Beyond lipofilling: adipose-derived stem cells in plastic surgery

Abstract

Adipose-derived stem cells (ADSCs) have emerged as a pivotal tool in the paradigm shift of plastic and reconstructive surgery from traditional tissue transposition toward regenerative medicine, owing to their abundance, minimally invasive harvesting, and potent regenerative capabilities. Beyond their multilineage differentiation potential, the therapeutic efficacy of ADSCs is increasingly attributed to their sophisticated paracrine activity and exosome-mediated signaling. This review provides a comprehensive synthesis of the biological characteristics of ADSCs, their underlying molecular mechanisms, and their diverse clinical applications in plastic surgery. We discuss the orchestrated roles of the ADSC secretome in promoting neoangiogenesis, modulating the immune microenvironment, and regulating extracellular matrix remodeling. Clinically, we highlight the latest evidence for cell-assisted lipotransfer (CAL) in fat grafting, the acceleration of chronic wound healing, anti-fibrotic strategies for scar management, and the emerging role of ADSCs in facial rejuvenation and anti-aging. While issues regarding standardization and long-term oncological safety remain, the integration of ADSCs with biofabrication and cell-free therapies represents a promising frontier. Ultimately, ADSCs hold the potential to achieve functional and scarless tissue regeneration and may redefine the future of plastic and reconstructive surgery.