How do you know if your fat pad descended enough for a lift vs. adding volume?

Question

After I had unforeseen volume loss from an aesthetic treatment, I noticed my face looks deflated and like it "dropped" more than before. How do I know if adding volume back is the right treatment versus pulling the fat pads to where they are supposed to be? If you don't pull the fat pads up but fat graft or fill over it, wouldn't that be not accurately addressing the problem? Thank you.

Tim Neavin, MD · Answer

Thank you for your question.  While it is difficult to know exactly what has happened without seeing photos, the story you are describing is not uncommon.  Often after radiofrequency fat loss develops in the face.  Like anything else in medicine the best first action is to obtain a proper diagnosis.  What is the exact issue contributing to the aesthetics?  Often, volume loss is the issue not descent --unless you are of advanced aged and have poor skin laxity.  I recommend you see a board certified plastic surgeon who specializes in fat transfer to guide you in the proper direction.

Marc Polacco, MD · Answer

Thank you for your question. I really love that you asked this, as it centers on a key concept of rejuvenation. For the best result, both are really key. As we age, we experience soft tissue descent as well as volume loss. Thus, intuitively, restoring descended tissue back into original position and adding volume are equally important. One or the other could certainly be done as well. I hope this helps, and all the best!
-Dr. P

Mats Hagstrom, MD (license on probation) · Answer

Without showing proper before and after pictures we can’t begin to make an assessment.

When patients lose volume from skin treatments whether they are laser treatments or radio frequency or a combination it is usually subcutaneous fat directly below the skin that is most vulnerable.

I’m not sure what fat pads you are referring to but most likely it isn’t a specific anatomic collection of fat but rather diffuse subcutaneous fat that was reduced in relationship to where the treatments were performed.

I don’t know how you propose suspending fat pads. I think the most simplistic view tends to be the way to go and generally most accurate. Most likely you lost a thin layer of fat just below the skin directly related to areas treated.  Volume restoration is most likely the best option since the problem seems to be volume a loss.

Duplicating volume loss exactly with the use of fillers or fat transfer is never going to match exactly but can get you towards correcting the outcome.

In comparison fillers are always more predictable, precise and forgiving in relationship to fat transfer but lack permanence.

Maybe you are a candidates for volume restoration for other areas maybe you’re a candidate for a facelift and there may be other treatments that can improve overall aesthetics despite the undesirable outcome of your previous treatment.

I suggest you follow up with the provider had the treatment and discuss your concerns with him or her.

If you want a proper assessment then consider scheduling in person consultations with local board-certified plastic surgeons. Ideally you should bring before and after pictures if you want an assessment in regards to the outcome of the previous procedure.

Best,

Mats Hagstrom MD

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