To fat transfer or to not fat transfer? (Photo)

Hello and thank you for your question! I think the plan to try filler first prior to going with fat grafting is a very sensible idea. There are not many procedures where you can do a "trial run" first like fat grafting after filler, so we definitely recommend doing so to see if the corrections/enhancements you are looking for can be achieved, and more importantly if your expectations can match what is ultimately doable.

It appears that you have moderate malar hypoplasia ( small cheek bones) which is the reason for this condition so early in your life. Augmentation of cheeks with cheek implants or fat grafts would improve this condition. Lower transconjuctival blepharoplasty should also be considered. Good luck.

This is your third post on the subject.Have you had any in person consultations so far?To make a high-quality assessment, we need a complete set of facial pictures, including profile pictures.In the end I need the right provider is going to be the biggest challenge regardless of what procedure you opted for.There are lots of lots of people offering, fillers, all with different backgrounds and some of them do OK work most of them do Mediocre work, and every once in a while, you’ll find someone who’s truly mastered the art of midface filler treatments. To get an idea of what’s possible, using fillers for facial aesthetic purposes, consider looking at the website of Dr. David Mabrie MD in San Francisco.I think his website is your face in our hands dot com. His work using only midface fillers is the best I’ve seen, and they are quantum steps better than what most providers can produce.Finding the right provider for whatever procedure you choose is difficult.It generally requires having multiple in person consultations.During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who look similar to what you do. Fat transfer is particularly challenging because early fat transfer results can look very impressive but they do not represent final long-term outcomes.Whenever reviewing before, and after pictures for fat, always confirm the timeframe of when the pictures were taken.After pictures need to be taken at least 3 to 6 months from the date of the procedure in order to be representative. as I mentioned in my previous response, you may want to get a cranial facial surgeons, perspective and cephalometric analysis.It appears that you have quite a tall maxilla.This is in the end, the fundamental primary problem.You don’t really have an abnormal soft tissue covering.The problem is almost always, always based on bone structure when it comes to facial aesthetics in young people.You’re not lacking fat in your face.It is the skeletal foundation that is slightly less than the Aesthetic ideal.Having an idea of what the right treatment is leaves you pretty far from having a quality outcome.Finding the best providers turns out to be quite difficult.In the hands of average providers or those who are below average results may be disappointing.Facial fat transfer is by its very nature, somewhat unpredictable, imprecise, and potentially unforgiving if patients don’t like the outcome.Generally, the issue is that some of the volume is lost over time and it’s probably better for providers to be more conservative, knowing that it’s better to build up volume until the results is Ideal rather than over treat. Still, because a significant of fat will not survive. The grafting process slightly over treating is usually considered appropriate.Mastering facial fat, grafting has a long and steep learning curve.Consider starting at the source working with providers who can properly assess and treat facial skeletal structure regardless of what treatment option you end up having.I think doing that will get you the best fundamental understanding of your own facial aesthetics.Best,Mats Hagstrom, MD