John Kang, MD

Hello, great question! In general, no matter age of patient, we don’t usually encounter a situation where the transferred fat can cause permanent sagging of the face, though it can appear that way temporarily during immediate swelling phase... what we see though is consultation for too much fat placed elsewhere and making the face unnaturally puffy looking and round looking...

Even though it is just one view,  the before and after picture show your Surgeon understands the artistry involved in contouring Asian faces...I also perform lots of fat transfer to revitalize the lost volume and recontour the face back to more youthful look... in order to achieve successful outcome, the Surgeon needs to understand the inherent difference in bony anatomy based on patients ethnic make-up... I think he has done an artistic job in highlighting the  attractive aspects of your face while softening the harsh aspect..... I can see that the prominence of your cheekbone has been softened, but. there is still mildly “sunken in” appearance which bothers you... this can usually be touched up either with fat or filler.... interestingly, very often that mildly  “sunken in” appearance is requested by my patients to achieve a more “V-line” appearance that many patients desire...In my practice fat transfer is performed under local and I always reserve the last 20% of fat transfer so patient and I can decide collectively where we want to concentrate the last 20% in the face in an inter-active manner...Go see your Surgeon for your concerns as he has the talent to help you.. Good Luck!

Great Question. You need to find a Board Certified Surgeon specializing in General Plastic Surgery, Facial Plastic Surgery, or Oculoplastic Surgery who have spent many years during training in thoroughly learning the anatomy of the eyes; and, observing and assisting many experienced Surgeons operate in and around the eyes. In my opinion finding the Surgeon who knows the anatomy and is familiar with variations of the anatomy which can affect the final outcome of the surgery is the most important.  So do your due diligence in finding a Surgeon who is properly trained and truly familiar with the variations of the anatomy encountered in and around the eye region.

Second would be the Surgeon’s artistic sense and technical skill. Usually it is safer to seek a Surgeon at least five years or more into their Clinical Practice during which time they would have either incorporated “Asian double eyelid surgery” into their “bread and butter” part of their surgical practice, or not; and by this time they would have had 1) enough reviews on the various Surgeon rating sites and 2)should have developed adequate portfolio of “before and after” pictures for you to decide whether Surgeons’s artistic and visual sense is in alignment with your sense of how your double eyelid should come out after surgery. 

As far as technique advancement over the years, there have always been nuances in techniques that ultimately affects the final outcome of the surgery. What has changed the most over the years  is the visual sense of Surgeons from creating more round, westernized eye to now, more almond shaped, natural appearing eye with a fold the patient “might” have been born with.  When I started my practice roughly 25 years ago, I saw too many Surgeons performing “attempted Westernization” technique which looked awful and were coined “sausage eyes” because lids looked too high and forever swollen and unnatural lending the eyes out of place with the rest of the face. I see whole lot less but still consult on patients for revision surgery after this type of surgical outcome. Try to avoid this outcome. Avoid unnecessary visible scars for sake of lengthening the eyes medically and laterally. Finally avoid the Surgeon performing exclusively suture technique because not everyone’s anatomy is amenable to this technique. 

In summary, there are enough nuances in the anatomy and of various techniques that you want to seek a Board Certified Surgeon who specializes in Asian double eyelid surgery. Good Luck! 

Hello

I am glad you are enjoying the effects of the Botox other than noticing worsening of the undereye fat bag... the reason why this is happening is the Botox is getting near the undereye muscle which weakens from aging process and is now more weakened by the Botox, further accentuating the lower eyelid fatbag and the puffiness.

Immediate fix would be not to Botox in the vicinity of the fatbag... long-term fix would be to undergo undereye fatbag surgery.. Talk to your Plastic Surgeon about these options and you will be glad you did... Good  Luck!

Hi you didn’t mention how old you are and if you need fat anywhere else in the face.. paranasal area is a great place for fat transfer but usually requires at least two sessions for permanent volume restoration. If this area is your only concern, Radiesse filler can be initially placed to give you an idea and may be substantially more economical than fat injection, and can last up to a year..... my other favorite option to this area is your own cartilage implants harvested from the ears...  Good Luck 

Hi always more helpful to see a picture of your concerned area.... but, to clarify, temporal “lift” will not do much in terms of lifting your cheek... but mid-face/cheek lift using a temporal “approach” will definitely help you... 

the difference lies in what Dr.keller alluded to which is in order to achieve an adequate mid-face/check lift, the surgical dissection need to pass inferior to your malar/ cheek eminence (aka the bucket-handle)... due to anatomical complexity in this area, technically speaking, some of us are very comfortable dissecting through this area, while others are not usually based on their background training.

you need to seek out a surgeon who truly understands the concept and complexity of mid-face/cheek lift using a temporal approach...... and not someone who simply advises temporal lift which will not help you... the biggest advantage is almost no visible scar as incision is hidden in your temporal hairline and if done properly, is a deep plane “vertical” lift which provides very natural lift. 

However based on your age, I would recommend seeking a surgeon well versed in surgical options as well as thread lifting such as Silhouette and PDO threads and energy based lifting such as Thermage  and Ulthera which are all FDA approved for varying degrees of mid-face and check lifting, often in conjunction with re-volumization using fillers or fat transfer.. and find out what are optimal options based on your age... good luck!