What are nano fat grafts?

What Are Nanofat Grafts?

Nanofat grafting is an autologous fat transfer technique where harvested adipose tissue is mechanically emulsified and filtered into particles smaller than 0.1 mm diameter, creating a fluid preparation rich in adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF) cells but devoid of viable adipocytes, used primarily for skin rejuvenation rather than volumization. 1, 2, 3

Technical Preparation and Cellular Composition

Processing Method:

• Adipose tissue is harvested via liposuction from adipose-rich donor sites 1
• The harvested fat undergoes mechanical emulsification (shuffling) followed by filtration to create particles <0.1 mm in diameter 2, 4, 3
• This processing destroys viable adipocytes but preserves the stromal vascular fraction and stem cell populations 3

Cellular Content:

• Nanofat contains no viable adipocytes after processing 3
• High concentrations of adipose-derived stem cells (ADSCs) remain intact with preserved proliferation and differentiation capacity 3
• Rich in stromal vascular fraction (SVF) cells and growth factors 2, 4
• The stem cells maintain equal proliferation and adipogenic differentiation capacity compared to unprocessed fat 3

Mechanism of Action

Regenerative Properties:

• ADSCs and SVF cells stimulate collagen synthesis and dermal restructuring 1, 4
• Growth factors promote tissue regeneration and angiogenesis 2, 4
• Reconstructs dermal support structures including collagen networks 4
• Improves skin quality through biostimulation rather than volumization 1

Key Distinction from Macrofat/Microfat:

• Unlike conventional fat grafting, nanofat provides minimal to no volumizing effect due to absence of viable adipocytes 1, 3
• The fluid consistency allows injection through fine needles (up to 27-30 gauge) into superficial dermal layers 5, 3
• Primary mechanism is regenerative/rejuvenative rather than structural augmentation 1, 4

Clinical Applications

Primary Indications:

• Facial skin rejuvenation and improvement of skin quality 1, 2, 3
• Treatment of fine lines, wrinkles, and superficial rhytides 2, 3
• Scar improvement (acne scars, surgical scars, burn scars) 2, 4, 6
• Dark lower eyelids and periorbital rejuvenation 3
• Sun-damaged skin restoration 2
• Chronic wound healing 4
• Alopecia treatment 2

Combination Therapy:

• Frequently combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) for enhanced facial rejuvenation 1
• The nanofat plus PRF combination showed >90% patient satisfaction rates at 12-24 months follow-up 1
• Combined therapy demonstrates superior and more durable results compared to hyaluronic acid alone, with significant improvements persisting at 12 months versus loss of significance in HA-only groups 1

Administration Technique

Injection Parameters:

• Delivered via microinjection technique using 27-30 gauge needles or 25 gauge cannula 5, 3
• Typical dosing: 0.2-0.5 mL per treatment quadrant 5
• Injected into dermis and immediate subdermis layers 1
• Retrograde injection fashion recommended 5
• Injection depth should be above the orbicularis oris muscle in perioral applications to avoid vascular complications 5

Clinical Outcomes and Evidence

Efficacy Data:

• Remarkable improvements in skin quality observed at 6 months postoperatively 3
• Significant improvements in scar characteristics based on Patient and Observer Scar Assessment Scale (POSAS), FACE-Q scores, and Vancouver Scar Scale 6
• Histologic evaluation demonstrates increases in skin thickness, collagen density, and elastic fibers 6
• Benefits include improvement in skin texture, elasticity, pore size, moisture, wrinkles, and pigmentation 1

Duration of Effects:

• Rejuvenation effects persist beyond initial treatment period 1
• The 3D volumizing effect (when present) does not last beyond 3 months 5
• Long-term skin quality improvements maintained at 12-24 months when combined with PRF 1

Safety Profile

Adverse Events:

• No severe complications reported in systematic reviews 6
• No infections, fat cysts, granulomas, or other unwanted side effects observed in clinical series 3
• Mild to moderate bruising, swelling, and tenderness are most common treatment-related effects, typically self-limited and resolving within days to weeks 5
• Mild pain or discomfort during injection may occur 5

Advantages Over Synthetic Fillers:

• Autologous sourcing eliminates risk of allergic reactions 1
• Lower risk of vascular occlusion compared to synthetic fillers 1
• More biocompatible and natural appearance 1, 5
• Cost-effective as it requires no additional equipment or culture time 4

Critical Clinical Pitfalls

Patient Selection Errors:

• Do not use nanofat when significant volumization is the primary goal - the absence of viable adipocytes means no durable volume enhancement beyond 3 months 5, 3
• For volume restoration, hyaluronic acid fillers or traditional macrofat/microfat grafting are appropriate, not nanofat 5

Technical Errors:

• Avoid superficial injection in delicate perioral areas - maintain depth above orbicularis oris muscle to prevent vascular injury 5
• Do not use large-bore needles - the fluid consistency allows and requires fine needles (27-30 gauge) for optimal delivery 5, 3

Expectation Management:

• Set realistic expectations that nanofat provides rejuvenation and skin quality improvement, not volumization 1, 5
• Inform patients that bruising is common and expected 5