It was interesting to read the article titled “Nanofat Grafting: Basic Research and Clinical Applications.”1 Clinical application of fat grafting has changed over the years from autologous fat aspirate to adipose-derived stem cell therapy. The authors have developed a simple technique of clinically useful adipose-derived stem cell concentrate without the need for complex isolation procedures. This will not only overcome the difficulty in injecting the fat with a fine needle, but also reduces the technical and ethical issues involved with the use of adipose-derived stem cells. However, the scientific validity of the terminology “nanofat grafting” is questionable. We feel “supermicrofat grafting” will be a better term for this innovative technique.
Autologous fat grafting has become the standard technique for filling soft-tissue defects using the Coleman technique.2 In this technique, fat is harvested with a 3-mm-diameter cannula with a 2-mm side hole and injected with large cannulas. This macrofat does not allow subdermal injection using small cannulas. Trepsat3 described the microfat graft technique in which fat was harvested with a 2-mm-diameter cannula with 1-mm side holes. Nguyen et al.4 used the microfat technique by multiperforated cannula with 600-μm-diameter holes and injected with a 25-gauge cannula (inner diameter, 260 μm). This facilitated very superficial and subdermal injection of fat. Tonnard et al.1 mechanically emulsified fat and filtered it with a sterile nylon cloth with a 500-μm pore size. The effluent collected is called “ nanofat” and injected with a 27-gauge needle (inner diameter, 210 μm). They have used 70-μm filters for isolation of stem cells (size range, 10 to 15 μm) during cell culture. Because the so-called nanofat is in fact in the micrometer range, we propose the term supermicrofat grafting for this technique to differentiate it from the microfat grafting technique and to avoid confusing it with nanotechnology. We feel the scientific terms should be precise and without any ambiguity.
A nanometer is one billionth of a meter. Use of materials at the nanoscale has led to expansion of nanotechnology in various scientific fields, including medicine. There are many diverse perspectives on nanotechnology, which necessitated a common definition for nanoscale. The U.S. government defines nanotechnology as science, engineering, and technology conducted at the nanoscale, which is approximately 1 to 100 nm.5 With this definition, we cannot even include isolated stem cells in the nanoscale. We hope the terminology of supermicrofat will reduce the confusion of equating emulsified fat aspirate to nanotechnology.
The author has no conflict of interest with respect to this communication.
M. T. Friji, M.S., M.Ch.
Department of Plastic Surgery
Jawaharlal Institute of Postgraduate
Medical Education and Research
Pondicherry 605006, India
1. Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: Basic research and clinical applications. Plast Reconstr Surg. 2013;132:1017–1026
2. Coleman SR. Structural fat grafts: The ideal filler? Clin Plast Surg. 2001;28:111–119
3. Trepsat F. Midface reshaping with micro-fat grafting (in French). Ann Chir Plast Esthet. 2009;54:435–443
4. Nguyen PS, Desouches C, Gay AM, Hautier A, Magalon G. Development of micro-injection as an innovative autologous fat graft technique: The use of adipose tissue as dermal filler. J Plast Reconstr Aesthet Surg. 2012;65:1692–1699
5. Nano.gov. National Nanotechnology Initiative. . (Online). Available at: http://www.nano.gov/nanotech-101/what/definition
. Accessed January 25, 2014
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