After 5 years, I don't think any further waiting will result in any significant change. When I see this kind of thing after fat transfer to the face I think of 2 things mainly: 1) something involving the technical details in the way the procedure was done in the first place, i.e, size of fat particles injected or total amount injected to one area, type of instruments used, depth of injection in the particular area, and so forth. These things are largely under the control of the surgeon, and 2) something that has changed in the patient's tissues over time, i.e, gain or loss of weight, interval aging and ongoing thinning or other changes of surrounding untreated tissues, newly acquired illness or medical conditions, and the like. These things are largely under nobody's direct control. Given your report of the early problems even during the healing phase, I tend to thing that in your case it was more the first rather than the second group of issues. The one thing that can be said here is that for all of those "doubters" who say that the volume obtained with fat transfer is not lasting, or that "all of the fat dies or gets reabsorbed," clearly this isn't the case! This underscores why it is so important to recognize that fat transfer is a very highly technically dependent procedure, and right from the beginning your results will depend upon how the entire procedure is done. The challenge with trying to correct these later results of technical inaccuracy is that there is no quick or easy way to just "go back in" and "pluck out" or remove the transferred tissue. We are finding that while fat transfer is a great tool for us to have, it behaves in a complex way that is very different from simply injecting a filler, where we wind up essentially with a more or less discrete deposit of a substance different from the surrounding tissues that can usually either be "dissolved" by simple injection or surgically removed with minimal trauma. Unlike fillers, the transferred fat tissues create a response that involves to some degree the introduction of entirely new cells to the grafted area which live and grow and produce their effects, and to some degree it also involves stimulation of the cells already present in the area to do new things as well. The tissues thus become wholly integrated as the transferred "adipose aggregates" become living, functioning parts of the local tissues. There is really nothing that can simply "dissolve" these tissues, at least discretely, accurately, and reliably, and attempts at surgical removal - either by "microliposuction or open resection - are difficult and often futile, sometimes creating whole new deformites that then must be reconstructed themselves. My purpose in describing all of this for you is not to bore you, scare you, or discourage you, rather it is to spell out the reality of fat transfer so that we understand what we are really dealing with - not some made up fantasy picture of how things "should" work - and this in turn will guide us better toward a solution. In many cases like yours, I will actually recommend further camouflaging of the area with additional (judiciously planned and executed) fat transfers. Fillers can certainly be used for this purpose too, especially as a temporary or reversible "trial run" if desired, but they have that ever-present disadvantage of being temporary if we are looking for a long term and lasting solution. Especially in areas like the temple which have broader, flatter surfaces, this approach may be better than trying to remove what is already there. The difference in technique when I do this is that I use fractionated, or "micronized" fat, that is fat that has been mechanically disrupted to form smaller and smaller particle sizes, sometimes small enough to be injected through even a tiny 30 gauge ("Botox-sized") needle as in the case of nanofat. Depending upon the degree to which the fat is processed, we may eliminate entirely all of the mature adipocytes (fat cells) from the injected tissue aggregate, thus retaining only the "regenerative" portions of the tissue, like stem cells and many other important components, and this allows for much more precise placement 3-dimensionally and a much greater chance that the resultant contours will be less irregular. For under the eyes, while nanofat is a very valuable tool, sometimes there is just too much of an absolute excess of transferred tissue (or its effects), and this must be addressed with a surgical removal under more controlled conditions. The only way to really know these things is with a detailed evaluation and examination in person. It is of the utmost importance that you seek out a surgeon who has lots of experience with fat transfer, and especially the newest techniques of fat transfer, as much has changed even in the last 5 years. This will give you the best chance at a successful correction of the problem, as you will hear about all options available to you and be able to select the one most likely to succeed in your specific case. Best of luck.
