Lipofilling, Autologous Fat Grafting

What is adipose tissue?

Adipose tissue is far more than a simple energy storage organ. It is a highly active tissue with important hormonal and regenerative functions. For lipofilling, fat is harvested from the patient’s own body, typically from areas with excess adipose tissue such as the abdomen, hips, flanks, or thighs.

In principle, two types of adipose tissue are distinguished.
White adipose tissue primarily serves as an energy reservoir and is the predominant form in adults.
Brown adipose tissue plays a role in thermoregulation but is only present in small amounts in adults and is not clinically relevant for lipofilling.

For autologous fat transplantation, exclusively white adipose tissue is used.

Biological effects of fat

Adipose tissue possesses remarkable biological potential. In addition to mature fat cells, it contains the so called stromal vascular fraction (SVF), which consists of precursor cells.

Stromal vascular cells are a natural component of adipose tissue and comprise a heterogeneous cell population including mesenchymal stem cells, endothelial cells, pericytes, and immune cells. In contrast to mature adipocytes, these cells are highly biologically active.

Their key significance lies in their regenerative potential. Stromal vascular cells release growth factors and cytokines that promote angiogenesis, modulate inflammatory processes, and support tissue healing. As a result, they improve local blood supply and enhance the structural quality of the surrounding tissue.

The mesenchymal stem cells contained within the SVF have the ability, under specific conditions, to differentiate into various cell types and to functionally support damaged tissue. Clinically, this potential becomes evident through improved skin quality, increased elasticity, and regenerative effects within the recipient area.

In the context of lipofilling, stromal vascular cells play a crucial role in the successful integration and long term stability of transplanted fat. This biological component clearly distinguishes autologous fat from purely volumising materials and makes fat grafting a particularly versatile and sustainable procedure.

These components are associated with the following effects:


  • Improved tissue quality

  • Enhanced microcirculation

  • Positive effects on skin structure and elasticity

  • Regenerative effects in the recipient area

It is precisely this combination of volume and biological activity that makes autologous fat so unique compared to conventional fillers or foreign materials.

Fat as a volumising agent

Beyond its biological effects, fat is an excellent natural volumising material. It can be selectively harvested from one region of the body and transferred to another.
Typical donor sites include the abdomen, hips, flanks, and thighs.


Common recipient areas are the face, for example cheeks, temples, and periorbital regions, the breast, the buttocks, and various body areas for contour correction in cases of asymmetry or tissue defects.

The principle is straightforward: excess volume is reduced where it is undesirable and restored where volume is lacking.

Methods of fat harvesting

The quality of the transplanted fat depends largely on the harvesting technique. The primary goal is to preserve as many viable fat cells and accompanying stromal cells as possible.

Common harvesting techniques include conventional manual liposuction, vibration assisted liposuction, ultrasound assisted liposuction, and water assisted liposuction.
While all methods have their place, they differ significantly in terms of tissue preservation.

Advantages of water assisted liposuction (WAL)

Water assisted liposuction has proven particularly effective for lipofilling.

Its advantages include a very short exposure time, gentle separation of fat cells from the surrounding tissue, minimal mechanical stress, no thermal damage as seen with ultrasound based techniques, and high cell viability of the harvested fat.

The fat is loosened by a fine water jet and simultaneously aspirated. This preserves cell membranes, stem cells, and growth factors to a large extent, which is a key factor for successful graft survival.

The BEAULI method

The BEAULI method is a form of water assisted liposuction specifically developed for lipofilling, with the aim of harvesting particularly vital and biologically high quality adipose tissue.

BEAULI stands for Bodyjet Assisted Liposuction. The actual naming of the method originates from Dr Klaus Überreiter from Birkenwerder, who played a key role in its early clinical application, definition, and establishment within aesthetic surgery. The goal was to create a standardised and especially gentle approach to water assisted fat harvesting specifically for fat grafting.

During my training, I was closely involved in the clinical application of this technique. As a resident, I actively participated in its implementation, including study support and perioperative patient care. This early hands on experience continues to shape my approach to autologous fat transplantation today.

By using a fine, pulsating water jet, fat cells are gently separated from the surrounding tissue and aspirated simultaneously. Exposure time is short, mechanical stress is minimal, and no thermal damage occurs. As a result, not only fat cells but also stromal vascular cells, stem cells, and growth factors are preserved to a high degree.

The fat obtained in this manner is characterised by high cell viability and favourable graft survival. Especially in sensitive regions such as the breast or face, the BEAULI method offers clear advantages in terms of safety, take rate, and long term result stability.

Processing and transplantation

After harvesting, the fat is processed, depending on the technique, by filtering, washing, or sedimentation. The goal is to obtain a clean and vital fat graft concentrate.

Transplantation is performed in small aliquots and across multiple tissue planes. This micro or nano depot technique improves vascularisation of the graft and significantly increases graft survival rates, up to approximately 70 percent.

Depending on the treated area, techniques and take rates vary.

  • In the face, very fine deposits result in high survival rates of approximately 70 to 90 percent.
  • In the breast, multilayered distribution leads to moderate survival rates of around 50 to 70 percent.
  • In body contouring, survival rates depend on the region and its vascular supply and are typically around 50 percent.

A portion of the transplanted fat is naturally resorbed by the body. This is expected and is taken into account during treatment planning.

Operative procedure and aftercare

Depending on the extent of the procedure, lipofilling can be performed under local anaesthesia or general anaesthesia. In most cases, the treatment is carried out on an outpatient basis. Inpatient monitoring is only required when larger volumes of fat are harvested.

The typical procedure includes

  • fat harvesting,
  • processing,
  • and transplantation into the target area.

