{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:11:06Z","timestamp":1787026266883,"version":"build-2736575974"},"reference-count":183,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell Dev. Biol."],"abstract":"<jats:p>Autologous fat grafting is widely used in reconstructive and aesthetic surgery because it is easy to harvest, well tolerated by the host, and produces natural-looking results. However, unpredictable graft resorption\u2014with reported volume retention ranging from 30% to 80%\u2014remains a major obstacle. To overcome this, two cell-based approaches have been developed: the stromal vascular fraction (SVF), a freshly isolated mixture containing approximately 1%\u201310% adipose-derived stem\/stromal cells (ADSCs) plus other cell types, and culture-expanded ADSCs, a more homogeneous population obtained under Good Manufacturing Practice conditions. Meta-analyses show that while SVF increases fat retention by a modest margin, expanded ADSCs can achieve substantially greater improvements, highlighting important biological and regulatory differences between the two preparations. ADSCs support graft survival not only through classic growth factor secretion but also via immunomodulation, intercellular mitochondrial transfer, and exosomal microRNAs that co-ordinate angiogenesis, inflammation, and fibrosis. This review summarises current clinical evidence for ADSC- and SVF-enriched fat grafting in breast reconstruction, facial rejuvenation, scar management, chronic wounds, hair restoration, and paediatric as well as elderly populations. We also critically assess adjunctive strategies, including platelet-rich plasma, exosome-based acellular therapies, decellularized adipose matrices, engineered hydrogels, and nanofat grafting, and discuss the role of mitochondrial transfer enhancement. Standardised summary tables of clinical studies and emerging technologies are provided to facilitate evidence synthesis. Persistent challenges\u2014such as the frequent conflation of SVF with ADSCs in the literature, the lack of standardised preparation and potency assays, and unresolved long-term oncological safety concerns\u2014are examined, and priority areas for future research are proposed.<\/jats:p>","DOI":"10.3389\/fcell.2026.1870729","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T09:23:47Z","timestamp":1781688227000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Advancing fat graft survival: from adipose-derived stem cell mechanisms to next-generation regenerative strategies"],"prefix":"10.3389","volume":"14","author":[{"given":"Xunuo","family":"Ma","sequence":"first","affiliation":[{"name":"Zhejiang Wanli University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leiting","family":"Xu","sequence":"additional","affiliation":[{"name":"Medical School of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianfei","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiudi","family":"Wu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Tao","sequence":"additional","affiliation":[{"name":"Ningbo College of Health Sciences","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1007\/s00266-024-04641-7","article-title":"Hand rejuvenation using autologous fat grafting: a systematic review of recommended doses, complications, and patient satisfaction","volume":"49","author":"Abu Alqam","year":"2025","journal-title":"Aesthetic Plastic Surgery"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e88493","DOI":"10.7759\/cureus.88493","article-title":"Maximizing the longevity and volume retention of fat grafts: advances in clinical practice","volume":"17","author":"Acharya","year":"2025","journal-title":"Cureus"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2339","DOI":"10.1007\/s12015-025-10921-9","article-title":"Innovative stem cell assisted lipotransfer approach for breast reconstruction in cancer patients: efficacy and safety of the LIPO MULTI-SVF study","volume":"21","author":"Agostini","year":"2025","journal-title":"Stem Cell Rev. 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