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Fat Processing Systems Abound! Where is the Evidence and How Do We Choose One?
Peter F. Koltz, M.D., Martin J. Carney, B.S., Jason M. Weissler, M.D., Aboude Nowaylati, M.D., Yashoda Singh, M.D., Joseph M. Serletti, M.D., Alexander F. Au, M.D..
University of Pennsylvania, PHILADELPHIA, PA, USA.

PURPOSE: Fat grafting has become omnipresent across plastic surgery. With large-volume harvest, the bourgeoning device race strives to create the ideal processing system. This study aims to critically examine existing fat processing systems and corresponding levels of evidence (LOE).
METHODS: A systematic review of the literature was performed to identify evidence basis for components of the processing systems. Components included (LOE): syringe versus pump aspiration (II), centrifuge (III), low-shear devices (IV), and closed system (IV). Graft viability-rates, corresponding LOE, and average follow up were collected. Finally, costs of disposables and time for routine harvest were collected.
RESULTS: Our search revealed five processing systems available: Puregraft, Revolve, Tulip, Beauli, and Khouri (KVAC), all of which had similar levels of evidence and publications validating use. Puregraft is the only system that does not recommend centrifugation. KVAC and Beauli have unique graft-harvest systems that provide regulated negative pressure to minimize shear. The Beauli ($199) and KVAC ($200) disposable systems were less than half the cost of competitors; however, Beauli requires approximately $50k capital cost. Evidence for each system provides improved graft survival over conventional fat processing methods.
CONCLUSION: Cost savings and graft viability improvements are making conventional processing obsolete in the operating room. This study demonstrates that several systems on the market provide evidence for efficient processing of high viability fat grafts.


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