Stromal Vascular Fraction-Assisted Fat Grafting: A Systematic Review and Meta-analysis of Clinical Outcomes

Autologous fat grafting is a cornerstone in plastic and reconstructive surgery, yet its efficacy remains limited by variable resorption rates. Stromal vascular fraction (SVF) has emerged as a promising adjunct to enhance graft survival. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SVF-enriched fat grafting compared with conventional fat grafting techniques.

A comprehensive literature search was conducted across Web of Science, PubMed, Embase, Ovid Cochrane, and Google Scholar up to September 2025, following PRISMA guidelines. Eligible studies included randomized controlled trials and observational studies comparing SVF-enriched and conventional fat grafting. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for randomized trials, and both the Newcastle-Ottawa Scale (NOS) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool for observational studies. A random-effects model was used to calculate pooled mean differences and risk ratios, with heterogeneity assessed using the I² statistic.

Eighteen studies involving eight hundred ninety-three patients were included. SVF-enriched fat grafting demonstrated significantly higher fat retention rates compared with conventional grafting (mean difference: 17.20%; 95% CI: 11.26-23.15; p < 0.001), though heterogeneity remained high (I² = 98%). Subgroup analyses showed consistent benefits across study designs and anatomical regions, with greater improvement in facial grafts than in breast applications. Among SVF preparation methods, automated enzymatic systems achieved the highest retention gains (22.8%; 95% CI: 16.5-29.1; p < 0.001). No major complications were reported, and rates of cyst or fat necrosis were comparable between groups (RR = 1.15; 95% CI: 0.57-2.33; p = 0.69).

SVF-assisted fat grafting appears to enhance volumetric persistence and overall graft survival without increasing complications, supporting its potential as a safe and effective adjunct in both reconstructive and esthetic surgery. While findings are promising, further high-quality randomized controlled trials with standardized SVF isolation protocols and long-term follow-up are essential to confirm these outcomes and establish best-practice guidelines for clinical implementation.

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