title: A classification of clinical fat grafting:  different problems, different solutions.
abstract: BACKGROUND
  Fat grafting has reemerged from a highly variable procedure to a technique with vast reconstructive and cosmetic potential. Largely because of a more disciplined and scientific approach to fat grafting as a transplantation event, early adopters of fat transplantation have begun to approach fat grafting as a process, using sound surgical transplantation principles: recipient preparation, controlled donor harvest, time-efficient transplantation, and proper postoperative care. Despite these principles, different fat grafting techniques yield impressive clinical outcomes.
  
  
  METHODS
  The essential variables of four types of fat grafting cases were identified and compared: harvesting, methods of cell processing, methods of transplantation, and management of the recipient site.
  
  
  RESULTS
  Each case differed for most of the variables analyzed. The two clinical drivers that most impacted these differences were the volume demands of the recipient site and whether the recipient site was healthy tissue or pathologic tissue. After these two drivers, a matrix classification of small-volume versus large-volume and regenerative versus nonregenerative cases yields four distinct categories.
  
  
  CONCLUSIONS
  Not all fat grafting is the same. Fat grafting, once thought to be a simple technique with variable results, is a much more complex procedure with at least four definable subtypes. By defining the essential differences in the recipient site, the key driver in fat transplantation, the proper selection of technique can be best chosen. In fat transplantation, different problems require different solutions.
authors.affiliation: Boston, Mass.; and Dallas, Texas From Back Bay Plastic Surgery and the University of Texas Southwestern Medical Center.
authors.forename: Daniel
authors.initials: D
authors.lastname: Del Vecchio
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D005145:Face / Q000601:surgery; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D016462:Mammaplasty / Q000145:classification / Q000379:methods; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000145:classification* / Q000295:instrumentation / Q000379:methods; D016378:Tissue Transplantation / Q000145:classification* / Q000295:instrumentation / Q000379:methods; D020858:Tissue and Organ Harvesting; D014950:Wounds, Penetrating / Q000601:surgery; D055815:Young Adult