Nanofat and microfat: what the two fat preparations actually do

Microfat: volume, because the fat cell survives the processing

Microfat is the harvest itself, washed but not emulsified. In the 2013 paper it was obtained with a multiport small-hole cannula and then served as the starting material for the extra processing step; in a 2020 case series of 50 patients, fat was aspirated from the medial thigh, inner knee or lower abdomen, flushed and washed with saline to obtain microfat, and only then emulsified. In both papers microfat is the intermediate product — which is why its fat cells are still whole when it is used as an end product in its own right.

Intact fat cells are what make volume possible. A parcel of living adipose tissue placed in a recipient bed can vascularise and persist as tissue — a categorically different proposition from a resorbable gel that occupies space until it is broken down. It is also why the questions asked before grafting for volume are different: donor area, weight stability, and how much of the placed volume survives the first weeks.

Where that volume is placed matters as much as how much of it there is, and the anatomical case for thinking in compartments predates both preparations. A 2007 study performed thirty hemifacial cadaver dissections after injecting methylene blue into specified regions, and reported that the subcutaneous fat of the face is partitioned into multiple independent compartments rather than behaving as one confluent mass: what had been loosely called malar fat turned out to be three separate compartments, and some structures described as retaining ligaments were simply fusion points where the septal barriers of adjacent compartments meet. It is worth being exact about what that study is. It dissected cadavers to map anatomy — it enrolled no patients, grafted no fat and measured no aesthetic outcome. It tells you where the compartments are; it does not tell you that any grafting technique works.

For the patient this most often concerns — a woman between 45 and 60 who has watched the midface flatten and the jawline soften over a decade rather than a season — compartment-level thinking is the difference between a face that looks restored and one that looks filled. Volume placed without reference to which compartment actually emptied reads as added, not returned.

What the research actually studied — and what it was not designed to answer

The four sources cited on this page are four different kinds of document, and reading them for what they are is the only way to use them honestly. None is a head-to-head clinical trial of microfat against nanofat for volume restoration — that comparison does not exist among the sources cited here.

The 2020 series deserves its details spelled out, because they are the kind that get dropped when a result is repeated second-hand. The product injected was not nanofat alone: the authors added 20% platelet-rich plasma, prepared from the patient's own blood, before injecting it with a 25-gauge cannula into the subcutaneous plane at multiple facial sites. Fifty patients were included, 48 women and two men, with no control group. The biopsies that showed increased dermal cellularity, vascular density and elastic and collagen fibre density were taken from the forearm, not the face, and from nanofat injected before the platelet-rich plasma was added. A lifting effect is also reported, identified from analysis of the before-and-after photographs within that uncontrolled series. The authors state plainly that the duration for which the effects persist is unclear, and that further studies should include instrumented skin measurement and a control group.

The 2017 review adds a caution from the opposite direction, and it is the authors' own: based on clinical experience and evidence to that date, they judge the regenerative effects seen with stromal vascular fraction in aesthetic surgery to be modest — there appear to be definite histologic findings of regeneration, but those improvements may not be clinically apparent to a patient when cell-enriched fat grafts are compared with fat grafts alone. That is a statement about one specific comparison, and it corrects the assumption that a regenerative component always produces a visible difference.

What neither preparation replaces

Three substitutions get made in patients' heads, and all three are worth dismantling before a consultation.

• Nanofat is not an autologous filler. A patient who wants a hollow corrected and is offered nanofat for it has been offered a preparation whose analysed sample contained no viable fat cell to occupy that space. The complaint is a volume complaint; the answer has to be a volume preparation.
• Neither preparation is a facelift. Both act on absent volume or on skin quality. Neither removes skin that has lost the capacity to retract. Excess skin is a surgical question — Dr. Thiago Perfeito performs facial surgery, and which category a given face falls into is decided by examination, not by a preference for avoiding an operation. The lifting effect reported in the 2020 series was identified from photographic analysis in a group of 50 patients with no control arm; it is not equivalent to a surgical result.
• Neither is a no-downtime injectable. Every preparation of autologous fat starts with a liposuction harvest, with anaesthesia and a donor area that has its own recovery. The fineness of the final needle says nothing about the size of the procedure that produced what goes through it. If a patient's real constraint is downtime, that is a reason to compare this route against injectable or energy-based options at consultation.

There is also a question of naming: nanofat is rich in stromal vascular fraction cells, but "contains regenerative cells" is not the same claim as "stem cell therapy", and the 2017 review's own verdict on the magnitude of those effects in aesthetic surgery was modest rather than transformative.

