What percentage of people have a problem after having facial fat transfer?

Question

I am interested in getting a fat transfer to my face, but keep hearing about fat lumps migration etc. for facial fat transfer what percentage of people have a problem after having the procedure is it big risk/low risk etc thanks

Thomas A. Mustoe, MD, FACS · Answer

That is an impossible question to answer precisely, because so much depends on the skill of the surgeon, the amount of fat being transferred, the age of the patient ( as age goes up percentage of fat survival goes down), and tne location of the fat.  In general I have seen many people over the years with unsatisfactory outcome after fat transfer and usually tne problem has been excessive fat transfer altering the shape of the face in an unnatural way or lumps.  Personally Inhave been doing fat transfer to the face for over 30 years in thousands of patients. I do not try to change facial shape, just restore some of the changes inn aging.  The need for revision is rare although some benefit from a second treatment and in general the results are relatively long lasting (a few years) but not permanent and in some cases patients return every couple of years to optimize underneath the eyes for example. Experience does matter: the learning curve to optimize results is lengthy.

Mats Hagstrom, MD (license on probation) · Answer

Before answering your question I think there are a lot of things that need to be defined.
Let’s post a question a little differently.
Let’s instead ask how many people feel that facial fat transfer procedures exceeded their expectations? The answer to that question is probably less than 5%.
Now let’s go to a question like what percentage of people found the outcome to be acceptable and somewhat consistent with what was described by the provider? For that question the answer is probably 60%.
How about the number of people who got results significantly different than they had anticipated?
For this one it’s probably also a majority answer.
Let’s ask how many people will regret having had the procedure?
My best guess is that is around 15%.
How many people actually have revision surgery? Probably 10%
How many people need revision surgery after one round of facial fat transfer. Probably 25%.
The answers can further be subdivided into certain anatomic regions in the face.
Threatens to be relatively good for giving diffuse overall volume.
Total facial volume restoration by carefully grafting conservative amount of fat throughout the entire face in for head chance to actually work well.
On the other hand adding very precise amounts of volume in small areas like around the lower eyelids or around the mouth tends to not deliver results even close to what patients had hoped for on a regular basis.
Grafting fat is inherently unpredictable, and precise and unforgiving.
In order for the fat to survive there Hass to be a sufficient amount of post tissue, the fat needs to be harvested using good technique and grafted using good technique. soft tissue layers tend to fluctuate greatly in different parts of the face and this causes grafted fat to have different amounts of supporting host tissue in different areas. even if fat is grafted evenly in different areas the amount of host tissue may be uneven and this will happen a big impact on how much of the fat survives.
Hopefully fat that doesn’t survive simply melts away but sometimes it can leave oil cysts or firm nodules of necrotic scar tissue.
Removing dead fat from the face is difficult and often requires open excision.
When you compare this to fillers which is extremely precise, completely independent of host tissue and the problem goes away if you don’t like the outcome it seems like a no-brainer.
Obviously fat is desirable because of its permanence.
Anybody interested in facial volume restoration should probably start by finding a provider they would consider using for fat transfer and let that provider start by working with fillers.
If they get you perfect results every time using fillers then you know at least they have the capacity to understand volume distribution and facial aesthetics in a way which is pleasing to you.
Before letting anybody do permanent and potentially irreversible operations to your face you should vet providers thoroughly.
This means having multiple in person consultations at which time you should ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
For fat transfer it is imperative that you know the time difference between the before and after pictures.
Early fat transfer results can look very impressive but they do not represent final results by any stretch.
After pictures should be taken a minimum of three but preferably six months after the procedure.
An experience provider should have no difficulty showing you at least 50 send some before and after pictures of commonly performed procedures.
Being shown a handful of preselected pictures which most likely represent the best results of a provider‘s career is totally insufficient to get a clear understanding of what average results look like in the hands of each provider.
As providers to show you as many examples of previous patients who had similar facial characteristics to your own. Ask them to show you examples of excellent outcomes, I have a child comes and outcomes I didn’t turn out as well as they had hoped for. I asked him specifically with the revision policy is and what the revision rate is.
When in doubt slow down and schedule more consultations.
Working with fillers before attempting a complex and uncertain permanent procedure sounds like a wise solution.
Delivering consistent liposuction and fat transfer results is more difficult than most people believe.
Substantial numbers of plastic surgeons think they’re better at these operations than they actually are.
Being a board-certified plastic surgeon with overall good reputation is not mean someone has mastered every procedure.
Whenever contemplating having fat grafted anywhere you need to know what the plan is if the results turn out different than what you had hoped.
How is fat going to be removed if you don’t like the outcome?
This question needs to be posed to all potential providers.
Fillers are so much better than fat when it comes to facial volume restoration that it’s hard to recommend anything but using fillers.
Take a look at the website of Dr. David Mabrie in San Francisco. he is a facial plastic surgeon whose practice is devoted exclusively to working only with facial fillers.
He does not do fat transfer but his volume restoration work because some of the best I’ve ever seen.
There’s a reason he only works with fillers.
Best,
Mats Hagstrom MD

What percentage of people have a problem after having facial fat transfer?

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