Do I need to dissolve all my lip filler to receive a surgical fat transfer to my lips? (Photo)

Question

I've been getting lip filler for the last 8-9 years. They're never as full as I want them to be no matter how much I do. I've had probably 5ccs in the last year and as you can see, not much volume. My body seems to metabolize the filler very quickly and recently I noticed they're becoming bumpy. I'm tired of the filler life I really want a more permanent solution. My question is do I need to dissolve my filler before I do it and why is it not a more widely common procedure?

Nelson Lee Novick, MD · Answer

Be very careful with fat injections. First, in most, if not all cases, the injected fat, removed from its donor blood supply, does not often last as long as so often promised and may not last much longer than a robust HA filler. What's more, fat transfer is a two-step, relatively expensive process, that involves large cannula removal of the fat from the donor site (belly, hips or thighs) and large bore cannula injection into the recipient site, which can engender real downtime. Further, fat cannot be dissolved with hyaluronidase, like HA fillers, if there are unwangted lumps and complications. And finally, the transplanted fat retains the characteristics of the donor sites, so that with aging a "midriff bulge" can potentially occur in the lips as it so often does in the belly fat, for example.  So, be quite cautious in going this route and make sure that you consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Jeffrey Lisiecki, MD · Answer

Which lip fillers have you gotten, and who was injecting them? I would also be curious to see your photographs over time as well to see how things have progressed over the years, and to see you in person to assess where the filler is. Be careful with fat grafting to the lips--the reason it is not very popular is because you can get lumpy or uneven results that are difficult to fix without cutting the fat out. I do it occasionally in older (50s-70s) patients along with full facial rejuvenation, but typically not in this situation in younger patients like you.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Yes, it would be best to first dissolve your current lip filler, because your surgeon will need to treat your lips in their natural state to serve as an accurate baseline before any procedure, as well as to avoid complications and unsatisfactory results.

I also suggest you do your due diligence and learn about how fat injections differ from fillers. Fat injection results are less predictable compared to fillers, and fillers can easily be reversed if the patient chooses to. Deciding whether fat transfer or fillers are right for you should be determined on a case-by-case basis in order to achieve optimal results.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with extensive experience with injectables and fat grafting. Such experts will have the optimal skills, as well as artistry and knowledge of facial aesthetics, harmony, and proportion, to ensure you achieve the most natural-looking results. During your consultation, your surgeon will evaluate your lips and skin quality, discuss your concerns and goals, recommend the best procedure, and ensure the best possible outcome.

James R. Gordon, MD, FACS, FAAO · Answer

Thanks for sharing your questions and photos. You must dissolve the fillers prior to receiving fat in to your lips. It’s quite possible to have a bumpy result with fat and it’s not easy to remove. Your better off trying a different filler. See an experienced injector for consultation proper guidance. Good luck!

Jason Emer, MD · Answer

I would highly recommend getting a formal evaluation with and treatment from a board-certified cosmetic dermatologist and expert in facial sculpting. Technique is the key so you'll want to see someone meticulous. An experienced physician will be able to determine which which technique will give you the subtle result you're looking for. See an expert. Best, Dr. Emer

Marc Polacco, MD · Answer

Thank you for your question. Typically before doing any permanent procedure, it is best to have your anatomy back to baseline. Otherwise, risk of over correction or under correction increases. Fat injection in the lips is fairly common, however, it is less common than hyaluronic acid filler because the result is less predictable. Fat survival varies during transfer, and it can also result in an uneven look in certain situations. There are silastic lip implants as well. The advantage is that they are permanent and easy to place (can be done in the office), but the downside is that they can be a little too stiff for some patients. Ultimately there is not perfect answer, and there are tradeoffs for each. I hope this is helpful, and all the best.
Dr. P

Daniel Barrett, MD · Answer

Dear Philosophical999974,
I perform a lot of lip injections with fillers such as juvederm and it works great. Many times I need to put more in one side than the other to attempt to even out the vermillion border (The red line of the lip). This helps provide more symmetry at times.For patients looking for a more long lasting result, I recommend fat grafting. That is, using your own bodies fat to make your lips naturally look more shapely. The bonus is that the results last many many years.
In general, I avoid using permanent prosthesis because I find that the lips are such dynamic and sensitive structures, the end result is not natural.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Andrew M. Ress, MD · Answer

Before doing any surgical procedures in general doctors prefer to dissolve all the existing filler first. In order to accurately place the fat and give you the best results you would have to dissolve the filler.

Cong Ivy Ran, MD · Answer

Dear Philosophical999974, Thank you for sharing your photos and concerns. Some of my patients also seem to have higher rate of metabolizing fillers in their lips, and that is very frustrating. The first options are often switching to different fillers try finding one that can last longer. I am sure you have tried as well but if not, this could be a quicker fix than surgery.
Now as to using fat, there are at least two ways historically fat is used for lip augmentation. One is called dermal fat grafting where a strip of fat with the associated dermal tissue is harvested and placed into the lips like an implant. The other is using processed autologous fat, also called microfat / nanofat, which functions like an injection. Neither procedure is consistent in outcomes and is riddled with problems of irregularity with most surgeons and that is why they are not more popular. Other less common procedures include lip implants with either silicone or gortex; these two procedures can be successful but because it is a foreign body in the lips and it is not without problems. 
Instead the more common procedures that people now do (for upper lip) is lip lift to give more red lip show. 
Hope this helps.

Leonard Grossman, MD · Answer

Presence of any filler in the lips will interfere with fat graft survival also known as fat take. This does not mean that you should dissolve all of your filler. In fact using fillers is not a bad choice as long as the results are good. I have been performing fat grafting into the lips since 1993 but I always tell the patients that it’s not the fat that takes but the connective tissue. In fat grafting small lip augmentation only a small amount of volume is created and in order for someone to create as much volume as what you currently have in your lips a large amount of fat graft would need to be performed almost making a lips look like those of an Orangutang. To summarise there is nothing safer and quick than hyaluronic acid fillers. I hope this helps and good luck from New York City Plastic Surgery s

Do I need to dissolve all my lip filler to receive a surgical fat transfer to my lips? (Photo)

Answers (11)

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