Fat Necrosis After Facial Autologous Fat Grafting: A Systematic Review of Reported Complications and Management Strategies

Background: Autologous fat grafting (AFG) has become a popular technique in facial aesthetic and reconstructive surgery due to its regenerative properties and biocompatibility. Despite its favorable safety profile, complications such as fat necrosis and lipogranuloma are underreported but can have significant clinical impact. Objectives: To systematically review the literature on facial fat necrosis and lipogranuloma following AFG, with a focus on clinical presentation, anatomical distribution, risk factors, diagnostic modalities, and management outcomes. Methods: A comprehensive search of PubMed, Embase, and Scopus databases was conducted to identify studies reporting fat necrosis or lipogranuloma as complications of facial AFG. Eighteen studies, including case reports, case series, and retrospective reviews, were included in qualitative synthesis. Results: The periorbital region was the most frequently affected site, often following forehead or glabellar fat injections. Lesions typically presented as firm, painless nodules or oil cysts weeks to months post-procedure. Cryopreserved fat and repeat grafting sessions were common risk factors. Diagnosis was largely clinical, with imaging and histology used selectively. Corticosteroid therapy (oral or intralesional) was the most frequently successful treatment. Observation was appropriate for small, asymptomatic lesions, while surgery was reserved for refractory cases. Clinical outcomes were uniformly favorable. Conclusions: Fat necrosis and lipogranuloma, though rare, are clinically relevant complications of facial AFG. Early recognition and non-invasive management with corticosteroids are often effective. Standardized terminology, improved reporting, and prospective studies are needed to inform best practices and enhance patient outcomes. EBM Level: IV-V