Postoperative care is generally uncomplicated. It is important

  • to avoid pressure on the transplanted area,
  • to keep the recipient region warm,
  • and to encourage early, normal mobilisation.

Compression of the donor areas is required for approximately six weeks.

Strenuous exercise, excessive physical strain, and pressure on the treated areas should be avoided for several weeks. Most patients return to everyday activities relatively quickly.

Why autologous fat?

Fat grafting occupies a unique position in aesthetic and reconstructive surgery because it is far more than a simple volume correction. It utilises living, autologous tissue that not only provides shape but actively interacts with the recipient site.

Autologous fat integrates seamlessly into existing structures. It feels natural, moves naturally, and ages together with the body. There is no foreign material, no capsule formation, and no material related long term risks. Instead, volume becomes an integral part of the tissue.

In addition, the biological dimension plays a crucial role. Fat does not only deliver volume but also regenerative properties. Stromal vascular cells, stem cells, and growth factors improve vascularisation, skin quality, and tissue elasticity. The result is not only increased fullness but often visibly healthier, softer, and more harmonious tissue.

Another key advantage is the dual effect of the procedure. Fat is removed where it is unwanted and transferred to areas where volume is deficient. Body contouring and volume restoration complement each other, creating highly individualised results rather than standardised outcomes.

Fat grafting requires precision, experience, and respect for the tissue. When performed correctly, it represents one of the most natural and sustainable ways to improve form, volume, and tissue quality simultaneously. This is why it has not only proven its value over many years but has continued to evolve and secure its place in modern plastic surgery.

Breast lipofilling- no foreign body but natural feeling

Breast lipofilling, also known as autologous fat grafting of the breast, is an established method for breast contouring using the patient’s own tissue. The goal is a natural increase in volume, improved shape, and enhanced tissue quality without the use of foreign materials.

During breast lipofilling, fat is harvested from areas with excess adipose tissue such as the abdomen, hips, or thighs, carefully processed, and then transplanted into the breast. The fat serves two purposes: it acts as a volumising agent and positively influences tissue quality through its stem cells and growth factors.

Unlike implants, no foreign body capsule is formed and there is no risk of capsular contracture. The breast maintains a natural feel and movement and adapts harmoniously to the body. This method is particularly suitable for patients seeking a moderate increase in size, enhanced fullness in the upper or inner breast, or correction of asymmetries.

Fat transplantation is performed in multiple fine layers distributed across different planes of the breast tissue. This technique is essential for adequate vascularisation and stable graft integration. Depending on individual conditions, part of the fat survives permanently, while another portion is resorbed by the body. This natural process is taken into account during surgical planning.

The procedure can be performed under local anaesthesia with sedation or under general anaesthesia, depending on its extent. In most cases, it is carried out on an outpatient basis. Inpatient monitoring is only required when larger volumes of fat are harvested or when additional procedures are planned.

Postoperative care is usually straightforward. The breast itself should not be subjected to pressure during the initial weeks. A specialised bra provides support rather than compression. In contrast, donor areas must be consistently treated with compression garments to reduce swelling, support skin retraction, and ensure an even result. Strenuous activity and excessive pressure should be avoided for several weeks. Warmth in the breast area and early normal mobilisation support fat graft survival.

Breast lipofilling combines breast shaping and body contouring in a single procedure. It offers a natural alternative to implant based breast augmentation, particularly for patients who prioritise natural appearance, softness, and the avoidance of foreign materials.

A technically demanding surgical procedure

Fat grafting is technically demanding and far more complex than simply transferring volume. The aesthetic and functional outcome depends on many small, often invisible factors that can only be reliably managed through experience.

The quality of the fat is determined already during harvesting. Pressure levels, suction strength, choice of harvesting technique, and a respectful handling of the tissue directly influence the vitality of fat cells and accompanying stromal vascular cells. The selection of suitable fat is equally important, as not all fat is appropriate for every region.

During processing and transplantation, sensitivity, precise technique, and a deep understanding of anatomy and vascular supply are essential. Fat must be placed in small amounts, evenly distributed, and without tension. Excessive pressure, incorrect layering, or inadequate technique can compromise blood supply and significantly reduce graft survival.

In inexperienced hands, this may lead to complications such as fat necrosis, inflammation, infection, palpable nodules, or poor graft survival with unsatisfactory aesthetic results. These risks are largely avoidable but require thorough training, surgical experience, and a respectful approach to the tissue.

Because fat grafting can achieve such natural and high quality results, it should be performed by an experienced surgeon. Experience in this context means not only technical skill but also refined aesthetic judgement and the ability to select the appropriate technique, suitable fat, and optimal strategy for each individual patient.

Why choose Dr Cromme?

The answer lies in experience. For more than two decades, Dr Cromme has been intensively involved in autologous fat transplantation and has performed well over one thousand operative procedures. This extensive clinical experience does not represent routine repetition but a profound understanding of tissue biology, anatomy, and individual variation.

Dr Cromme understands which fat is best suited for each anatomical region, how it must be harvested and processed with appropriate pressure, and how it should be transplanted in a tension free and vascular friendly manner.

In addition, his early and active involvement in the development of modern lipofilling techniques, including participation in clinical studies and intensive patient care, forms the foundation of his current approach. This background continues to shape his respectful handling of tissue and his commitment to achieving natural and stable long term results.

The combination of long standing surgical experience, a high volume of procedures, and a refined aesthetic sense makes the decisive difference. Especially in a procedure that relies so heavily on precision and sensitivity as fat grafting, experience is not an addition but a prerequisite for a safe and convincing outcome.

Do you have any questions or would you like to make an appointment? Feel free to write to us directly.

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