Dynamic fate of beige adipocytes in fat grafting and inflammatory regulation

Autologous fat grafting is widely used in reconstructive and cosmetic surgery, but its success is limited by unpredictable graft survival. Recent studies have found that white adipocytes within fat grafts can transform into beige adipocytes—a process called browning—yet whether this process helps or harms graft survival remains unclear. Here we show that beige adipocytes, whether generated in the laboratory by serum deprivation or observed in mouse fat grafts, exhibit higher metabolic activity but are also more prone to apoptosis than white adipocytes. Using a genetic tracing system that permanently labels beige adipocytes in mice, we demonstrate that these cells can proliferate, revert back to white adipocytes when the local environment stabilizes, and do not dedifferentiate into progenitor cells. We further identify that two immune-related components—CD206-positive macrophages and tyrosine hydroxylase—are essential drivers of browning in fat grafts. Our findings suggest that browning represents an adaptive but metabolically costly response, and that modulating this process may offer a strategy to improve clinical fat graft retention.