How to correct bad facial fat grafting? (Photos)

Question

Hi, i had fat grafting for scars and it looks very wrong. It seems overfilled in my left cheek and has a horrivleble contrast between my upper and lower cheek now. The upper area is fat. The scars are still there. Please what can i do to reverse this? At least the stark line?

Mert Demirel, MD · Answer

Fat grafting can be difficult to reverse because the surviving fat becomes living tissue. If the cheek looks overfilled or has created a sharp line between the upper and lower cheek, the first step is to determine whether this is true excess fat, swelling, scar tissue, or uneven fat placement.
If the grafting was recent, it is usually best to wait until swelling settles and the fat survival stabilizes. This can take several months. Early aggressive correction can sometimes make irregularity worse.
If the fullness is mature and truly overfilled, options may include very conservative liposuction, small surgical fat removal, or careful contouring by a revision facial surgeon. These procedures must be done cautiously because removing too much can create dents, asymmetry, or more scarring.
If the issue is a stark transition line rather than overall excess, sometimes blending the contour is safer than trying to remove all the fat. This may involve treating the scar tethering, adding small amounts of filler or fat to the lower area, or resurfacing treatments for the scars themselves.
Unfortunately, the original scars may not improve just because fat was added. Acne or depressed scars often need separate treatments such as subcision, microneedling, laser, TCA CROSS, or staged scar revision depending on the scar type.
My advice would be to see a facial plastic surgeon or dermatologist experienced in fat grafting complications and acne scar revision. Ask whether the problem is overfilling, scar tethering, or surface scarring. Correction is possible, but it should be gradual and conservative rather than trying to “reverse everything” in one step.

Zoran Potparic, MD · Answer

I am not sure, based on your history, whether fat grafts were used for treatment of accne scars, volume augmentation or both. In our experience, only nano fat grafts should be used for scar treatment in face, usually combined with dermabrasion. Correction of volume and lumpiness after overcorrection with fat grafts should include a combination of liposuction and additional fat transfer. It is a very difficult procedure that requires experience. Good luck.

Julian De Silva, MD · Answer

Hi ji ha, thank you for your question, and I am sorry this has been distressing. The good news is that overfilled fat grafting can usually be improved. Grafted fat that has survived behaves like living tissue, so unlike filler it cannot be dissolved with an injection, but an overfilled area can be reduced with very careful micro-liposuction, and a sharp transition line between the upper and lower cheek can often be softened either by reducing the fuller area or by conservative blending of the border. Timing matters: fat continues to settle for around six months after grafting, so if you are earlier than that it is worth waiting before any correction. The original scars are a separate issue, as fat adds volume beneath them but does not remove the scar tissue itself, and they may need their own treatment plan. I would recommend an in-person assessment with a surgeon experienced in revision facial fat grafting, who can examine the cheek in movement as well as at rest before advising you.

How to correct bad facial fat grafting? (Photos)

Answers (3)

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