RE: Problems with fat transfer?

  • 4 years ago

View 4 doctor answers to Had Problems with Fat Transfer?

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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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threads. I have seen patients whose fat resorbed. There is a lot of study to better understand the grafting process. For probably 90% of my patients the fat remains as I expected. There can be variable resorption for different reasons including smokers, sickness, change in metabolism. For fat to disappear after 2 weeks I might suggest that the harvest and processing technique may have influenced the health of the fat cells that were grafted. Again, post or send photos. Hope this helps you.
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I will post on my profile ( I believe that is the right place to post photos) examples of results and give the timeline.
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No, am not a smoker and have not been sick. I saw a video where the fat was spun around after harvesting, this Dr. did not do this, he just took it from my stomach area and re-injected it in my face and lip, he said he would do it again, but am worried now.
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post or send me the photos and I will try and help you.
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Fat grafting in the past was used for burn victims, severe accident injuries, and for major genetic deformities. For those situations, I can certainly understand it's use and naturally it would be worth the risk given the severity of the deformity. Faced with no other alternative, any improvement, even the most minimal, would be far better than none. It was not used as it has been for the last several years, for minor cosmetic flaws or simply to have a more youthful appearance. Putting a relatively normal looking person at a high risk of ending up worse off, with lumps and distortion, is a misuse of it's original purpose. Most of the women I know of who have had a bad experience with FT looked far better before the procedure. Most of them are under 40!!! Some in their early 20's. It's outrageous. What reputable PS would expose these young women to that kind of risk? I went to my PS for an entirely different procedure, breast implant removal. I thought for my age, 60, I looked pretty good before walking into his office. I never even heard of FT before & had been using temporary fillers for a few years, with great success. By the time he finished pointing out all my flaws, I was convinced I must have been fooled by my own mirror. He sold the procedure to me as non-evasive, cost-saving & convenient compared to temp treatments, and no risk. He did mention that on rare occasions the fat could reabsorb, but assured me that to date, he had never had that happen. Foolishly I believed him. My bad. My result is not the worst I've seen either. Some of the results I've seen are nothing less than tragic. Even worse because they are still so young. My current problems are more physical than cosmetic now & I have done all that is possible with surgery given the damage is in the eye area. The FT on my face finally reabsorbed after 3 years with only minor lumping on one side. My eyes don't close completely because of the lumping in the crease of my upper eyelid, but my ocular PS surgeon warns me that trying to remove those lumps will put my vision at risk. Several eye surgeons told me the same thing, so I am heeding their advice. I have exhausted all alternatives for a fix & $30,000 later I am out of options. Gratefully, my ocular PS was able to remove the hard lumps from under my eyes relatively successfully, except now I have nasty dark circles that weren't there before. Better, yes, but definitely more aging than what I started out with before FT. As it stands, I will permanently have to use thick gels at bedtime & drops several times during the day to keep my eyes from drying out. My eyes are so light sensitive now I can't go outdoors without sunglasses even on cloudy days (and I live in Hawaii). My eyes are constantly red and irritated. Is the promise of looking younger worth risking that kind of result? I'm paying a huge price for my lapse in good judgement. My goal now is to do whatever I can to stop women from risking a similar fate with FT...even if I have to grab them by the hair and drag them out physically.
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Thank you for your honesty. You sound very intelligent and approached this decision with the right approach. Would you be willing to send me your pictures to look at. If even one patient has such a traumatic experience, we need to educate our peers differently. I agree grafting in the twenties and thirties is not the same. Most all of my patients are in their sixties.
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Dr. Ditesheim, I do appreciate you have taken our concerns seriously & have taken the time to respond. Pretty brave of you to do that actually and I believe that you are genuinely interested in resolving some of the issues we've mentioned here. I sincerely thank you for that. It's too late for me, but if you can help make this procedure any safer for other women then that's certainly a step in the right direction. Here is a link on this site where I posted photos of my eyes before and after. [http://www.realself.com/question/upper-and-lower-eyelid-surgery ]. Please note that I reversed the photos in error when I posted them, so the "after" photo is on the left...and the "before" photo is on the right. Sorry for the confusion. My left eye (the after photo on the left) shows the lumping about 4 months after the FT. The lumping actually became worse with time as it hardened (up until about 9 months)...most of it just under my brow bone down into the crease & then an additional lump surfaced right on top of the brow bone itself. Near my nose above the crease towards the brow, there is a tubular line of swelling (apparently where the PS injected the fat) that isn't all that visible in the photo, but is much more apparent in natural light. Also note that the "before" photo is actually my other eye (the right eye). The "before" photo of my left eye ended up with my hair hanging over it & was difficult to see clearly, so I posted the other one. But both my eyes were pretty much the same before, so it's still a good representation of how my eyes looked prior to FT. I believe the PS was trying to make my eyes look less deep set by filling in the crease. I happened to like that look, so was quite shocked when I ended up with barely a crease at all when he was finished. Not to mention that it's uneven. I never asked for fat in my eye area, we only discussed putting it in my face. My eyes simply seemed to disappear. My husband's first question was, "Where did your eyes go?" I was devastated. The lumps under my eyes, just where the cheekbone begins, don't really show up in these photos, they got harder & more obvious with time as well. But at least I was able to have those removed with surgery after a year and a half after the FT & now just have the dark circles to deal with. Apparently it is unavoidable when removing the lumps to not also remove some of the original natural fat in the process. Thank you again for your concern.
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I am genuinely concerned. I did look at your photos. If you have a set of before and afters that would be helpful. I am writing blogs all the time and you are right, the more we as plastic surgeons know about potential problems, the better we can take care of the next patient.
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I am so grateful for your sharing this terrible ordeal that you have gone through, what I had was minimal but still not worth the risk.
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Please see my recent post. I do believe there should be more oversight with regard to who can perform plastic surgery procedures. However, I hope my information is helpful. Additionally, there is a downloadable form on my website for selecting the right plastic surgeon for you. Clearly you have had complications and I am so very sorry. Having unfavorable results, particularly to the face can be heartbreaking. I am also very sorry that you had the experience of not finding a plastic surgeon to provide a revision surgery. Fat grafting revision surgery does take exceptional skill and time, but there are plastic surgeons who could help you. I wish you the vest best.
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It's 4 months now and I am happy with my cheek fat transfer. I am blessed now with high cheeks. I hope you all get good results. Be sure and massage the areas to help reduce swelling.
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Hello, my English is bad, i´m sorry.5 MOnths ago, i had fat grafting to the malar region near cheekbone.I regret it, because its doesn´t look good, that look puffy.My question is, why i´m still swollen after 5 months, or its Fat?My Dr had injected 1 cc right und 1,5 cc left. I think its not much?But i can feel the SWELLING MUSCLE in the malar Region. It was sharp canulla.I had MRI, but nothing was found, no cyst, no lumps, no infection. I can´t understand why it looks so puffy. the fat that was taken out, looked hard and lumpy, perhaps it was not fat rather dermal fat?
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Hello, my English is bad, i´m sorry.5 MOnths ago, i had fat grafting to the malar region near cheekbone.I regret it, because its doesn´t look good, that look puffy.My question is, why i´m still swollen after 5 months, or its Fat?My Dr had injected 1 cc right und 1,5 cc left. I think its not much?But i can feel the SWELLING MUSCLE in the malar Region. It was sharp canulla.I had MRI, but nothing was found, no cyst, no lumps, no infection. I can´t understand why it looks so puffy.I
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