Autologous fat transfer and nanofat in Baghdad and Karbala: volume, skin quality and scars
Your own fat can restore lost volume, and finely processed nanofat can improve skin texture and some scars. Only part of the fat survives, and the risks need an honest discussion.
Fat grafting uses a small amount of your own fat, taken by gentle liposuction (usually from the abdomen or thighs), purified and re-injected where volume has been lost, such as the cheeks or the backs of the hands [1][3]. Because it is your own tissue there is no allergy risk, and the fat that survives can last a long time. Not all of it survives, so planning is honest from the start. Since 2018, Dr. Tehami has performed more than 70 autologous fat and nanofat procedures, for facial and body rejuvenation and for scars (his own clinic figure, October 2026).
Key points
- On average roughly 40 to 60% of the injected fat remains after a year, so a second session is sometimes needed
- Fat transfer adds volume. Nanofat does not: it is used to improve skin texture and quality
- Evidence is reasonable for facial volume and the backs of the hands, and promising but still developing for scars
- Under-eye and lip treatment are possible only in selected cases and with extra caution
- A very rare but serious risk of any facial injection, including fat, is blockage of a blood vessel that can cause loss of vision or a stroke
How fat transfer works
A small volume of fat is collected through a fine cannula, purified to remove fluid and oil, and re-injected in small amounts where it is needed [1]. The fat cells that establish a blood supply survive and stay. Those that do not are gradually absorbed by the body.
In a meta-analysis of 52 studies with 1,568 patients, about 50 to 60% of the injected volume was retained at one year, patients needed on average 1.5 sessions, and 4.8% of procedures had a complication [1]. Most of those patients had reconstructive surgery, and most studies were of a lower level of evidence. A review of facial fat grafting in 4,577 patients found a lower average retention of about 42% at around 14 months [2]. That is why we explain retention as roughly 40 to 60%, and why a second session is sometimes planned.
Where it is used, and how strong the evidence is
The evidence differs from one area to another, so we tell you which group your treatment falls into.
- Cheeks, midface and temples: an established use for volume loss, with good satisfaction in studies, although most of the research is of lower quality [1].
- Backs of the hands: a review of 10 studies with 320 patients found hand fat grafting effective and generally safe. Reported problems included swelling, temporary numbness, small cysts or irregularities and, rarely, infection. The evidence is still low level [3].
- Burn scars: a review of 14 studies with 885 patients found that all reported improvement in the scars, but the studies were varied and mostly uncontrolled [4].
- Surgical, traumatic, painful or tight scars: studies report better softness and less pain, but only one of 23 studies in a major review was of higher quality [5]. Promising, not proven.
- Acne scars: supported only by small studies, often combined with other treatments. Fat can be one option, not a stand alone cure.
- Under the eyes: possible in selected cases. The skin is thin, so lumps and visible irregularities are more likely, and the area around the eyes is one of the sites where blood vessel blockage has caused loss of vision [9]. We are conservative here.
- Lips: selected cases only. Fat survival in the moving lips is variable and often poor, and there is very little controlled research.
Nanofat: for skin quality, not volume
Nanofat is your own fat, finely processed so it can pass through a very small needle. The fat is mechanically emulsified and filtered. In the original laboratory work, the mature fat cells were destroyed by this processing while other cells from the fat tissue (the stromal vascular fraction) remained [6]. Because so few viable fat cells are left, nanofat is not used to add volume. It is used to improve skin texture and quality, for example in some scars or fine lines [6].
A 2025 review of 12 studies, including 5 randomised trials, found short-term improvement in scar appearance and texture. However, the two higher quality randomised trials showed no lasting benefit beyond 12 months, and processing methods are not standardised [7]. So early results are encouraging, but long-term results are less certain, and we see nanofat as a supporting treatment rather than a guaranteed fix. It is not "stem cell therapy".
Dr. Tehami took part as an investigator in a clinical study of mechanical nanofat for the depressed scars left by cutaneous leishmaniasis (the "Baghdad boil"), a scar type that is common in Iraq. You can read about it on the research page.
