Platelet-rich plasma versus plasma gel for fat graft survival under cigarette smoke exposure: An experimental study

Autologous fat grafting is widely used in plastic surgery, but graft survival remains unpredictable, particularly under compromised conditions such as cigarette smoking. Smoking impairs microcirculation and tissue oxygenation, adversely affecting graft viability. Platelet-rich plasma (PRP) has been proposed as a biological adjunct that enhances angiogenesis and tissue regeneration. Plasma gel (PG), similarly derived from PRP and retaining various growth factors, as a fibrin-based volumizing scaffold. This study aimed to evaluate whether PRP or PG can mitigate cigarette smoke-induced impairment of fat graft survival and to compare their respective effects.

Thirty male Sprague-Dawley rats were assigned to control (n = 10) and smoke-exposed groups (n = 20). Smoke-exposed animals were divided into PRP (n = 10) and PG (n = 10) groups. After six weeks of smoke exposure, autologous fat grafts were implanted bilaterally, with the right side receiving treatment and the left side serving as an internal control. After six weeks, graft retention and histological parameters were evaluated.

Smoke exposure reduced graft retention and increased fibrosis and necrosis. PRP improved graft retention (64.9% vs 36.5%, p = 0.004), reduced necrosis, and increased viable adipose tissue. PG did not improve graft retention (p = 0.084) and was associated with higher fibrosis (p = 0.015). PRP-treated grafts showed greater retention than both the Control and PG groups (p < 0.001).

PRP improves fat graft survival under cigarette smoke exposure, whereas PG does not. PRP may be a useful adjunct in recipients with compromised conditions.