Introduction Autologous fat grafting (AFG) has both aesthetic and reconstructive applications. Described by Neuber in 1893 there are numerous applications of AFG as the body of evidence for its use has expanded. The earliest controversies were evident in lipofilling for breast defects post-oncological treatment, and to this day some countries do not allow it for fear of inducing tumourogenesis in an oncologically ablated field. Adipose-derived stem cells (ASCs) have been shown pro-oncologic behaviour in xenografts, however, this has not been reproduced in clinical observations thus far.

Material and Methods We sought to review contemporary harvesting and processing techniques for AFG in the craniofacial region, therefore distributed a survey to evaluate the opinion and clinical impact of oncological risk across four European countries with possibly differing clinical attitudes. 

Results In the craniofacial region AFG is mostly used for aesthetic indications, cannula hand-held aspiration and centrifugation seem to be the predominant harvesting and processing techniques. Half of our respondents tell patients about the possibility of pro-oncologic behaviour of AFG. We found no significant geographical differences between the German-speaking and the English groups concerning their harvesting and processing technique. German participants seem to perform AFG more often and mostly use it for cosmetic and post-cancer treatment sequelae, English participants homogenically use AFG for cosmetic reasons.

Conclusion Theoretical pro-oncologic behaviour of craniofacial AFG does not deter surgeons. Perhaps, we shouldn’t consider discussing this complex area of oncogenesis with patients as there is no elevated risk from what we know.