Excision of Fat Graft Overfill?

I had fat grafting to my cheeks approxmiately 2 years ago which ended up a bad case of overfill. I believe there are 4 ways to handle this situation : steroids, microliposuction, excision, and a lower facelift. I wanted to learn a little more about excision (if applicable to the cheek area). For example, would the incisions be placed inside the mouth? I want to gain a general understanding of this approach (applications and benefits vs. risks/complications). Many thanks for your comments.

Doctor Answers 8

Excision of Fat Graft Overfill

I would agree that, in general, the only directed ways to remove excess fat, regardless of its origin, is via liposuction or direct excision.  (Injecting a substance that "melts" fat may be an option at some point if there is an FDA-approved targeted material that does not diffuse to too great a degree).  Lipo can be done using any of a variety of techniques, including those that help "melt" that fat (such as ultrasonic or laser-assisted).  If it's a small amount then lipo is probably the best approach and it has the advantage of being easier to "feather" the edges.  A larger amount may require direct excision.  Either of these can be done at the time of a facelift though that is not typically enough of a reason to do a facelift (which remains a procedure that lifts and tightens tissues of the face).

I hope that this helps and good luck,

Dr. E

New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Removal of Fat Grafting Overfill

      Incisions can be made in many areas to disguise or minimize scarring.  The other methods may be appropriate as well depending upon fat graft location and abundance.  If you did not need a lower facelift before you probably do not need one now  and the scars may be too much of a burden.  Find the plastic surgeon with ELITE credentials who performs fat grafting procedures and revisions on a regular basis.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Fat injections

Dear genmod,

  • Your concerns are valid, and there are different ways to handle it
  • It all depends on what your exam looks like and what your goal look is
  • When you are ready, seek out a consultation with a fat transfer specialist


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Removal of fat overfill

Removal of the fat can be done through the same access points where the fat was injected using microcannulas. Although excision is an option, this can be tricky as the fat to be removed will have to be feathered into the surrounding areas so as not to create another contour deformity.  I agree with the other surgeons that alluded to doing an open excision if something else was to be done, but not for the fat removal alone.

Good Luck


Robert Kratschmer, MD

Robert Kratschmer, MD
Houston Plastic Surgeon
4.5 out of 5 stars 36 reviews

Cheek Fat Reduction From Fat Injection Overfill

If removal of fat from overfilled cheeks is to be performed by direct excison, the approach would have to be through some form of a facelift incisional approach. While this can be done, that seems like a big effort is that is the only objective. Liposuction using small cannula through a stab incision inside the corner of the mouth would be easier to undergo and likely to be just as effective as open excision.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Photos would be helpful

Depending on where the actual overfill is anatomically, different approaches may be ideal. On the eyelids direct incision would be helpful. If its elsewhere and its a small focal region, once could attempt steroid injection, and then microliposuction. If its a large contour irregularity, and you are good candidate for a facelift, then this gives excellent exposure, but I wouldn't use this approach just to deal with the fat.

Posting a photo would be helpful

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Excision is often performed when micro-liposuction cannot be done


Thank you for the question.  It is preferable to remove excess fat through micro-liposuction as opposed direct excision since the fat can be contoured better, the incision is very small, and there is less risk of complications such as nerve or muscle injury.  There are times however that liposuction cannot be performed safely or adequately such as in the lower and upper eyelid areas.  In these areas direct excision is often the safest ways to removed excess fat.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 165 reviews

Fat Grafting - Too Much of a Good Thing?

Structural fat grafting is a powerful tool for correcting one of the primary processes of facial aging: the gradual loss of facial soft tissue volume, which primarily represents the atrophy of facial fatty tissue. The importance of restoring facial fullness cannot be emphasized enough, for without it, very few facial cosmetic surgical procedures are truly rejuvenating. As we age the skeletal features of the face become more obvious, and create subtle visual clues that tell the observer 'this is an older person'. Fat atrophy is often very obvious when it appears as hollowness in the temple area and as flattening of formerly full cheeks, but can also exist as more subtle changes that still convey an appearance of advancing age, such as the development of a hollow in the space between the upper lid and eyebrow, or as indentations in a formerly smooth and gently curving jawline.

Lifting skin and trimming the excess has been the standard approach to the treatment of facial aging for centuries, but when performed without some means of restoring the youthful fullness of facial soft tissues, the result is an older-looking person with tighter skin. The word 'rejuvenation' means literally 'to restore youthfulness' or 'to make young again', so if the goal of surgery is to rejuvenate the face then it cannot be accomplished solely by means of redraping the skin and removing the excess.

In my practice fat grafting is not an afterthought that is thrown into the surgical plan for the occasional patient. It is a key component of almost every major facial rejuvenation surgery that I perform. It is in fact that very first part of the surgical procedure for my patients undergoing a full facial rejuvenation surgery.

Fat grafting also gives the surgeon the ability to provide a minimally invasive, quick recovery solution for some of the earliest signs of facial aging, in many patients long before they could or should consider a more involved (and much longer recovery) procedure like a facelift. Most people show evidence of facial soft tissue atrophy in their thirties, long before they develop the degree of skin laxity that warrants skin redraping and removal. So younger patients now have a means for 'turning the clock back' by maintaining or restoring facial fullness through structural fat grafting. These enhancements look beautiful and natural, not like surgery, and over and over I hear fat grafting patients tell me that "none of my friends or co-workers can figure out why I look so great".

As with any cosmetic surgical procedure, there can certainly be 'too much of a good thing'. Over-grafting of fatty tissue will distort facial features and produce unnatural proportions that look like surgery rather than appearing to turn back the clock. An important part of my preoperative evaluation is reviewing photographs with patients from their twenties and thirties (and from their forties for patients in their sixties and seventies). Such photographs are invaluable in confirming the manner in which a face has aged, and in planning a surgery that is designed to help a patient look more like their youthful self.

It is impossible to know exactly how to proceed without an in person consultation. But, your situation can be helped. Look for a physician experienced in correcting fat overfilling. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.