Clinical applications and derived therapeutic strategies of adipose-derived stem cells in autologous fat grafting

Abstract Autologous fat grafting is widely employed for aesthetic augmentation and soft tissue reconstruction owing to its readily available source, high tissue compatibility, and natural contouring properties. However, its efficacy exhibits significant variability across individuals and anatomical sites, with volume retention and tissue quality proving challenging to maintain long-term stability—a critical issue limiting clinical scalability. Adipose-derived stem cells (ADSCs), possessing rich paracrine activity and multidimensional microenvironmental regulatory capabilities, represent a key strategy to enhance the clinical efficacy of fat grafting. The current clinical focus in fat grafting has progressively shifted from cellular supplementation towards regulating the internal environment: ADSCs synergistically promote graft-recipient tissue adaptation and integration by facilitating angiogenesis and endothelial function recovery, modulating immune responses, remodelling inflammation-related signalling networks, and influencing matrix metabolism and fibrosis progression to some extent. This narrative review comprehensively summarizes the primary biological mechanisms and key experimental/clinical evidence supporting ADSC-augmented fat grafting across applications including breast reconstruction and post-surgical restoration, facial rejuvenation, and scar/chronic wound management. It further summarizes trends in engineered and acellular approaches, including combinations with platelet-rich plasma and other protocols, the translational potential of effector carriers such as exosomes and their miRNAs, and the role of material platforms like decellularized adipose matrices and hydrogels in enhancing the persistence and delivery efficiency of ADSC effects. The conclusion addresses core challenges including standardized preparation and quality control, efficacy evaluation systems, long-term safety, and regulatory compliance. It proposes research directions for clinical translation, aiming to establish more stable and verifiable technical pathways for regenerative repair.