Rectus Abdominis Fat Grafting: Outcomes and Safety

Background: Rectus abdominis fat grafting (RAFG) has emerged as a valuable adjunct to liposuction and abdominoplasty to enhance muscular definition and abdominal contour. Despite its growing popularity, evidence regarding safety, standardization, and outcomes remains limited. This study described a standardized protocol for ultrasound-guided or direct-vision RAFG and evaluated clinical results, complications, and patient satisfaction. Methods: A retrospective review was conducted on 182 consecutive patients who underwent liposuction or abdominoplasty with intramuscular fat grafting to the rectus abdominis between 2022 and 2024. Fat was injected under high-frequency ultrasound guidance or direct vision during abdominoplasty. Demographics, operative time, graft volumes per metamere, complications, and pre- and postoperative BODY-Q abdomen scores were analyzed. Results: The cohort included 182 patients with a mean age of 37.2 years and a mean body mass index of 26.4 kg/m 2 . The average fat graft volume per patient was 85 mL, distributed across 4 metameres (15, 20, 20, and 30 mL). Complications directly related to the grafting procedure occurred in 2 patients (1.09%): 1 surgical-site infection and 1 fat necrosis. No cases of fat embolism were observed. Mean BODY-Q satisfaction scores improved from 12.5 to 26.2 on a 28-point scale. Conclusions: RAFG using ultrasound guidance or direct visualization with a metameric, small-volume protocol is a safe, reproducible technique that enhances abdominal definition. Its low complication rate and significant improvement in patient satisfaction support its inclusion in contemporary body contouring practices.