RE: Problems with fat transfer?

  • 4 years ago

View 4 doctor answers to Had Problems with Fat Transfer?

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A poster here posted about an amazon e-book published by a patient about botched fat transfers. So I went ahead and bought it... here are a few quotes - "The moment he starts the injections into your face, your face begins to swell significantly. Due to the swelling, the doctor cannot accurately visualize the placement of the fat." "Oral marketing tactics include claiming the procedure has been performed for a long time, but is now more predictable because of the new techniques (Lies.)" "Oftentimes, the reason he hasn't seen [a problem] himself, is due to poor follow-up with his own patients after the procedure. That is the reason he hasn't "seen" this type of issue or problem." All very interesting!
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I have wondered about the first thing you mention. How do docs KNOW how much to add in places since as soon as a needle penetrates, you could have great swelling? I mean for anything, NOT just fat. Really, how? They can't be following you home to see how it turns out, so what happens if stuff is asymmetrical -- for me my greatest problem in general as I am disgustingly asymmetrical.
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Hi Unoq...what's the name of the book?
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The name of the book is "cosmetic surgery and lying, unethical, deceitful doctors" by Kimberly Gavondrich. It's more like a long essay than a book, but interesting reading nonetheless, as have never seen a book like it before. A poster Grace on here posted about it and I got the message in my email, so that's how I came to know about it... I'm assuming it was written by a poster from Realself (although I can't be 100% sure). Realself is referenced in the bibliography.
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Yes it's a very relevant question! I never thought about that until I read it there. But I did think about how the doctor knew exactly where the fat was going with all the jabbing around with the cannula. It seems as if they throw it around in any direction. Fat grafting is a procedure which should come with a strict license or a firm limit on how much can be transferred in one session. But ideally, it should be put to bed.
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What can I tell you from my own experience with fat grafting over 10+ years: ( this is my experience): First the good: 1. Fat grafts can restore lost facial volume to give a more natural facial shape 2. Fat grafts take better in the cheeks than anywhere else in the body 3. Fat can be placed where filler cannot 4. The change from fat grafting is complimentary not in place of a facelift Now the Bad: 1. Yes, sometimes the fat goes away. 2. Yes, fat transfer is not always predictable 3. Every "experienced plastic surgeon" who does FT has had results that are less than perfect and patients who are less than happy 4. In the wrong or inexperienced hands, FT can be a disaster What has experience taught me: Fat transfer can produce some spectacular results and can come closest to creating a really "youthful" face, both by restoring volume and changing the quality of the skin. This is also true for the hands. Fat transfer is very delicate and knowing what the right "recipe" is for each person is very difficult. Too little, the "wow" may go away. Too much and you won't recognize the person in the mirror. Gain weight and you could look very strange. This is an evolving field and it is exciting, but not completely understood. MY advice: At a consultation, see pictures, you can ask to see great results, less dramatic results and even results where the fat "faded". Ask to see a series of pictures over time: 1 month, 1 year, 2 years. And be willing to see an improvement and have more than one session, rather than trying to do too much and be disappointed. Hopefully this is helpful.
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nadia: great question: it is really delicate. Over the last 6 years I have recorded the fat graft volumes in different parts of the face and have followed these patients with photographs over time to see if I can see what can be documented. I have also compared the fat grafting results to the person's younger photos. It is very humbling and it requires both understanding the science of the anatomy, bone structure and physiology of aging. And, an art to know what will be an improvement for each person, similar to make-up.
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The fat is organized into specific compartments in the face, it is very complex anatomy. Aging is very similar if not identical for all of us, but since our face structure is different, we don't all look the same ( either when young or when older). The fat or filler has to be placed exactly in the place where the volume is needed. It is not always in the valley or hollow. So how much fat is placed, how it is placed and where it is placed are all crucial. How do I know how much to use? Experience and when I am not sure, I am conservative and tell all patients that more than one session may be needed.
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Hello Dr, the Ebook is on Amazon. It came out a few days ago but there's already a review down for it. If you put the title into Amazon you can find it there. It's more of an essay than a book.
