Fat Transfer to Fill Buccal Area?

What causes lumps after Fat grafting? If the doctor does not overfill and uses microinjections, would that mean that I will not get lumps and uneven sides? Does a thickness of the skin play a big role there too?

Doctor Answers 6

Smooth results with fat transfer to the face

Fat transfer is a terrific procedure which can achieve excellent results. Like all procedures, there is always a possibility for an imperfect result. As you can see from my colleagues, fat grafting is best done with very small amounts of fat being injected (grafted) bit by bit across a wide area. It is not really intended to fill a small concentrated area in the way that other fillers can (for example, Restylane or Juvederm). It can, however, bring balance to a drawn or sullen appearance caused by a deficiency of fat. this type of overly thin appearance does happen in the mid cheek (buccal area) and can be greatly improved with fat grafting.

The results of fat transfer are more related to technique and your body's reaction to the grafts than your anatomy or thickness of the skin. While particularly thin skin may show irregularities more easily, these irregularities are usually minimal and smooth over time as the healing process remodels the grafts. Where lumpiness can happen is when the fat is transfered in larger globules and/or your body has a reaction to the grafts. A reaction to the grafts can be purely inflammatory and related to the stress of the procedure on the local tissue, or a lack of sufficient blood supply to keep a larger amount of grafted fat alive. The latter can lead to fat necrosis which will usually result in a temporary firm nodule which softens and absorbs in time.

If your surgeon has experience and is conservative with his/her technique you can expect nice results. The buccal area has a lot of margin for error and can accept a good amount of fat grafts without appearing too full or lumpy. I frequently graft these areas when performing a facelift to help achieve a fuller cheek in very thin patients. If you are not comfortable with fat transfer you may want to consider Sculptra as an alternative. Sculptra is an absorbable material that causes your own tissue to grow in the injected areas and plump them in time. The actual injected material ultimately goes away leaving only your own natural tissue. The advantage of this is that it can be done in the office without a surgical procedure (which fat transfer would require). The downside is that it typically takes 2-4 sessions (3 on average) to achieve the final results you may be seeking. The costs are comparable.

I hope this info helps!

Miami Plastic Surgeon
4.9 out of 5 stars 20 reviews

Fat injections for the cheek, buccal area

Fat injections should be made in small aliquots (amounts) and delivered through as small a needle or cannula without traumatizing the fat. This helps increase the host's circulation spread around the fat cells and deliver oxygen to the central fat transplant to support its life until a new circulation can take hold. Even with this technique, though, some fat cells live and some die. Rarely cysts can form. Asymmetry, or an unbalanced result with one side better augmented than the other, can occur. Fat injections provide many people with great results, but even with great injectors who have a lot of experience, there is a unpredictable aspect with some fat injection outcomes.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Fat Grafting

The results from fat grafting are dependent you your own anatomy, skin thickness, tissue atrophy and surgical technique. A combination of all of these leads to the final result. In the correct hands, fat grafting is a great procedure. However, if the injector is not as experienced, you may do better with an off the shelf filler. However, fat grafting tends to be more economical in the long run, since most people have an unlimited amount of fat to harvest. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Newport Beach fat transfer and fat grafting

Fat grafting is best done with small amounts of centrifuged fat injected by a skilled physician with micro injections. Typically this leads to a nice symmetrical enhancement of the area. Fat transfer is dependent on each patients anatomy and skin thickness. During the consultation phase your surgeon will discuss your options and whether you are a good candidate for this procedure.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Fat Transfer Technique issues

I agree with Dr Lam, lumps and bumps are us ally related to lack of experience and skill. If you inject too much in one spot you will probably have problems. Getting rid of the lumps after the fact can be quite challenging. Skin thickness can be an issue as lumps are seen more often around the eyes where the skin is so thin and less often in the cheek where it is thicker and the fat is injected deeper. Hope this helps.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Fat Grafting Lumps

Fat grafting lumps are caused by inexperienced hands. I rarely see anything like this because I tend to put very very tiny injections of fat in the correct plane. When you are working around the eyes, then the fat needs to be by the most experienced hands. Fat grafting to the buccal area is pretty easy and can be done with larger boluses safely (in my opinion). However, I also don't believe in just filling one area for the following two reasons:

1. it typically does not lead to as a predictable a result because the fat may not perfectly hold in any one area but in multiple areas it is enough to create a wow effect. i call this the 5% rule (see the video below).

2. fat transfer to one area because it is fat from the belly or thighs may grow at a different rate than the rest of the face. that is why i rarely if ever perform buccal fat transfer in isolation.


dr. sam lam

Sam Lam, MD, FACS
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 57 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.