What Is Nanofat Grafting? History and Biological Basis
Nanofat grafting was described by Belgian plastic surgeon Dr. Patrick Tonnard in 2013 and systematised through a technique published in Plastic and Reconstructive Surgery in 2014. The method is based on converting standard adipose tissue into a stromal vascular fraction (SVF) by removing structural adipocytes through mechanical emulsification and filtration.
The resulting "nanofat" material contains no intact fat cells; instead, it is a biologically active cocktail comprising adipose-derived stem cells (ADSCs), growth factors, cytokines, and extracellular matrix components. This characteristic is precisely what makes nanofat useful not merely for volume augmentation but for active tissue regeneration.
At Virtuana Clinic, nanofat grafting procedures offered to our patients in Izmit and Kocaeli are planned for areas such as under-eye quality, the periorbital zone, facial rejuvenation, and scar treatment β and are combined with standard lipofilling or PRP when indicated.
Microfat, Macrofat, and Nanofat: What Are the Differences?
Different forms of fat grafting vary according to the problem they target and the desired outcome:
| Fat Graft Type | Particle Size | Primary Effect | Target Area |
|---|---|---|---|
| Macrofat (Lipofilling) | 800β2000 Β΅m | Volume augmentation, deep tissue filling | Face, breast, buttocks, dorsum of hands |
| Microfat | 200β500 Β΅m | Moderate volume + partial regeneration | Periorbital, nasolabial, fine areas |
| Nanofat | Below 25 Β΅m (liquid phase) | Tissue regeneration, skin quality improvement | Under eyes, periorbital, thin skin, scars |
Biological Actives in Nanofat: Stem Cells and Growth Factors
Multiple biological components underlie nanofat's regenerative capacity:
Adipose-Derived Stem Cells (ADSCs)
ADSCs isolated from adipose tissue β the richest source of mesenchymal stem cells β are reprogrammable multipotent cells. They can differentiate into fibroblasts, chondrocytes, and vascular cells. Through paracrine signalling, they stimulate collagen synthesis, angiogenesis, and tissue repair. Preservation of the stromal vascular fraction (SVF) during nanofat preparation keeps ADSC concentrations 3β5 times higher than in standard fat grafting.
Growth Factors and Cytokines
VEGF (vascular endothelial growth factor), bFGF (basic fibroblast growth factor), TGF-Ξ² (transforming growth factor), and IGF-1 (insulin-like growth factor) are abundantly present in the nanofat matrix. These growth factors:
- Stimulate dermal fibroblast proliferation β increased collagen production
- Trigger new capillary network formation (angiogenesis) β improved tissue nutrition
- Regulate melanocyte activity β support for skin tone evenness
- Drive scar tissue into remodelling β efficacy in scar treatment
Treatment Areas: Where Is Nanofat Used?
The liquid structure that allows fine-needle injection and nanofat's regenerative capacity make it particularly valuable in the following areas:
- Under eyes (periorbital): The most frequently chosen application area for tear-trough deformity, dark circles, and thin skin irregularity. An ideal alternative in very thin periorbital areas where standard hyaluronic acid fillers are not suitable.
- General facial rejuvenation: Combination of microfat volume addition across the entire face followed by nanofat skin quality regeneration β the "Lipofilling + Nanofat" protocol.
- Hand rejuvenation: Collagen stimulation and volume support on hand skin that has thinned and developed prominent veins with ageing.
- Scar and blemish treatment: Tissue renewal in acne scars, surgical scars, and burn scars. Combination with TCA CROSS or microneedling is used for deeper scars.
- Neck and dΓ©colletage: For signs of sun damage, loss of skin elasticity, and early ageing.
- Perioral area: In perioral lines and lip volume loss, within a combination protocol with hyaluronic acid.
The Procedure: Step-by-Step Nanofat Grafting Protocol
- Fat harvest: Aspiration of 20β40 mL of fat from small areas such as the abdomen, inner thigh, or inner knee under local anaesthesia (thin cannula, low negative pressure)
- Washing: Rinsing with Ringer's lactate or PBS to remove the blood-mixed tumescent solution
- Mechanical emulsification: The collected fat is mechanically fragmented by passing it back and forth 30 times between two syringes via a Luer-to-Luer connector
- Filtration: Passage through a 0.5 mm pore filter β intact adipocytes and fibrous stroma are removed, yielding an ADSC-rich liquid phase
- Injection: Intradermal or supraperiosteal injection into the target area using 27Gβ30G fine needles or microcannulas
Total procedure time ranges from 45 to 90 minutes depending on the size of the fat harvest site and the treatment area. General anaesthesia or deep sedation is not required; local anaesthesia and, if needed, mild sedation are sufficient.
