Autologous fat-derived products for skin and scar optimization in rhinoplasty and nasal reconstruction: A systematic review.

Background: Rhinoplasty and nasal reconstruction are technically demanding procedures in which optimization of the skin and soft-tissue envelope remains challenging, particularly in revision surgery and in patients with thin or scarred skin. Autologous fat-derived products have emerged as regenerative adjuncts that may improve scar quality, skin texture, and aesthetic outcomes beyond simple volumetric augmentation. Objective: To systematically evaluate the clinical outcomes of autologous fat-derived product grafting in rhinoplasty and nasal reconstruction, focusing on scar quality, skin characteristics, aesthetic outcomes, patient satisfaction, safety, and durability. Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251087473). A comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, and Google Scholar was conducted from database inception to June 2025. Human clinical studies reporting outcomes of autologous fat-derived products in rhinoplasty or nasal reconstruction were included. Study selection, data extraction, and risk-of-bias assessment were performed using predefined criteria. Because of substantial clinical and biological heterogeneity, a structured qualitative (narrative) synthesis informed by Synthesis Without Meta-analysis (SWiM) guidance was undertaken, with outcomes organised by product class. Results: Twelve studies published between 2007 and 2024, involving 768 patients in aggregate across non-pooled studies, met the inclusion criteria. Interventions included microfat, nanofat, stromal vascular fraction, adipose-derived stromal cells, platelet-rich fibrin-enriched fat, and diced fat composites. Most studies reported improvements in scar appearance, skin quality, and tissue pliability, with favorable aesthetic outcomes and high patient satisfaction. Only one study used objective three-dimensional imaging; the remainder relied on subjective assessment. Complications were infrequent and generally minor. Conclusions: Autologous fat-derived products appear to be well tolerated and may be useful adjuncts in rhinoplasty and nasal reconstruction, with a consistently low rate of minor, self-limiting complications. However, the available evidence is of low certainty: it is drawn predominantly from small, uncontrolled, subjectively assessed studies that pool biologically distinct fat preparations and is geographically concentrated in East Asian populations. Reported aesthetic benefits should be interpreted with caution. Well-designed comparative studies using standardised processing protocols, blinded three-dimensional outcome assessment, and adequate follow-up are needed before firm clinical recommendations can be made.