Facial Fat transfer into SMAS - where should the fat be placed?

Question

Liposuction to lower 1/3 of face left me with little to no subcutaneous fat. I have now seen 6 PS, most local. Last 2 consults say that my buccal fat is gone (taken by lipo); dark bruising for 3 months there. Some say superficial fat transfer shows irregularities, deep fat placement into SMAS muscle recommended. I’d like a staged procedure that replaces the fat where it came from (subcutaneous), but have been told the fat will die or look odd. Where should the fat be placed? Fat in muscle?!

Tim Neavin, MD · Answer

It is hard to give you a precise answer without any photos.  However, to answer your question fat is generally placed in multiple layers from the bone to under the skin.  It can be placed in the muscle or subcutaneous layer or SMAS layer.  Sometimes all of the layers.  I am not sure why you were told that the fat will die or look odd.  Fat transfer is something I routinely do for situations like this.  Sometimes radiofrequency can melt fat and leave volume deficiency.  Be sure to see an experienced plastic surgeon that does a lot of fat transfer.  For more information about fat transfer please click on the link below her watch the video.

Mats Hagstrom, MD (license on probation) · Answer

There is no right or wrong answer for this. It doesn’t come down to a yes or no, muscle or non-muscle. Take a look at anatomy pictures of where facial muscles are. The SMAS is a flimsy membrane that is not anything close to what anyone would consider substantial post tissue for fat transfer. Typically fat should be grafted in small amounts stratus fied through different layers as much as possible.  Placing high volumes of fat close to the dermis puts patients at higher risk for palpable fat necrosis and uneven contours. Grafting should be done from many different angles crisscrossing to create a grid with the most diffuse distribution of grafted fat.  conservative a grafting through a multi step approach is your best option.  The greatest potential complications will come from grafting too much fat in a single session.

It seems hard to believe that buccal fat was removed with Liposuction since this fat pad is typically removed from a small incision on the inside of the mouth and it’s fairly deep compared to superficial fat.

The bottom line, find the most talented and experienced provider and let him or her do their job.

Trying to select providers based on described technique isn’t the way to do this.

Choose the most experienced provider who seems to really understand facial fat transfer and has the greatest amount of experience with it.

Do this by asking each provider to show their entire collection of before and after pictures for facial fat transfer results during in person consultations. I recognize you’ve already had multiple consultations but that is the best way to confirm as surgeons experience.

A surgeon who can put down a collection of before and after pictures that reads like a telephone book who has very few justified negative reviews on various physician review websites is typically the person you want.

Lastly when reviewing before and after pictures for fat transfer procedures it is imperative that you know when after pictures were taken. Fat transfer results can look amazing within the first few days or weeks after the procedure but these pictures are not at all representative a final results.  Avoid any provider who attempts to show you early postoperative results as some thing other than early postoperative results.

Patients get too wrapped up in technique, equipment or technologies thinking that these are what makes the difference.

In the end it’s the skill and experience that separates those who are truly great from the rest.

Usually when you stumble upon someone who has mastered their craft you get a sense of confidence and it becomes clear the person simply knows what they’re doing.

I would also encourage you to follow up with your initial provider or at least let them know clearly that you’re not happy with her outcome so that provider can stop doing facial liposuction or at a minimum adjust their technique.

Consider writing honest appropriate reviews about your experience so other patients can learn from what happened to you.

Best,

Mats Hagstrom MD

Robert T. Buchanan, MD (retired) · Answer

There are several major lessons to be learned from your question. First, never do liposuction on the face except for very specific problems. These are so rare, however, that you could essentially never consider liposuction on the face. Secondly, you need to be very careful who you let do procedures. Even if you had a reasonable need for liposuction, you should never have obtained the results you have. That latter precaution especially applies to selecting someone to do corrective work and specifically fat grafting. There is a lot of misinformation about fat grafting as many physicians try it like they were doing off the shelf filler injections or without understanding how fat grafting works. Many of the responses you have gotten reflect this lack of real knowledge and experience in fat grafting. You are right. You need fat placed where you had it removed and, to get it to live, you may need two or more sessions. Deep placement will never correct the superficial irregularities and there is no muscle in the SMAS. You want to look for a plastic surgeon who is trained in grafting and also has significant experience with fat grafting and gets excellent results with at least 75% fat survival.

Facial Fat transfer into SMAS - where should the fat be placed?

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Facial Fat transfer into SMAS - where should the fat be placed?

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Everything you need to know about Facial Fat Transfer

Our mission is to create a world where every investment in modern beauty is Worth It.