Options for reversing fat transfer?

Question

I was advised by a doctor 6 years ago to have fat grafting done to my pre jowl sulcus area instead of fillers. The doctor placed the fat behind the pre jowl into the jowls. Since then I’ve had accutite, lipo & kybella & nothing has helped. The areas on each side are only about an inch in length & an inch in width. I understand the marginal mandibular nerve is in this area. But I'm wondering why nothing so far has worked?

Geuris Cruz Quiroz, MD · Answer

Thanks for your question. Sorry to hear about your experience. Unfortunately, there are areas of the body where you can try many treatments and your body rejects them or, as in your case, nothing happens. Everyone is different and unfortunately to answer your question, in my opinion your body doesn't want to cooperate in the improvement you've been looking for, it's just your body type.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding removing transferred fat in the jowl area. It’s unfortunate that previous liposuction didn’t produce the desired result, possibly due to the delicate nature of the area and the associated risk of nerve damage.

You indeed have options to address this. A more aggressive liposuction can be considered, although care must be taken due to the close proximity to nerves. Another approach would be a direct surgical removal of the fat through an incision made around the ear, similar to a facelift procedure. This would allow for direct visualization and excision of the fat and any associated scar tissue while preserving nerve integrity.
After exploring other modalities, I hope this clarifies the viable surgical approaches to address transferred fat to the pre-jowl and jowl regions. Discussing these options thoroughly with a qualified plastic surgeon to determine the most suitable approach based on your circumstances and preferences is crucial.
Sincerely,

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we always need to see proper before and after pictures. For patients who have had multiple procedures, we need to see accurate documentation of before and after pictures, including each procedure you’ve had subsequently. If you don’t have proper before, and after pictures and ask each provider, you’ve had treat this area to forward all the pictures they took. Consider reposting with a complete set of before, and after pictures, including the Revision Work.
Without including pictures, we can’t begin to make an assessment.
Facial aesthetics are primarily determined by underlying bone structure. Soft tissue coverage is usually very consistent from person to person and when patients have issues with facial aesthetics, they’re generally based on the underlying bone structure. This is especially true for facial aesthetic issues on young people not directly related to facial aging. An imbalance between the Mandible and Maxilla is the most common reason for issues around the lower 1/3 of the face.
I personally try to encourage people to avoid facial fat grafting, because the procedure is inherently, unpredictable and precise and unforgiving if patients don’t like the results. Fillers on the other hand, are highly predictable, very consistent and extremely forgiving if patients are unhappy with the outcome.
Revision Work is many times more difficult than primary procedures, and considering that facial aesthetics inherently challenging to start with patients should be extremely selective in choosing providers. Each time somebody has a new operation in the same area things become distorted, increasingly complex, and the chance of having a successful positive outcome is decreased.
Simply making an assessment and differentiating between tissue variables is inherently difficult, and often different providers will have very different explanations of what the underlying problem is. Most plastic surgeons are soft tissue oriented and look for soft tissue solutions to problem, which in fact are often based on facial bone structure.
Consider re-posting with pictures, though your situation sounds complex and based on what you described an in person second opinion, consultations sound warranted.
Patient should come prepared for second opinion consultation bringing with them, operative reports, all sets of before and after pictures for each previous procedure. These can all be obtained by contacting your previous providers and asking them to forward complete medical records.
Best,
Mats Hagstrom, MD

Options for reversing fat transfer?

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Options for reversing fat transfer?

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