In 2007 Rigotti injected lipoaspirate into irradiated defects and demonstrated tissue regeneration. In 2011 the International Society of Plastic Regenerative Surgery was established. 

The fascinating history of fat grafting.
Mazzola RF, Mazzola IC.
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Aina Greig

St Thomas' Hospital, London, UK

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