I have lupus panniculitis & have formed ulcers on the side of face. It's taken away fat tissue. Can I get a fat transfer?(Photo)

Question

Why do you think I get these ulcers? What could it be that's eating the tissue away from my face? I am interested in a fat transfer but unsure if I should get one. My ulcer leaks puss and smells ( thinking infection) and it takes forever to heal. I also get swelling under my eyes. I have a vegan diet and was told to overdose on leafy greens. Please help!!

John L. Burns Jr., MD · Answer

This is a highly unusual situation.  You need to culture the drainage to see what type of organism you are infected with.  I would advise seeking the care of a dermatologist.  The infections needs to be completely healed before considering reconstruction such as fat grafting or scar revision.

Jason Emer, MD · Answer

I have a significant number of patients i have done fat transfer, silicone and other fillers for with this condition.  The only issue is that if your lupus continues to flare there is concern you could lose the transferred fat or the fillers can be irritated.  I suggest you see an expert.  If you have controlled diseased for over 6 months and have a good relationships with your treating physician (who should be an expert in treating this), then you can start under going treatments. Active disease like ulcers need to be treated first before any surgical interventions.  Do not compromise your care for cost or distance.  Best, Dr. Emer.

Samir Shureih, MD · Answer

You have a rare variant of cutaneous lupus, Lupus profundus, subcutaneous lupus, occurring in 1-3%. You need to be under the care of a rheumatologist till the lupus is in complete remission. Then you can consider fat transfer in coordination with the rheumatologist and the plastic surgeon

Mark A. Brzezienski, MS, MD, FACS · Answer

I would be very careful with allowing anyone to treat the sites of draining ulcers with fat transfers.  Fat injection is helpful in so many venues, but I have not read about any experience with this particular problem.Be sure to integrate an excellent dermatologist and rheumatologist into your treatment plan. Injection of any substance can become infected with the bacteria that are populating your skin lesions and lead to a deep tissue infection.  There have been some advances in the treatment of auto-immune diseases with monoclonal antibody drugs.  My advise is to hold on injection therapy until your facial lesions have been controlled.

Mats Hagstrom, MD (license on probation) · Answer

Developing facial ulcers for no apparent reason is not common. There is typically some underlying source, most commonly some type of skin cyst formation which gets infected. This typically needs to be treated surgically as well as with antibiotics. I highly recommend being seen by a plastic surgeon or an ear, nose and throat specialist. Facial fat transfer may be an excellent choice. Another alternative is to use of temporary facial fillers. Based on the amount of fat atrophy, the volume required would be substantial.Considering the price of fillers, this procedure would not be inexpensive. One advantage to using facial fillers prior to facial fat transfer is the ability to demonstrate the potential outcome to the patient. Fillers are typically more accurate than fat transfer, and some fillers, such as Radiesse, are fairly long-lasting. Any facial infection would absolutely have to be healed prior to any elective procedure. A discussion with your rheumatologist would also be appropriate prior to an elective procedure. I suggest consulting with a board-certified plastic surgeon to get a more accurate assessment.Best of luck,Mats Hagstrom, M.D.

I have lupus panniculitis & have formed ulcers on the side of face. It's taken away fat tissue. Can I get a fat transfer?(Photo)

Answers (5)

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