Cheek Indents After Fat Grafting

I had fat transfer, and now have indents across my cheeks. The fat goes above or below the area where it should. Is there a method to make the fat go or take in the spot where I need it? If so, I would try it. Thanks.

Doctor Answers 5

We prefer nontraumatized fat-fascial grafts

Fat-fascial grafts (LiveFill) are harvested directly. They are not aspirated through a canula or injected the way fat injection grafts are. While fat injection grafts are 25% alive at the time they are harvested, LiveFill grafts are 88% alive according to our studies. We have presented the results of these studies at ASAPS and ASPS meetings, and the results appeared in Plastic and Reconstructive Surgery journal

LiveFill grafts are also placed differently than fat injections. A pocket is made, and the grafts are placed into the pocket. They do not migrate. They are not placed under pressure, allowing them to go through tissue planes.

We have effectively used LiveFill grafts for the cheek area instead of cheek implants.

One of the particular problems of the cheek area is that there is a septum in the cheek of many patients causing an indentation. The tissue is literally tighter in that area, much like a belt in a pair of pants. Even when material is placed right below that crease, it tends to migrate to areas above or below the crease. In my experience this problem cannot be completely overcome, but can be minimized, by a combination of cheek elevation (cheeklift), and direct placement of LiveFill.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

You might need a fat injection touch up

You might need a touch up to place more fat in the area that is depressed. Or you can remove the fat that is above and below which may be more difficult. You should discuss this with your surgeon. He will hold your hand so to speak through this and help you get the best results.

Touch ups are usually less involved and will take less time. Sometimes the more elevated areas above and below could be due to swelling that will come down. Patience is required in this case and it may get better with time. Your surgeon will be the best to counsel you on this. Don't worry, it can be improved.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Fat Grafting, Specialzed Technique and Tools for Best Result

Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.

Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.

With structural fat grafting, small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Fat grafting can have variable take

It also depends on how far you are out from the fat grafting. Early on, there still may be swelling and some of the fat may not all take. Later (after 6-8 weeks or so), the swelling should have run its course and the fat that is present should have revascularized and "taken" by then.

If you are further out from the surgery, you may be a candidate for additional fat grafting or cheeklifting to smoothe out those contours. Unlike hyaluronic acid fillers that can easily be reversed with hyaluronidase (an enzyme), fat cannot easily be reversed. Good Luck.

Leonard Lu, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 26 reviews

Few options for fat grafting

Fat grafting is a very good technique for facial augmentation. The key technical factor is the location of the injection. If fat is injected too superficial the risk from dents is higher.

To fix any new dents, few tricks could be done.

1. Wait until all the swelling is gone. If the injection is early you can massage the fat. Deeper lympahtic massage by hand or using a machine could also help.

2. Very dilute steroids injected locally could help to melt the fat.However,this has to be done very carefully to avoid the subcutanous fat from get resorbed.

3. Surgical revision with a micro cannula could help with the fat pockets.

4. Finally, in select cases removal of the fat injected unsing an open method through the lower lid or so.

Hope that helps!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 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.