Percutaneous Retrograde Intramuscular Echo-Guided Fat Grafting (PRIME-GRAFT): A Novel Technique to Increase Safety and Improve Results

SUMMARY: Achieving natural and dynamic body definition remains a challenge in body contouring surgery. High-definition lipoplasty has enhanced aesthetic outcomes by sculpting the superficial fat layer, and intramuscular fat grafting (IFG) has been used to improve muscle volumization. To further optimize results and improve safety, the authors introduce a novel approach: percutaneous retrograde echo-guided IFG (PRIME-GRAFT). PRIME-GRAFT combines the principles of ultrasound-guided fat grafting and direct percutaneous access using a 2.1-mm blunt cannula, ensuring precise and safe fat distribution along the muscle fibers. Unlike traditional techniques that use larger cannulas and bolus injections, PRIME-GRAFT follows a linear retrograde deposition approach alongside the muscle fibers, minimizing trauma and maximizing fat survival. The combination of a thin cannula and ultrasound guidance allows for precise fat deposition at the muscle, including its origins and insertions, enhancing muscle definition and shape and improving the final aesthetic outcome. A retrospective study on 71 patients (21 men, 50 women; mean age, ~43 years) who underwent PRIME-GRAFT demonstrated consistent results, achieving natural muscle definition without complications. The technique was applied to various muscle groups, ensuring harmonious body proportions. The ultrasound-guided approach improves procedural safety by preventing injury to structures adjacent to the target muscle. The use of color Doppler imaging further minimizes the risk of vascular damage. The results indicate that PRIME-GRAFT is a safe and effective minimally invasive technique for improving muscle definition in body contouring surgery. This innovation provides a standardized, precise approach to IFG, enhancing both aesthetic outcomes and procedural safety.