Dermal Graft

What is Dermal Graft

A dermal graft (Dermal Graft) is a surgical technique in which the "dermal layer (dermis)" from one's own skin tissue is harvested and transplanted to sunken or tissue-deficient areas. The dermis is located directly beneath the epidermis and is a dense connective tissue composed of collagen, elastin, hyaluronic acid, and other components, possessing both elasticity and strength. By embedding the harvested dermal fragment into the transplant site, natural volume and three-dimensional tissue contour are reconstructed.

Unlike injectable fillers such as hyaluronic acid, because autologous tissue is used, absorption and degradation are unlikely to occur, allowing for long-term maintenance effects. Furthermore, compared to fat grafting, it offers superior structural support capacity and is suitable for three-dimensional contour correction such as depressed scars, under-eye hollowing, and nasal bridge augmentation.

Scientific Evidence of the Procedure

The scientific utility of autologous dermal grafting is supported by multiple studies. A study published in Archives of Plastic Surgery (2014) reported that when dermal grafts are shaped into a roll form and transplanted in nipple reconstruction surgery, the projecting contour can be maintained over the long term (DOI: 10.5999/aps.2014.41.2.158). Additionally, according to a report in the International Journal of Molecular Sciences (2014), autologous dermal fibroblasts produce collagen and glycosaminoglycans after transplantation and possess the function of organizing surrounding tissue structure (DOI: 10.3390/ijms15058407).

Furthermore, a review in Scars, Burns & Healing (2022) details the mechanism by which acellular dermal matrix (ADM) induces host cells after transplantation, promoting angiogenesis, collagen remodeling, and tissue integration (DOI: 10.1177/20595131211038313), and the same biological mechanisms operate in autologous dermis. The transplanted dermal tissue becomes integrated through anastomosis with surrounding blood vessels and is maintained as living tissue over the long term.

Procedural Steps

【Harvest Site and Anesthesia】The harvest site is selected from inconspicuous areas such as the postauricular area (behind the ear), the inguinal region, or the lower abdomen. Under local anesthesia, the dermis layer is thinly sliced while preserving the epidermis. The harvest site is carefully closed with intradermal sutures. The donor site is refined to result in a fine linear scar.

【Transplantation】A small incision is made in the skin at the transplant site, and a subcutaneous pocket is created. The harvested dermal fragment is shaped to an appropriate size and inserted and secured within the pocket. Because the skin surface incision is kept minimal (approximately 2-3 mm), postoperative scarring is extremely inconspicuous. Operative time varies depending on the site and area treated, but is generally 30-90 minutes.

Downtime and Recovery

Postoperatively, both the transplant and harvest sites experience swelling and ecchymosis. Swelling peaks at 2-3 days post-op and subsides over 1-2 weeks. Bruising varies among individuals but typically resolves within 2 weeks. Showering is permitted from the next day, but bathing, strenuous exercise, and alcohol consumption should be avoided for 1 week postoperatively. Suture removal (if applicable to the harvest site) is performed around 7 days post-op.

Complete graft integration and stabilization of contour takes approximately 3-6 months. Some initial firmness may be felt, but over time it softens as it integrates with surrounding tissue. Long-term resorption is reported to be less than hyaluronic acid or fat grafting, with effects typically maintained over 1 to several years.

Primary Indication Sites

Under-eye hollowing and tear trough deformity (nasolabial sulcus)

Depressed scars (from trauma, acne scars, surgical scars, etc.)

Nasal bridge, temple, and cheek hollowing

Glabellar and forehead creases (supportive filling for deep wrinkles)