The practice's own route for autologous fat grafting is the Lipocube protocol, described on its own page; this page is the technical vocabulary behind it, not a description of that protocol's technique. Dr. Thiago Perfeito's practice has no commercial relationship, sponsorship or financial arrangement with the manufacturer of any device or system named here.

Frequently asked questions about nanofat and microfat

• What is nanofat?

  Nanofat is a patient's own fat, harvested by liposuction and then processed by emulsification and filtering until it becomes a fine suspension that can pass through a very narrow needle — as fine as 27 gauge in the 2013 paper that described the technique. In that paper's laboratory analysis, no viable fat cell was observed in the nanofat sample, while adipose-derived stem cells were still richly present. It is technical vocabulary from plastic surgery for a way of preparing autologous fat, not a brand or an off-the-shelf product, and it is used for skin quality rather than for volume.

• Nanofat vs microfat: what is the actual difference?

  Both come from the same liposuction harvest, and the difference is one processing step afterwards. Microfat is washed but not emulsified, so its fat cells remain intact and it can be used to restore volume. Nanofat is that same microfat put through an additional emulsification and filtering step, which is why the sample analysed in the 2013 paper contained no viable fat cell. A 2017 review classifies them by parcel size along with a third term, millifat, placing nanofat at the fine end of the scale at 400 to 600 micrometres. The shared harvest is why the two words get used interchangeably; the extra step is why they do different jobs.

• Does nanofat work for under eyes?

  It depends on what is causing the problem under the eye. Dark lower eyelid skin was one of the indications treated in the 2013 clinical group, alongside superficial fine lines and scars, with the benefit described as improvement in skin quality. But when the under-eye complaint is a visible groove from lost volume at the transition between eyelid and cheek, what is missing is volume — and a preparation in which no viable fat cell was observed has nothing in it to occupy that space. Which of the two situations applies is determined by examination, and the answer changes the treatment entirely.

• Is nanofat facial rejuvenation supported by published research?

  There is published research, and it is worth knowing its design. The 2013 paper that named the technique reports 67 clinical cases treated for superficial rhytides, scars and dark lower eyelids, with skin-quality improvement reported at six months, alongside a preliminary laboratory study of three fat samples. A 2020 case series followed 50 patients, with no control group, injecting nanofat to which 20% platelet-rich plasma had been added; all patients reported skin-quality improvement, and biopsies showed increased dermal cellularity, vascular density and elastic and collagen fibre density. Those authors state that the duration of the effect is unclear and that further studies are needed, including a control group. So the evidence is real but early — case groups and histology, not controlled trials.

• Can nanofat be used instead of a filler?

  No, and this is the most common misunderstanding about it. A filler works by occupying space. Nanofat is emulsified and filtered to the point where the sample examined in the 2013 study contained no viable fat cell, so there is nothing in the suspension to occupy space — its proposed mechanism is the regenerative cell population it retains, acting on skin quality. If the complaint is a hollow or a deflated area, the preparation that addresses it is one with intact fat cells, or another volume option discussed at consultation.

• Can microfat and nanofat be used in the same session?

  Yes, when the examination finds both needs in the same area — absent volume in a deeper plane and compromised skin quality in a more superficial one — each preparation can be placed in the layer it belongs to. A 2017 review lists deep fat compartment grafting, superficial fat grafting, nanofat and stromal vascular fraction among the components becoming important in contemporary facial rejuvenation. Whether to combine them in an individual case, and in what proportion, is a decision made in person rather than a fixed protocol.

• Does nanofat require anaesthesia and recovery time?

  Yes. Every preparation of a patient's own fat begins with a liposuction harvest from a donor area, under anaesthesia, and that donor area has its own swelling, bruising and recovery period. In the 2020 case series, minor complications were noted in all 50 patients: redness and oedema for two to four days, some bruising, and pain at the donor sites. One patient developed nodules at the lower lid that resolved spontaneously after one month. The fineness of the final injection needle does not make the overall procedure a minor one.

• Can nanofat or microfat replace a facelift?

  No. Both act on absent volume or on skin quality, and neither removes skin that has lost the capacity to retract — that is a surgical question, and Dr. Thiago Perfeito performs facial surgery. A lifting effect was reported in the 2020 case series, identified from analysis of before-and-after photographs in a group of 50 patients with no control arm, and those authors ask for further study; that is not equivalent to a surgical result. Which category an individual face falls into is determined by clinical examination.