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Don't you start swelling as soon as they cut you for a procedure? As soon as they give you the first injection? How do they know how anything will turn out? ..
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Asking for pictures of patients several years out is a good idea and one I wish I'd thought of at the time. Then again, I was told that fat was a dermal filler with your own fat. This is exactly what the doctor told me before I made the decision to go ahead. The problem with my case was that the doctor said that it was really simple to do, so I never thought to do my due diligence. Checking that he was board certified and had a certain number of years of experience was enough for me to feel confident in the fact I could have a decent result with a filler that was simply like restylane. Having mild hemifacial microsomia I was actually a good candidate for the procedure... on paper at least. One of the big issues was that the doctor put most of the fat in the wrong side of my face. The deficient area is on the right, and he put most in the left. And it pretty much went downhill from there. As my entire experience of dermal fillers had been an occasional fifteen minute restylane injection, mainly into that side, I really had no grasp on what the fat procedure entailed because the expectations weren't set for what I received. I thought it would be like restylane, and was actually more worried about the liposuction aspect. Coupled with the fact I am from Europe, and had the fat injections done in Beverly Hills - well, I simply didn't know that they tended to go for an overfilled look in that locale. One only has to look at Kim Novak to see what those standards of beauty have evolved into. Had I known such a problem existed, I would've chosen another place to do it in, or stuck with fillers for longer - until I was in my 30s at least. It seems that a fair handful of us with bad fat injection results got it done in one of the major cities, although of course it happens everywhere and to many people on Realself unfortunately...
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True... I wonder how they know how noses turn out in particular. That's a surgery that a good portion of people end up dissatisfied with, and you'd think the whole thing would swell into a vegetable when they break the bone...
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You state that you are from Europe, where? I do know very good plastic surgeons in Europe who have expertise in fat grafting. If you think that will be of benefit to you, let me know.
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Great post from Dr. Ditesheim. I would like to add that in addition to carefully checking the background and credentials of a plastic surgeon, people considering fat grafting view many, many before and images of patients who have had fat grafting. My site include before and after images of more than fifty fat grafting patients with additional photos available in my office. Some of the poor results are due to inexperience, lack of expertise or absence of improper tools and training. Sometimes unfavorable results boiled down to different aesthetic sensibilities. I prefer a very natural look. Some physicians, and patients prefer a "done" surgical look. In fact, I have had some people tell me (in a negative way) that my patients don't look like they have had surgery. That is my goal. But clearly, some people have different ideas. For people who have had problems, help is available. Look very carefully at the training of your plastic surgeon, and examples of their work. A press release or television appearance can claim a plastic surgeon is "the best" but that is really meaningless. What is meaningful is checking training. Did your plastic surgeon attend a top tier medical school and graduate at the top of their class? Did they receive eight to ten years of formal surgical training including a fellowship from prestigious university medical centers? Finally, I stress again to look at dozens and dozens of patient before and after fat grafting photos. Fat grafting is permanent. That is great news when you select the right plastic surgeon.
