How deep must fat be inserted when performing a cheek fat transfer? How do you make sure that you won't damage a facial muscle?

Question

I saw that the face has different layers. upperskin/superficial fat/muscle and deeper fat. What is the best technique to perform a good Cheek fat transfer?

Christian G. Drehsen, MD · Answer

Depth of fat injections is usually related to the purpose of the procedure. If cheek bone area enhancement is being considered and one wants to produce a modest uplift, a deeper injection is necessary into the facial compartment and muscular space to produce the desired effect. If a more limited and superficial correction is needed the fat can be injected into the subcutaneous space, sometimes accompanied with needle release if fibrous indentations are present. In any case fat injection consists of depositing fine threads of fat dispersed gently with a blunt tip needle. In my experience of several thousand fat injections, I've never encountered muscle damage. 
Christian Drehsen, MD

Afshin Farzadmehr, MD · Answer

This is an excellent question which further emphasizs the know how of doing this procedure well.  Over the 19 years I have had women asking to have restoration of their cheek with fat or even have cheks similar to Kim Kardashian or other celebrities they have liked.  This is only possible through proper injection technique and knowledge of facial structures and know how.   I have not seen a single adverse event with my injection and treatments of fat transfer and purpose here is not to teach others where and how to inject since that is a cumulitive knowledge and expereince of years.  Nevertheless, you should be rest assured that a well experienced and knowlwedgable doctor would put your mind at ease and worries when you go for consult.   Thanks for excellent question

Lily Lee, MD · Answer

Fat grafting (especially to the face) should be done in microdroplets with a blunt cannula. You are absolutely correct that there are very key structures in the face that would be devastating to harm. However, the likelihood of this goes down when small droplets are carefully placed with a cannula that is not sharp. Therefore, key structures such as nerves and arteries are less likely to be damaged and merely pushed aside. I like to put fat in all different layers in the face (deep, intramuscular and subcutaneous). Spreading it out between the different layers without overwhelming any one layer is best for the longevity of the fat cells and natural appearance.

Jon A. Perlman, MD (retired) · Answer

Fat can be used to highlight and augment the cheek bone area and cheek pad or can be used to fill the depression of the soft tissue of the cheek correcting hollowing from weight loss and aging.  Chin augmentation, prejowl augmentation and strengthening of the jaw line and angle of the jaw are also uses for fat grafts.For cheek hollowing I place fat in the subcutaneous layer away from any nerves and for the malar eminience (bony region) I inject into the cheekpad superficial to the muscles nerves and the bone.If you've found an experienced plastic surgeon they will have their technique that has produced successful results.  Jon A Perlman MD FACS 
  
Certified, Am Board of Plastic Surgery 
  
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS) 
Member, Am. Society of Plastic Surgeons (ASPS)
  
Beverly Hills, Ca

Richard W. Fleming, MD (retired) · Answer

The fat injected to augment the cheek is placed right on the cheek bone. Therefore, there is very little risk of of injuring the facial muscles.  I've never seen this problem in over 25 years of augmenting the cheek using this technique.

How deep must fat be inserted when performing a cheek fat transfer? How do you make sure that you won't damage a facial muscle?

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