Nanofat + PRP Combination: Why Is It Powerful?
Combining platelet-rich plasma (PRP) with nanofat significantly increases the growth factor load. Platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and thrombopoietin from PRP enhance the activation and retention rate of nanofat ADSCs. Thanks to this synergistic effect:
- Collagen synthesis begins 25β35% faster than with nanofat alone
- ADSC viability and retention rate increase
- Angiogenesis accelerates, establishing new tissue nutrition earlier
- Overall skin quality and luminosity improvement is more pronounced
At Virtuana Clinic, the majority of nanofat procedures are planned in combination with autologous PRP. This is the standard protocol we prefer for accelerating clinical outcomes and increasing their durability.
Nanofat vs. Hyaluronic Acid Filler: Which Is Preferred and When?
| Feature | Nanofat Grafting | Hyaluronic Acid Filler |
|---|---|---|
| Mechanism of action | Biological regeneration β collagen stimulation | Mechanical volume and hydration |
| Duration of effect | 12β36 months (ongoing improvement in tissue quality) | 6β18 months (subject to biodegradation) |
| Skin quality improvement | High β collagen, elastin, ADSC effect | Limited β primarily mechanical filling |
| Under-eye safety | High β compatible with thin tissue | Tyndall effect risk β careful product selection required |
| Reversibility | None (autologous β irreversible) | Dissolvable with hyaluronidase |
| Procedural complexity | High β harvesting step required | Low β ready-made product injection |
Clinical Evidence: Nanofat Efficacy
In the original study published by Tonnard et al. in 2014, nanofat applications in 67 patients reported 85% patient satisfaction with facial skin quality; standardised measurements in blinded photographic assessment showed statistically significant improvements in skin tone, luminosity, and fine line reduction.
A systematic review published in the Aesthetic Surgery Journal in 2020 presented a meta-analysis of 12 studies showing 78% patient satisfaction with nanofat in periorbital applications and demonstrating that ADSC viability was 3.2 times higher than with standard lipofilling.
A 2022 randomised study examining the PRP combination documented β via ultrasound elastography β that collagen density increase in the combination group was 31% greater than in the nanofat-alone group.
Recovery and Post-Procedure Expectations
Nanofat grafting involves far less trauma than standard lipofilling. A typical recovery timeline:
- First 24β48 hours: Mild swelling and redness at injection sites, minimal tenderness at the harvest site
- Days 3β7: Superficial bruising, if present, begins to resolve; can be covered with make-up
- Weeks 2β4: Tissue reorganisation; temporary tissue irregularity is normal in some patients
- Weeks 6β12: Collagen synthesis becomes evident; improvements in skin quality and luminosity are observed
- Months 6β12: Full regenerative effect; collagen density and skin thickness at maximum
Average social downtime is 3β7 days. A compression garment over the fat harvest area is recommended for 3β5 days.
Who Is an Ideal Candidate β and Who Is Not?
Ideal candidates:
- Patients with under-eye dark circles or purple/purple-brown discolouration
- Patients for whom hyaluronic acid in the periorbital area is unsuitable (very thin skin, Tyndall risk)
- Patients wishing to improve overall facial skin quality without volume-focused treatment
- Those seeking skin renewal for acne or surgical scar treatment
- Patients who have responded to PRP and are seeking a stronger regenerative effect
Contraindications:
- Active skin infection or inflammation at the treatment site
- Anticoagulant use (physician assessment is mandatory)
- Pregnancy and breastfeeding
- Coagulation disorder or thrombocytopenia
- Active autoimmune disease
- Insufficient adipose tissue for harvesting (BMI <18.5 is a significant limitation)
Nanofat Grafting at Virtuana Clinic
At Virtuana Clinic, serving Izmit and Kocaeli, nanofat grafting is planned through a detailed facial analysis and tissue assessment by the physician. Prior to the procedure, each patient is informed about whether combination with standard lipofilling is needed, how PRP addition will affect the outcome, and what realistic expectations to have.
Particularly for under-eye applications β given the anatomical delicacy of this area and its proximity to vascular structures β treatment is carried out with millimetric precision under experienced physician supervision. Post-procedure assessments at months 3 and 6, with objective photographic and measurement documentation entered into our database, are part of our standard protocol.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.