Global Risk Assessment for Fat Transfer (GRAFT Score): Redefining Safety and Accuracy in Lipoinjection Procedures

BACKGROUND: Due to the variability in the technique and risk of complications for Intramuscular fat grafting, there is a need for a standardized approach. We are introducing a new scoring system, designed to guide surgeons in performing intramuscular fat grafting safely and effectively. METHODS: We conducted a retrospective review of patient records from January 2020 to December 2024. The inclusion criteria encompassed all patients who underwent fat grafting as part of High-Definition Liposuction (HDL). Complications were analyzed based on their occurrence. The GRAFT Scoring system was developed through inter-rater agreement among four evaluators, followed by the creation of a postoperative evaluation protocol for fat grafting, incorporating ultrasound imaging. RESULTS: A total of 1,284 muscle groups from 651 consecutive patients were analyzed. Of these, 511 cases were women, while 140 cases were men. Median age of the cohort was 37 years (IQR 11, 18-59 years), with a median BMI of 24.2 kg/m² (IQR 3.8, 17.7-33.3 kg/m²). Muscles were classified into four categories-Low Risk, Moderate Risk, High Risk, and Prohibited-based on the scoring system. The protocol for postoperative adipose graft evaluation was based on the reported complications and the overall aesthetic outcomes. CONCLUSION: GRAFT Score provides a structured, user-friendly method to classify muscles for intramuscular fat grafting, emphasizing safety and precision. By simplifying risk categories, this system facilitates decision-making, reduces complications, and enhances patient outcomes. A standardized protocol for postoperative fat grafting evaluation is a promising tool to standardize future studies.