The evidence of volume loss, as a primary aging factor, was clearly described by Lambros. In this sense, the demand for dermal fillers that are safe, long-lasting and biocompatible has grown. Autologous fat grafting has been widely used, especially by plastic surgeons, as the best choice. However, the lack of reliability and consistency in the final clinical results is a major concern, which may generate the need for multiple procedures. In fact, the literature does not provide clear data on how much the injected fat really lasts. From the end of the 1980s, Coleman advocated the meticulous systematization of lipografting a s a solution to minimize the lack of reliability of the method and he continued to have expressive, consistent and long-term lasting results, until, in the mid-1990s, he began to observe other attributes of fat grafts, like improved skin quality, wrinkle smoothing, decreased pores and improved pigmentation. Tonnard et al. reinforced this clinical impression and published intradermal injection of fine needle fat (SNIF) and nanofat graft, with even thinner needles. The objective of this work is to report how to perform fat grafting in facial rejuvenation, detailing indications, patient preparation, methodology, fat-graft preparation, forms of injection and post-procedure care. With adequate selection of patients and the facial areas to be treated; and after adequate fat harvesting and processing, facial fat grafting can be used more consistently in deeper application in the hypodermis and deep dermis for volumizing effect and more fluidly in application with more delicate cannulas or needles in the superficial dermis to improve skin quality, fine wrinkles and pigmentation.

Francisco Albuquerque is a board certified plastic surgeon, practicing in aethetic and reconstructive surgeries since 2014. He is also a full member of the Brazilian Society of Plastic Surgery and a professor at the medical school of the “Centro Universitátio Claretiano de Rio Claro" - São Paulo - Brazil.