Review of fat grafting and the fate of the subperiostal fat graft

Fat grafting has been widely used over the past100 years for soft tissue augmentation. Despite a number of publications which show poor long-term results, it is still one of the most preferred soft tissue fillers. After liposuction became popular in 1980s, an easier method of transfer, lipoinjection, once again brought attention to fat grafting. New methods to increase durability of fat grafts were developed. Placing the fat graft into a well vascularized recipient site was one of the most accepted ideas. Fat grafting into the muscle and over periosteum showed satisfactory results in the long term. All the fat tissue transplanted into a recipient site will probably not survive; the area then contains necrotic fat tissue and this can cause depressions which are easily seen if the overlying skin is thin and has been previously traumatized. Placing the fat grafts subperiostally can be a solution to this problem. In our experimental study we compared subperiostal fat grafting with supraperiostal fat grafting in a rat model. Fat graft weight changes and histopathological examinations in both of the groups showed similar properties. Thus subperiostal grafting is an alternative augmentation technique in areas where the overlying skin is thin.