Why Didn't my Fat Transfer or Restylane Injections Work?

It is improbable that you did not work.  However it does very much sound like you did not get the effect you need to be satisfied.  This might be a function of how aggressive your surgeon is in filling these areas.  Generally I very much like Perlane for the nasolabial fold but no question the job can be done with fat, Restylane, and other fillers as well.  Consider posting before and after images so we have a better understanding of your concerns.

Fat transfer around the mouth is less predicatable as it is a moving area and the fat needs to establish a blood supply.  This is why it will do better in areas around the cheek or "malar area."  Fillers may soften this area but will not be permanent and your surgeon can talk to you about the differences in filler options.

I do not like fat transfers for smile lines. however, Restylene is a good filler for smile lines. its possible u might simply just need some more filler to give u the optimum results. I once had a patient who required three times the amount of filler I would use for other patients. the other option is u might want to try Radiesse for smile lines instead of Restylene

The survival of grafted fat is variable from procedure to procedure. As it is essentially impossible to quantify the survival of grafted fat as a percentage of the total amount of fat that was transferred, I instead tend to look at it in terms of what percentage of the overall improvement (that is seen early postoperatively) is still persistent at four months postop. If it's still there at four months, then it has a blood supply and will persist long-term. In my experience, most patients show a 50-80% persistence of the early improvement at four months. If less than 50% of the improvement has persisted, most patients need and want a secondary fat grafting procedure. We perform such fat grafting 'touchup' procedures at a significantly reduced cost compared to the initial procedure, and patients are advised of the potential expense before they have their initial surgery. Once in a great while we have a patient who experiences limited fat survival and who has very little long-term change in their appearance following their fat grafting procedure, and for such patients we offer a secondary procedure at no charge. Another way to look at this issue is to ask 'what percentage of patients require a secondary fat grafting procedure in order to get the result they are looking for?'. Because my approach to fat grafting is conservative, I have a fairly high number of patients who return for a second procedure. I would much prefer to have a patient like what they get and return for more, than to have a patient who is unhappy because they feel that their fat grafting was overdone. If you look at reviews posted by fat grafting patients who have had a very negative experience with the procedure, you find an abundance of patients that feel that an excessive amount of fat was placed in their face. They're not just unhappy - they feel disfigured. So a conservative approach is absolutely critical to success with facial rejuvenation by means of structural fat grafting. To be worth a patient's time and money, fat grafting needs to look natural, and not like a trip to the operating room.

Fat injection is not a perfect science in the sense that the fat cells often do not take a 100%.  Injecting other fillers in the folds can be very helpful, but they do not usually eliminate the folds or lines totally either.