OK to Get Fat Grafting 6 Months After Being Injected with Hyaluronic Acid?

Question

I got Juvederm in the upper cheeks, eye troughs, and nasolabial area. It is now 6 months, and I would like to consider a more permanent solution like fat grafting. Is it okay to do so?

Vivek Bansal, MD · Answer

It should be fine.  Just find a Board Certified Plastic Surgeon to do your work and offer other alternatives. Thank you for your question and good luck with everything.

Rodney A. Green, MD · Answer

Occasionally I have had patients where they decided that they did not want the hyaluronic acid filler (Juvaderm or Restylane) anymore for some reason. Sometimes the filler can last a very long time, much longer than is generally thought. I have had patients with Juvaderm that lasted several years in the lower eyelids for example.

	Fortunately if it is necessary to remove the hyaluronic acid this can be done very effectively, within hours often, by injecting hyaluronase. This has to be ordered specially by your doctor from a compounding pharmacy.

	It works quite dramatically.

Catherine Winslow, MD · Answer

Hello. You probably still have some Juvederm persisting. Since Juvederm can persist for over a year in some people, the best bet is to remove as much as possible with hyaluronidase. Hyaluronidase is a fast-working injectable that can help take away the persisting HA (Juvederm), allowing for more precise volumizing with fat and less "guesswork". I would recommend one or two injections spaced about a week apart, then scheduling the fat augmentation.

	Good luck!

Erez Sternberg, MD · Answer

It is perfectly okay to have fat grafting as a more permanent solution to filling of the face to replenish volume loss. I usually have my patients try fillers first to make sure they like the results and to get a feel for how much volume they will need. This is what you have already done. Now, after 6 months, much of the HA filler is already gone and you know that you were happy with the initial results. This makes you a perfect candidate for fat grafting. Fat grafting can be very long lasting or permanent but here are a few things you should know:

	1. Fat grafting will cause significant bruising and swelling for about 2 weeks when done correctly.

	2.  You will be over filled at first and look too swollen, but this will go away.

	3.  You will likely need a touch up procedure after the first fat grafting session to achieve balance and add to areas from which some of the fat absorbed.

Steven Wallach, MD · Answer

It is certainly ok to inject fat grafts into areas that had juvederm or restylane. However, you may want to wait until the fillers completely resorb so that you can add the amount of fat that you would like to place. Remember,e ven with fat grafts revisions are the norm sometimes two or three times to get it to the level that you desire.

Shashidhar Kusuma, MD · Answer

Yes, it can be done.  Hyaluronic acid injections and fat injections can be done together or spaced apart.  Your doctor who is going to be doing it will have to consider the amount of product or fat to inject to account for the appropriate correction of the area.

	You may lose some of the fat grafting due to resorption, but should get good augmentation with the procedure. alternatively you may want to reinject with the same hyaluronic acid product used earlier instead of the fat grafting as well.

	Please remember that fat grafting is not refined to the point where we can get consistent, reproducible outcomes. It may not be permanent. In some cases you may lose a significant volume of the injected fat in 3 -6 months. In other cases, you may have it last a long time and also gain improvement in the skin quality as well. 

	 

	good luck

Fereydoon S. Mahjouri, MD · Answer

In my experience, Juvederm last 9-12 months. therfore there are some residual H.A. still present in the injection sites. There is no contraindication for re-injection of other fillers to enhance or replace the previous fillers. There is no published data to indicate that the survival of fat grafting is influenced by excistance of other fillers in the injection sites. Feel comfortable to proceed with your plan, providing he/she is a qualified surgeon.

Edward Szachowicz, MD, PhD · Answer

I agree that you are probably within the last stages of the gel filler. But the gel fillers may leave certain areas faster than others depending on amount, location, and how much movement there is in the area.

	But all you need to safely proceed is to have the physician inject the areas with a hyaluronidase enzyme prior to your treatment to make sure all the gel filler has been broken down.  Hyaluronidase is a enzyme which breaks down or reverses the effect of the gel fillers made of hyaluronic acid (Restylane/Perlane & Juvederm).

	To be absolutely certain all the gel filler is gone, repeat the enzyme treatment again in a couple of days. Then you can safely proceed with fat grafting.

Laura E. Skellchock, MD (in memoriam) · Answer

The only thing to think about is that there may be some Juvederm left in the area. If this is the case, your physician might want to fill in a little more, to account for the loss of volume from this last bit of Juvederm. To be absolutely certain that you're starting with a "clean slate" you could wait 4-6 months more, at which point you'll be back to your baseline.

OK to Get Fat Grafting 6 Months After Being Injected with Hyaluronic Acid?

Answers (9)

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