Cheek sagging - what is the best solution? Fat grafting?

Question

I got a rhinoplasty and buccal fat removal when I was 20 years old. Very happy with my nose job to this day and I was happy with buccal fat removal results initially. However, I don't know if it is due to age or buccal fat removal long term effects but I'm not so happy now. I feel like my cheeks don't sit where they used to and I have significant volume loss around my eyes as well. I have tried filler and pdo nova threads. What is a better solution? Fat grafting? Looking for something longterm

Marc Polacco, MD · Answer

Thank you for your question. Typically the area under the eye is where we notice volume loss and descent first. Filler is a popular solution, but for a permanent solution, I prefer a SOOF lift. Using an incision on the inside of the eyelid, the cheek fat directly under the eyelid is elevated to help restore lost volume. Fat grafting will add volume as well, but it won't lift the fat that has fallen. I hope this information helps!

Tim Neavin, MD · Answer

Thank you for your photos.  Sometimes when buccal fat is removed it can impart an aged appearance.  True, fillers do have their limitations.  #1, they are temporary.  2, they are to discrete meaning that they only focus on very small areas.  Global fat transfer is a very effective way to restore use into the face.  Fat transfer to the face when performed properly harmonizes the face, building a top-heavy face of youth.  In my experience,  threads do not work well.  They do not improve volume.  They can redistribute tissue a little bit, but it certainly is not as effective as fat transfer.  Fat transfer is a permanent solution to the aging face.  It should be performed by skilled people who do a lot of this.  For more formation of a fat transfer please book the video or click on the link

Zoran Potparic, MD · Answer

Based on these photos, you seem to be candidate for periorbital fat grafting. This will include placement of fat (micro and nano) grafts along cheek/eyelid junction and mild augmentation of lateral brow. Transconjunctival lower blepharoplasty, without skin removal, should be considered as well. Good luck.

Darryl J. Blinski, MD · Answer

I recommend a mini FL w SMAS plication/fat grafting to indented side of buccal area. Best to seek in person consultations from boarded PSs.

Mats Hagstrom, MD (license on probation) · Answer

Restoring buccal fat volume is difficult. The buccal fat pad is deep in the cheek and it’s a substantial amount of fat all taken out from a very small place.

Fat transfer is not good at restoring a significant amount of volume in a small place but it’s better for giving diffuse overall volume.

Also, grafted fat is usually placed subcutaneously in the fat layer between the skin and deep cheek structures. The buckle fat bed is usually taken out from the inside of the mouth and is relatively deep.

Fillers don’t have delimitation‘s that fat transfer does.

You can do it either one but fillers  are more forgiving, precise and predictable.

Fat transfer for this type of work is best done slowly building up small amounts of fat in stages in order to not overdo it and create palpable fat necrosis and to get the desired outcome.

The drawback with buckle fat removal is that it causes problems later in life for some.

Best,

Mats Hagstrom

Cheek sagging - what is the best solution? Fat grafting?

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