The re-emergence of fat grafting and its now widespread use can be credited to many factors. But one of the most significant of these is the realization that fat is a ubiquitous connective tissue which contains a plethora of stem cells. Many of the improvements in tissue quality seen after fat grafting have been credited to these stem cells that come with the graft. This has not yet to be conclusively proven but it is understandable why that is a reasonable supposition.
The clinical uses of fat injections knows few boundaries. Its ease of injection and being a natural tissue lends itself to being tried for a wide variety of augmentations and the treatment of pathologically altered tissues. One of these potential applications is in the treatment of problematic scars.
In the October 2013 issue of the Journal of Craniofacial Surgery, an article was published entitled ‘Autologous Fat in Scar Treatment’. In this paper, the authors present their observations after 6 years of autologous fat graft experience in scar remodeling. In twenty (20) patients that had painful and retracted scars around joints, they were injected with microdroplet fat injections. They were assessed using an observer scale and durometer (firmness) measurements.
In all fat injected scars, a measureable improvement was seen in both appearance and function. Scars were less painful and were more supple with increased range of motions. All scars were less hard by durometer assessment compared to other scars treated by sham saline injections.
While this is not a large patient enrolled study, it shows that fat placed into and around a scar can change both its feel and its biologic behavior. It is not certain whether this is due to actual fat interpersed into the scar helping to break up the dense collagen fibers or whether it is extraneous factors outside the scar delivered by the fat graft that helps modify the collagen fibers.
While fat grafts show some promise as a scar treatment, it is not just for any scar problem. Its use would be indicated for difficult scars like those from burns and caused by the tissue altering effects of radiation. These broad-based pathologically-altered scar types would benefit most by whatever ‘tissue normalizing’ effect fat grafts may have to offer.
Dr. Barry Eppley