Background:　Adipose-derived　stromal　cells　(ADSCs)-derived　exosomes　(ADSC-Exos)　account　for　the　proangiogenic　potential　of　stem　cell.　This　study　aimed　to　investigate　the　effect　of　ADSC-derived　exosomes　(ADSC-Exos)　on　the　survival　in　fat　grafting.　Methods:　A　nude　mouse　model　of　subcutaneous　fat　grafting　was　adopted.　Hypoxic　preconditioned　ADSC-Exos　and　ADSC-Exos　were　injected　around　the　grafted　tissue.　The　fat　graft　sample　was　weighed　and　examined　by　hematoxylin　and　eosin　(H&E)　staining　and　immunohistochemistry.　Laser　Doppler　flowmetry　and　CD31　immunofluorescence　staining　were　used　to　analyze　neovascularization.　Results:　ADSC-Exo　and　hypoxic　ADSC-Exo　groups　had　a　significantly　higher　weight　of　fat　graft　and　more　perilipin-positive　adipocytes　than　the　control　groups　from　2　to　8　weeks　after　grafting,　and　the　hypoxic　ADSC-Exo　group　had　better　outcomes　(all　P　＜　0.05).　H&E　staining　showed　that　ADSC-Exos　attenuated　infiltration　of　inflammatory　cells　around　the　fat　grafts.　Laser　Doppler　flowmetry　showed　that　the　two　ADSC-Exo　groups　had　better　blood　perfusion　in　the　graft　tissue　than　the　control　groups　(all　P　＜　0.05).　Immunofluorescence　demonstrated　that　the　hypoxic　ADSC-Exo　group　had　significantly　more　CD31-positive　cells　than　the　ADSC-Exo　group.　In　vitro　study　showed　that　hypoxic　ADSC-Exos　treatment　significantly　increased　the　migration　(at　12　and　24　h)　and　in　vitro　capillary　network　formation　(at　12　h)　in　the　human　umbilical　vein　endothelial　cells　(HUVECs)　as　compared　with　the　ADSC-Exo　group　and　control　group　(all　P　＜　0.05).　Conclusions:　Co-transplantation　of　ADSC-Exos　can　effectively　promote　the　survival　of　graft,　neovascularization　and　attenuated　inflammation　in　the　fat　grafts.　Hypoxia　treatment　can　further　enhance　the　beneficial　effect　of　ADSC-Exos.　(C)　2018　Elsevier　Inc.　All　rights　reserved.