Fat Grafting Lumps When Smiling

Hi Femme Fatale,

Sorry to hear that you are suffering from fat graft complications.  Most importantly you should continue following the advice of qualified and experienced fat transfer surgeons.

Accent XL is a non-invasive method of sculpting fat.  It may be possible to smooth your "lumps" with a series of treatments.  This area is extremely delicate.  Your evaluation should be performed by someone with a great deal of experience. 

Microliposuction may help if there is a palpable mass of fat.

Dr. Few has given you very good advice.  Patience and waiting as the five docs that you have consulted with won't get you into any additional trouble. 

Hopefully your problem will resolve soon.  Be well.

Dr. P

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There is nothing wrong with waiting until a problem is stable, and at that time reassess critically to see if any revision surgery needs to be done.  Usually this timepoint is some time after six months.

Fat injection fat can sometimes be aspirated with a very fine liposuction canula.  In my experience, however, this is sometimes touch since the fat that does survive tends to be very "gristly" and does not aspirate well through a canula.  Sometimes the adjacent native fat is more vulnerable to the suction and well intentioned suctioning of the tougher fat injection fat can actually cause irregularities that compound the initial problem, not improve it.  Usually when we revise the lower eyelids and have irreguarities from prior fat injection grafts, we remove them through direct incisions.

At the time of any revision, we assess for why the patient had the fat injections in the first place.  Was there hollowness in the lower eyelid area?  Was there drooping of the cheeks that could benefit from a cheeklift?  There are many types of cheeklifts, so which one?  Would the patient benefit from moving up the thicker cheek tissue slightly to cover the lower eyelid hollowness?

Will the patient be better and more simply served with volume replacement with temporary Hyaluronic acid filler?  Or a nontraumatized fascial fat graft such as LiveFill placed directly into the tear trough or eye-cheek junction?

All these revision procedures have risk with them, so we have a candid discussion on how bad the problem really is, and whether revision surgery is even indicated.

The lower eyelids are the most delicate area in the entire body, for fat injection or any other procedure because of the extremely thin lower eyelid skin and the difficulty in correction of problems if they do occur.

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