Risks and side effects
Common effects are swelling and bruising for one to two weeks, and sometimes small lumps, unevenness or asymmetry that may need a touch up. The treated area can be overcorrected, and grafted fat can grow if you gain weight. Some people have an acne flare or soreness where the fat was taken [1][8]. Less often, some fat hardens (fat necrosis) or forms oil cysts, or an infection occurs [8].
A very rare but serious risk of any facial injection, including fat, is fat entering a blood vessel and blocking it, which can cause permanent loss of vision or a stroke [8][9]. In a review of blindness after cosmetic facial injections, autologous fat was the most frequent material, in 15 of 32 cases [9]. In a review of facial fat grafting complications, 13.4% of the reported adverse events were injections into a blood vessel [8]. The highest risk areas are between the brows, the nose, the forehead and around the eyes.
We reduce this risk with blunt cannulas, slow low-pressure injection in small amounts, and careful anatomy-based technique, especially around the eyes and between the brows. Tell us immediately about any change in vision, severe pain or change in skin colour during or after treatment.
Is it right for me?
Fat transfer suits people who have lost volume in a specific area, have enough fat to take a small sample from, and accept that part of the fat will not survive. Nanofat suits people whose main concern is skin texture or certain scars rather than volume. At your consultation we look at the area, your skin and any scars, your health and medicines, and what result you hope for, and we tell you plainly if another treatment would serve you better.
Frequently asked questions
How much of the injected fat stays?
On average roughly 40 to 60% of the injected volume remains after a year. The rest is absorbed in the first months, which is why a second session is sometimes needed.
Is nanofat the same as fat transfer?
No. Fat transfer adds volume. Nanofat is fat processed so finely that very few fat cells survive, so it is used for skin texture and some scars, not for volume. Its short-term results are encouraging but long-term evidence is mixed.
Can fat be used under the eyes or in the lips?
Only in selected cases and with extra caution. Under the eyes the skin is thin and the area carries a higher risk of lumps and, rarely, blood vessel blockage. In the lips fat survival is variable and often poor.
Is the result permanent?
The fat that survives can last a long time, but it behaves like the rest of your body fat and can grow if you gain weight. Natural aging continues, so the face keeps changing over the years.
References
- [1] Krastev TK, Beugels J, Hommes J, et al. Efficacy and safety of autologous fat transfer in facial reconstructive surgery: a systematic review and meta-analysis. JAMA Facial Plast Surg. 2018;20(5):351-360. Source
- [2] Gornitsky J, Viezel-Mathieu A, Alnaif N, Azzi AJ, Gilardino MS. A systematic review of the effectiveness and complications of fat grafting in the facial region. JPRAS Open. 2019;19:87-97. Source
- [3] Vermeersch N, De Fre M, Verhoeven V, Hunter JE, Tondu T, Thiessen FEF. Autologous fat transfer for hand rejuvenation: a systematic review on technique and outcome. JPRAS Open. 2022;32:182-194. Source
- [4] El Sewify O, Zhu XM, Tremblay C, Delisle E, Shahrokhi S. The utility of fat grafting to manage burn scars: a systematic review. J Burn Care Res. 2025;46(6):1269-1275. Source
- [5] Riyat H, Touil LL, Briggs M, Shokrollahi K. Autologous fat grafting for scars, healing and pain: a review. Scars Burn Heal. 2017;3:2059513117728200. Source
- [6] Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013;132(4):1017-1026. Source
- [7] Al-sabri G, Alavi S, Alkaabi S, Maningky M, Forouzanfar T, Helder M. The effectiveness of nanofat in the management of skin scars: a systematic review. Aesthet Surg J Open Forum. 2025;7:ojaf080. Source
- [8] Schiraldi L, Sapino G, Meuli J, et al. Facial fat grafting (FFG): worth the risk? A systematic review of complications and critical appraisal. J Clin Med. 2022;11(16):4708. Source
- [9] Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S. Blindness following cosmetic injections of the face. Plast Reconstr Surg. 2012;129(4):995-1012. Source
This content is general medical education and does not replace a personal consultation. Any prescription must be coordinated with your local doctor.
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