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I am a plastic surgeon (board-certified) in Charlotte, NC. I now see why my patients are scared to death about fat grafting. Everyone hopes to look better and it is so disheartening to read posts of horror stories. So in my experience with face fat grafting over the last 10 years, here is what I can tell you: 1. Fat grafts to the face do survive, especially in the cheeks. Fat grafts work best for those who have lost volume in the cheeks from aging. 2. If you gain weight, the fat grafts can get bigger! So if you are young and your weight may change, be very careful. 3. More is not better. Some patients will need a small amount and others more. Not everyone is the same. Each of us has a facial bone structure that is the foundation of our faces ( it's why we look like our parents as we age). This is why experience is critical. 4. This is not a surgery you want because you want a "deal". Any plastic surgery will come with a cost and a recovery. It can also come with complications and disfigurement, so seek out expertise and know what is best for you before you do anything. 5. It's really about looking more beautiful, not just fuller in the face. Too much fullness can be disfiguring, make you look fat or just less pretty. This is why your facial bone structure is so critical. Ask yourself, is your face thin, hollow or do you have full cheeks. If you could add, where would it look better? 6. ALWAYS go back to your younger pictures to see facial shape and bring these with you to your consultation. Hope this has been helpful. Dr. Jeffrey A. Ditesheim, Charlotte, NC www.empowermd.com
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Dr Ditesheim- I went to a to doc who claims to be one of the best in fat and we addressed bone structure and everything else. He overfilled because he said most gets absorbed. He had my pics from all different stages in life at all different ages. Its a crapshoot I have lumps and bumps and would never do it or recommend it. Paid a bloody fortune , too. Don't tell us about what should be. We live it
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RedRoxie...exact same happened to me. My PS was a reconstruction specialist. Several articles written about him restoring a woman's face who got mauled by a dog. I had every reason to believe he knew what he was doing. So even with due diligence in researching a PS, fat transfer can go very wrong...and it's not a rare event. And why aren't the other PS policing their own? If this is a procedure that requires special training, then why isn't there a special license for doing it? Why is every PS out there able to perform this procedure with no or little training? And just how is the lay person supposed to know this when checking their credentials? We assume, as we are told to, that a PS approved by the proper medical boards is qualified to do the procedure. Everyone I have met who has had a bad result had a well credentialed PS. We looked at their photos, brought in our own, etc. My PS was recommended by another doctor. What else are we supposed to do...resort to a crystal ball? No, this is a problem that needs to be addressed by the PS's themselves. It's pretty obvious given the number of terrible results that there is a problem. This will continue to happen unless the PS's who ARE specifically trained in this start taking action or speaking out against those who are not. It's their responsibility to see to that. This is just as much their fault as the PS's who go to a weekend seminar...and then practice it on their unsuspecting patients with abandon. We believed our PS's when they told us it's a harmless procedure...& that they knew what they were doing. They are the supposed "experts" we are paying top dollar for. Until this procedure has been perfected to the point where there is far less risk...then it shouldn't be done at all. It's ruined far too many lives. We've been treated like guinea pigs for a procedure that is not ready for prime time. No one seems to know how to fix it either. I went to several PS who wouldn't even try because they "didn't want to be responsible for someone else's mess." So what exactly are we supposed to do now? What can we do as laypersons to get this procedure the proper oversight it desperately needs. The doctors who do the revisions are certainly aware of the problem...so why aren't they speaking out and getting their fellow surgeons to do something about it?
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You nailed it Not so Good. Bottom line- it's a money maker. Plain and simple. We keep handing it over so they will continue to take it. Stop doing fat!!!!
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Yes agree, it just does not work. Mine looked great for 2 weeks and now it looks worse than ever.
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Yes agreed! Mine looked great for 2 weeks and then worse than ever, it does not work long term.
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Dr Ditesheim, Please post photos of before, after 6 months, one year out and 3 years out- of a fat transfer patient over 50. I would gladly post my pix, if there was anything positive to report after 11 months. Like Red Roxie, I was referred to a supposedly reputable PS and paid a fortune. At first, I thought my temples were back. All I have left are the lingering effects of nerve damage, where the fat was removed from my butt, without even being discussed. Yes, My butt hurts and is now malformed. Well, there are the permanent marks from the canula (think that is what it is called), too. There are trained docs that can probably do FT well. I think this might work as a very slow process, a little at a time, for those that are willing to go through the recovery period, over and over again. There are so many money making gimmicks- destroying women's lives.
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Yes, I will help you and all others above try to get to the bottom of this. I am as concerned about the comments you make both personally and professionally. Yes, I will try and post results with time information. If you are comfortable, post your photos before and after at intervals. Or if not comfortable you can send them to me. I will try and help you if I can.
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Thank you for your comment. I understand and want to help you and help our speciality provide only excellent results. Whatever is done by non-plastic surgeons, I cannot attest to. But fat grafting has been done for over 100 years, there is a reason why it has had periods of excitement and disappointment. I suggest posting your pictures or send them to me to review. I really do take your comments and experience seriously, this is how we make it better for you and everyone else.
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RedRoxie, I am sorry for your frustration. I wish I could magically make everything right and good for you. I encourage you to post or send your pictures and I will be glad to look at them and try and help you if I can.
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