Heated treatment caused fat atrophy around side of my nose, cheek & above upper lip. Fat Transfer, Filler or facelift ? (Photos)

Thank you for sharing the photos. Unfortunately, we see this too often, where patients are left with significant fat atrophy and deep-seated scarring resulting in skin irregularities and dents after heat treatment. Sadly, facial soft tissue is not as forgiving as other parts of the body. I suggest avoiding fillers at all costs, as they will only exacerbate your problems. I am not aware of your age, and the picture you have included gives rather a limited view of your face, so it is difficult to say if you are a candidate for a facelift. Nevertheless, be cautious about the next step and make sure you see someone with extensive experience in this type of complication, as these are relatively complex. Fat grafting, perhaps with nano transfer in the first instance, would certainly help to rejuvenate the skin and improve its health and vascularity, which is often compromised after heat treatment. However, this is unlikely to resolve the issues completely.

Thank you for the photos. Was it RF? I see lots of RF induced atrophy. Atrophy is best managed by micro and nano fat injections. This is definitely improvable with fat transfer.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. I'm really sorry you're going through this—fat atrophy from heat-based treatments (like radiofrequency or ultrasound) is a distressing and unfortunately not uncommon complication. When fat loss affects delicate areas like the sides of the nose (nasal sidewall), cheeks, and upper lip, restoring volume and symmetry becomes both an aesthetic and structural challenge. Each corrective approach—fat transfer, dermal fillers, and a mini facelift—has different strengths, and the best option often depends on your skin quality, age, extent of volume loss, and your goals. Fat transfer (autologous fat grafting) is often ideal in cases of fat atrophy, especially for long-term correction. It uses your own fat (usually from the thighs or abdomen) and transfers it to the depleted areas. Dermal fillers, particularly softer hyaluronic acid fillers, offer a non-surgical, precise way to restore volume. They're well-suited for areas like the nasolabial folds, upper lip, and cheek contours. Fillers are reversible and adjustable, making them a good first step if you're unsure about fat transfer. A mini facelift won't replace volume directly but could help reposition sagging tissues and improve contour around the midface and mouth if there’s been accompanying laxity or descent after the fat loss. It’s usually better suited for structural lifting rather than pure volume restoration, and is often combined with fat grafting or fillers for comprehensive results. I hope this helps and best of luck!

You have very common areas for facial fat atrophy, regardless of the cause. Fillers are great when there’s only a little needed, and if you need a significant amount, fat transfer becomes the best option. It really takes an in person look to determine how much you will need. You could likely get away with a few syringes of filler. I would recommend seeing someone who is facile with both Options so that you get the actual best one for you.
Best of luck! Dr. Mark Boschert Renaissance Plastic surgery, St. Peters, Missouri