Decellularized Adipose Matrix for Soft Tissue Regeneration: Enhancing Angiogenesis and Adipogenesis

Human decellularized adipose matrix (hDAM) has emerged as a promising, off-the-shelf option for soft tissue augmentation, providing a biocompatible scaffold that supports angiogenesis, adipogenesis, and volume retention with minimal immunogenicity. This systematic review synthesizes preclinical and clinical evidence on hDAM's regenerative potential, focusing on its capacity to integrate with host tissue and enhance volume retention. A comprehensive literature search was performed across multiple databases yielding 21 studies (14 preclinical, 6 clinical, and 1 combined) that met eligibility criteria. Risk of bias (RoB) was evaluated for animal and human studies using the Collaboration for the Assessment of Risks and Benefits of Anticancer Therapies (CAMARADES) and RoB In Nonrandomized Studies of Interventions (ROBINS-I) tools, respectively. Key preclinical findings indicate that hDAM supports progressive angiogenesis and adipogenesis, with significant weekly increases in vessel formation and adipocyte development. Linear mixed models were used to quantify these rates, showing an increase of 0.366% per week (p < 0.001) in the percentage of CD31+ positive area, and a 3.88% rise in perilipin-positive area per week (p < 0.001), representing angiogenesis and adipogenesis, respectively. Variability in regeneration rates underscores the influence of different hDAM preparation methods, such as enzyme-free decellularization and ultrasonication, which have been shown to improve cell compatibility and volume retention. Clinical studies demonstrate that hDAM achieves notable volume retention and patient satisfaction, particularly in facial and body contouring applications, while also improving skin texture, tone, and functionality. Compared with traditional autologous fat transfer and synthetic fillers, hDAM offers advantages in integration, resorption rates, and low complication risks, without donor site morbidity. Limitations of current studies include variability in hDAM preparation techniques, inconsistent outcome measures, and a paucity of long-term follow-up data. This review establishes hDAM as a safe and effective scaffold for soft tissue regeneration and provides a quantitative analysis of its regenerative timeline. Standardizing preparation methods and outcome measures, coupled with more randomized clinical trials, will be essential for optimizing treatment protocols. Future directions include exploring patient-specific factors and combination therapies to enhance hDAM's applicability in reconstructive and aesthetic surgery.