Testosterone injections, especially if you are treating testosterone insufficiency should not have any impact on the survival of grafted tissues. Cause, grafted fat, is somewhat unpredictable in precise, and can potentially be unforgiving when done for facial Voluma augmentation. Fillers are a much better treatment choice. Fillers in comparison to grafted fat is highly precise, predictable, and very forgiving. If you do, choose fat grafting, then the choice a provider is paramount since the learning curve for doing these procedures well, both in regards to patient assessment and technical skill is fairly long and steep. When reviewing before, and after pictures, always confirm the timeframe of when after pictures were taken. Early fat transfer results can look very impressive but do not represent what the final results look like. Final results from fat transfer typically take 3 to 6 months from the date of the procedure. Removing grafted fat can be difficult and sometimes not possible in certain parts of the face. It’s probably better to stay on the conservative side, recognizing that building up volume over a few procedures may in the end given a better final outcome. If in doubt, I suggest staying with fillers because they are superior with far higher, long-term patient satisfaction, then facial fat transfer. Patients, considering having permanent and irreversible aesthetic procedures, should fat providers carefully and work hard at finding the best provider in their community. Recommend patients do this by having multiple in person consultations. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar facial characteristics to you around the garden ask providers to show you a variety of outcomes, including excellent outcomes, average outcomes, and outcomes that did not turn out, as well as they had hoped. We all have a variety of results and it’s fair game for patients to ask to see pictures other than preselect pictures, representing the best outcomes of a providers career. Being shown only the best results of the providers career is grossly insufficient in getting a clear understanding of an average results may look like when your results are likely to end up looking like. Ask providers specifically about revision rates and revision policies. Ask them how many patients have required revision surgery, including worst case scenario. Grafting tissue requires certain fundamental variables to all be in place in order for the procedure to be successful. One of those is having a sufficient abundance of host tissue to support the graft. Soft tissue coverage of the face varies in thickness substantially, especially around the orbits. This is one of the reasons why grafting fat can be so unpredictable in this area. Success of the procedure is not simply based on how fat is injected, but depends substantially on how much tissue the patient has to support certain amounts of grafted fat. There’s no correct number of consultations required to find the best provider. The more consultations, you have the more likely you are to find the best provider in your community. For a complex procedures, I suggest patient start by having at least five in person consultations, but consider having more and less you feel very confident you found the best provider. Getting consistent quality predictable results with facial fat Transfer is more difficult than most people believe. Best, Mats Hagstrom, MD