The practice, legal across the Atlantic, raises a crucial question: is donor consent truly clear?
It’s not fiction. In the United States, injectable products made from human fat extracted from corpses are used to plump the cheeks, correct hollows, or increase the volume of breasts and buttocks. And this is not new.
For about a decade now, products like AlloClae (from Tiger Aesthetics) and Renuva (from MTF Biologics) have been prescribed in American aesthetic clinics. These substances are made of fat recovered from tissue donors. After a rigorous purification process that eliminates all genetic material, this fat is injected into patients. These patients do not face any health risks. “The body recognizes Renuva once injected,” explains Evi Chnari, Vice President of Research and Development at MTF Biologics, to The Guardian. “The patient’s own cells then transform it into their own fat.”
This is a legal practice in the United States, approved by the FDA (Food and Drug Administration). Patients are increasingly turning to it, turning away from lipofilling, which involves extracting fat from one area of the patient’s body by liposuction to reinject it into other areas. This shift is attributed to medications like Ozempic and others that have made people too thin for fat to be extracted from themselves.
“Injections of hyaluronic acid are being avoided due to the health risks they pose. On the contrary, ‘necro-cosmetics,’ as they are called in the United States, are becoming essential. ‘I thought this would deter everyone,'” says Dr. Haideh Hirmand, a plastic surgeon in New York interviewed by The Guardian. “But ultimately, it doesn’t bother many people.”
And why not? With the vast majority of the public strongly in favor of vital organ donations to save lives, why should we be uncomfortable with fat donation for aesthetic purposes? Putting aside the fact that living in a society where the pressure for perfect buttocks, breasts, and cheekbones is undesirable: is there an ethical issue in retrieving fat from the body of a person who has given consent?
Well, maybe. Because, in fact, fat donors have not always given their consent clearly.
Consent: a gray area
In the United States, the Uniform Anatomical Gift Act (UAGA) allows for the collection of tissues from tissue donors. However, as reported by The Guardian, an investigation relayed in 2012 by American radio NPR revealed an alarming figure: tissue bank recruiters only mentioned cosmetic use in 29% of cases.
This means that the vast majority of families or registered donors are unaware that their fat could be used for purely cosmetic procedures. They often think that their donations will be used exclusively for vital transplants (heart, kidney, liver) or for unquestionably necessary cosmetic surgeries (for severe burns, for example).
Although some companies claim to now obtain clear consent, tracking remains complex. The forms vary by state, and there is no perfect traceability guaranteeing that the restrictions expressed by a donor (for example, “only for vital transplants”) are adhered to throughout the production chain.
A risk for vital organ donation?
The main concern of bioethicists is not so much about cosmetic use itself, as it is about its indirect consequences. “If the number of donors decreases because people fear that their bodies will be used for this kind of cosmetic surgery, the disadvantages of this practice will outweigh the benefits,” warns Ryan Pferdehirt, Vice President of Ethics Services at the Center for Practical Bioethics.
One donor can save eight lives and enhance 75 others. If the revelation that a loved one’s abdominal fat could end up in a buttock lift causes families to withdraw their consent for organ donation, the human cost could be significant.
