Platelet-Rich Fibrin-Enhanced Fat Grafting for Gluteal Contour Deformities in Compromised Soft Tissue: A Technical Note.

Gluteal contour deformities resulting from localized soft tissue atrophy represent a challenging reconstructive problem, particularly in patients with compromised recipient-site tissue quality. Autologous fat grafting is commonly used for contour restoration, although graft retention may be variable. We describe a technical approach to platelet-rich fibrin (PRF)-enhanced autologous fat grafting that incorporates mechanical micronization of PRF, integration with harvested adipose tissue, and micro-aliquot injection. A representative case of steroid injection-induced gluteal lipoatrophy is presented to demonstrate the application of the technique and long-term clinical outcomes. PRF was prepared from two 10-mL red-top Vacutainer tubes without anticoagulant using low-speed centrifugation at 2800 rpm for five minutes. The resulting fibrin clot was mechanically micronized and combined with harvested adipose tissue at a 1:3 PRF-to-fat ratio by volume. A total of approximately 20 mL of composite graft was injected into the affected gluteal region within the subcutaneous plane. The patient demonstrated sustained clinical improvement in contour without clinically apparent overcorrection or recurrent contour deformity at 5-year follow-up. Because this report describes a single case without a control group, objective volumetric assessment, or imaging-based evaluation, the observed durability cannot be attributed specifically to PRF augmentation. This technical report demonstrates the feasibility of incorporating mechanically micronized PRF into structural fat grafting and provides long-term clinical observation following its use in a compromised gluteal soft tissue bed. Further controlled studies are required to determine whether PRF augmentation provides an incremental benefit over conventional fat grafting alone.