Dermal graft transplantation: how much survives after transfer? Absorption and precautions revealed by research

Dermal graft transplantation involves partial absorption of transferred tissue over time. When dermis and fat are transplanted together, reports indicate that 15–45% is absorbed[1]. Some studies assess absorption only by patient satisfaction or need for revision surgery, so long-term retention rates still show considerable variation.[2][3]Results vary depending on location and extraction method.

What types of depressions is dermal grafting used for?

Dermal grafting is a method in which the surface layer is removed from one's own skin and the dermis underneath is transplanted. In research, "dermal-fat grafting," which transplants the dermis together with the fat layer beneath it, is commonly used.[4].

Textbook applications include raising the bridge of the nose in people with insufficient cartilage, augmenting the bridge in those with thin skin, and smoothing surface irregularities of the nose.[4]It is also used for facial depressions resulting from injury or surgery.[3].

How much of the transplanted tissue remains?

It is realistic to expect that some will be absorbed. Previous research reports that 15–45% of dermal fat grafts are absorbed over time.[1].

In studies using it for nose revision surgery, we planned for approximately 20% absorption.[2]Absorption tends to be slightly higher at the bridge of the nose and just above the tip compared to other areas.[2].

The possibility of reducing absorption exists through techniques such as folding the graft before placement or inserting slightly more material.[1]Even if the result appears slightly unnatural immediately after surgery, it may blend naturally over several months.[2].

How does this differ from fat injection or cartilage?

We did not find any studies directly comparing dermal grafting with other methods under the same conditions within the scope of our research. For reference, facial fat transfer has been reported to show wide variation in retention, with 25–80% of the injected volume persisting long-term.[5].

In locations where cartilage is an option, such as nasal rim depressions, cartilage—which is absorbed less—may sometimes be recommended.[4]Which material is suitable depends on the location and depth of the depression.

Infection, scarring, and considerations about the donor site—what should I know?

Even with your own tissue, complications are not eliminated. Dermal-fat grafting has been noted to be more susceptible to infection than other materials.[6][3][6].

The donor site will show a linear scar, and there is a limit to the amount that can be harvested.[3]Additionally, it is noted that dermal grafting is less suitable for areas that move frequently, such as the lips.[3].

The thickness of the dermis and the amount of fat vary depending on the donor site.[6]When tissue is harvested from wrinkled areas of the buttocks, the dermis can be too thick, and dissatisfaction with the nose appearing round has been reported.[6].

What should I confirm before undergoing the procedure?

During your consultation, please ask about the following points:

Location: Is the depression in a frequently moving area such as the lips?[3]

Expected absorption: How much extra volume will be placed, and is there a possibility of revision surgery if resorption occurs?[1][2]

Donor site: The location of the resulting scar and the thickness of the dermis at that site.[3][6]

Alternative materials: Compared to cartilage or fat transfer, which is more suitable?[4][5]

Whether dermal grafting is appropriate for your specific depression and how much is likely to remain cannot be decided from this article alone. During your examination, discuss the location and depth of your depression and the scarring at the donor site, and confirm your options if resorption occurs.