Does fat grafting "take" in areas where facial implants are? I am putting submalar cheek implants in but may need some f/g as well. Also if I need to remove implants and scar tissue forms can the area be successfully fat grafted?
Fat Grafting over Facial Implants
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Fat grafting over implants generally OK
Fat grafted over implants should do well as long as it is injected into healthy vascular tissue. There is a small risk of infection of the implants.
Fat grafting over existing cheek implants
The problem with implants is that as facial fat goes away over time, the implants become more and more visible. They can show an apple-like appearance when the patient smiles.
If the implant has a large submalar component, there develops in the face a large lower bulge in the cheek as facial fat wastes away, creating the illusion of old age (the center mass of the cheek falls with time).
The survival of all grafts will depend on the blood supply around the grafted material. It will also depend on how much of the fat that is transferred is alive.
With fat injection, most of the grafted material is dead. In our practice, we do not use fat injection for that reason. Rather, we use strips of the patient's fat and fascia, disarticulated. We term this LiveFill(R) in our practice. LiveFill is 88% alive when it is transplanted rather than around 20%- 25%. Viability studies vary widely with injected fat, but in general the more precise the method of looking at viability (i.e. glucose uptake), the lower the survival of grafted material.
More often than not, we remove existing implants completely, and replace them with LiveFill grafts. This also enhances the blood supply around the new graft since the bloodless implant is removed. It also enables positioning of the cheek mass not possible with implants.
Fat Grafting works fine over facial implants
Fat Grafting works fine over facial implants. I have done this succssfully a number of times. With continued aging, facial implants become more exposed. Fat transplantation provides a convenient option for covering up the implant. Theoretical blood supply issues have not been a problem in my experience.
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Fat grafting over implant
There may be much less surface area of good blood flow around the new fat graft (injection) because of the implant's physical presence. This might decrease the chance of the fat cells living in their new environment. Also there is a very rare chance that a secondary procedure could cause a local infection which might create a need for the implant to be removed.
It is certainly possible to graft over the implants. However, it seems unusual that you are planning this now. The implants should achieve your goal otherwise you should just proceed to fat grafting as the first step.
Fat Grafting or Injections need a blood suppy to live
You can graft around an implant but it depends on the blood supply around the implant. Typically, around the implant a layer of scar tissue usually forms. Scar tissue is notoriously known for its low blood supply. Bringing fat next to the implant has the potential to live if done right. Over time with the survival of fat around the implant, additional fat grafting can be done there to further increase the volume around the implant. If you remove the implant, the success of fat grafting can be attained but within the scar tissue, the fat has a more difficult time to survive.
This may mean that you will need to do more touch ups to the area. Fat grafting can lead to long term results. It is all about the technique. In my practice, fat does survive and sometimes near 90% of the fat can survive. This is true, so much so, that I need to be careful not to put too much fat in to certain areas. It is easier to put more fat into the area than to take it out.
Facial Implants and Fat Grafting
The situation you describe does not seem problematic to me.
Cheek implants are placed directly on top of the bone, whereas fat grafting is a much more superficial procedure in the cheek and lower eyelid region (typically in the level of the skin fat or muscle directly below the skin). There should not be a decrease in blood supply for the fat to take.
Best of luck!
Fat grafts require blood flow to survive
In order for a fat graft to survive there must be blood flow that re-attaches to it. This is diminished in the area directly next to an implant so the take there might be less. As to the future, it would be possible to re-graft the area but here again, scar tissue and its lower blood supply may affect the take negatively.
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