To answer your question, yes, something can be done. Find a plastic surgeon with considerable experience and expertise with structural fat grafting, and with the correction of unfavorable fat grafting results. Removing overfilled areas of fat can be challenging, but it is possible. In some areas, such as around the eye area, direct excision of excess fat through surgical incisions is often required. In areas of greater soft tissue fullness, like the cheeks, fat can be aspirated (gently removed by suction using fat grafting cannulas of slightly larger diameter than those used for placement of fat) to reduce an 'overgrafted' appearance.In years past, plastic surgery patients who looked "done" had that appearance because skin was pulled tight without adding soft tissue volume, and patients were left with hollowed-out and windswept-looking faces. Today, it seems that the increasing use of non-surgical temporary and semi-permanent fillers, and the permanent filler that is fat grafting, has produced a new kind of "done" appearance: the artificially overfilled face. If a physician is new to fat grafting, and especially if they are not confident about their instrumentation and technique, then they may tend to over-graft thinking that a large amount of the fat probably will not survive. However if a large amount of that grafted fat does survive, the patient is left with an unnatural and sometimes bizarre look. Another part of the problem can be the physician's aesthetic vision and understanding of facial aging. There are facial areas where adding volume restores a more youthful appearance, but others where adding volume creates a distinctly unnatural appearance. Balance and overall facial harmony is important as well - for example, overfilling the jawline and lower face will create a heavy, square-jawed, masculine appearance. Additionally, there are facial areas where naturally-occurring fat, which increases in volume with advancing age, ideally should be removed: the area above the nasolabial folds, the area lateral to the corner of the mouth, and the jowl area. As I described above for removal of excess fat from a prior fat grafting procedure, excess naturally-occurring fat can also be removed by gentle aspiration (suction) using larger-diameter fat grafting cannulas. Failure to reduce these naturally full areas at the time of a fat grafting procedure can also contribute to an overly full or 'heavy' post-fat grafting appearance.I try to create the greatest aesthetic improvement possible without creating an unnatural appearance. This concept is critical: the nature of fat grafting is that fat survival often is not 100%, and therefore some patients will require secondary fat grafting procedures to build on the results of the first one. If a physician's approach to fat grafting respects this reality, then that practice will offer secondary fat grafting procedures at a very reasonable cost, which allows patients to achieve their desired endpoint in volume enhancement without appearing overgrafted and without assuming an excessive expense.Fat grafting (and simultaneous strategic fat reduction) is very much like sculpting, and the sculpture is not always complete after the first session in the artist's studio. Secondary sessions, usually quite minor compared to the initial procedure, are sometimes required to perfect the result. In many cases, a series of two or three structural fat grafting / strategic fat aspiration procedures can simulate the results of a more invasive facelift-type procedure, particularly in the cheek and jawline area - as long as the overlying skin tone is good.If a physician's approach to fat grafting is that the procedure is a 'one-shot deal' and 'you get what you get', then that practice does not respect the scientific basis of fat grafting and patients will tend to get disappointing and unnatural-appearing results.
