I had facial fat grafting a year ago, I am still overfilled and very unhappy with the results. What can I do?

I have performed facial fat grafting for years.  I have also seen several patients who have been over filled and require modification of their facial fat grafting.  The cheeks seem to be the most popular places to over fill.  Micro liposuction is the best initial approach for removal of some of this unwanted fat.  It is not a perfect solution as properly placed facial fat grafts are done is several anatomical levels of the facial soft tissue.  I would strongly advice against the use of Kybella.  It is not a predictable    amount of fat that can be predeterminced to be removed from the  area with the use of Kybella.  You may get more assmemtry after its injected than beforehand.  The potential risk of facial nerve injury is also very real with the use of Kybella and that will be an unforgivable consequence.

This can be imporved with transfer to the temples, forehead, and pre-auricalar area. Just about every "peanut head" I see after transfer elsewhere benefits from more fat to the adjacent areas, rather than removing fat. If you must remove fat, do NOT use Kybella. It is imprecise. You must see someone who uses microcannulas and knows what they are doing.

It is always good to follow advice of your surgeon. Kybella may be a modality which can help with reduction of undesired fat although we do not have any experience with that method. Other option would be elective liposuction with small cannula. Both carry danger of nerve injury in a small degree. If you already have scar in that area (lower blapharoplasty) that incision can be used for direct excision of redundant fat. Good luck. 

This is needs an in-person evaluation. A combination of 5/FU steroids, lasers, microneedling/prp and radiofrequency can give improvement. See an expert. Best, Dr. Emer

Hello DF1231,The draw back with fat grafting is that it is quite difficult to reverse the effects if you aren't happy with the results.  With fat grafting the grafts are placed in multiple layers to help establish a blood supply and take of the grafts.  If you feel you've been over injected, trying to remove these various layers can be difficult.  Treatments are best determined based on an in person evaluation.  Kybella is FDA approved for the submental or double chin area.  It would dissolve fat in other places but it can affect nerves temporarily.  If one of the facial nerves were affected it could give a Bell's palsy type appearance, although the studies showed these were all temporary.  Steroids can be used but run the risk of changing the color of the skin (although it's a low risk), and trying to just treat the fat and not the surrounding musculature can be difficult.  Liposuction isn't much of an option because the fat is in multiple layers and not necessarily ones that liposuction can reach.  External heat devices may be of benefit, although usually limited, such as Ulthera or radiofrequency devices. I hope this helps and good luck.  

Hi and welcome to our forum!
In general, 30-50% of grafted fat does not survive. This variation makes it difficult to predict the exact amount to inject. If overcorrection occurs, kybella (deoxycholic acid, a bile acid) will destroy fat cells, resulting in contour improvement. The FDA has cleared the drug for use under the chin only at this time. Therefore, the use of kybella for cheek fat represents off-label administration.
A more aggressive surgical option would consist of a conservative liposuction of the areas previously treated.
Follow the advice of your plastic surgeon.
Best wishes...

Thanks for your question ... this is becoming a bit more common now with the popularity in fat grafting unfortunately.  If massage has not helped then the next options I would consider would either be a small amount of steroid injection vs kybella.  Done properly both can safely dissolve the fat and help contour this area.  I would recommend that you discuss this with your surgeon or another board certified surgeon.

I have been doing fat grafting for something like 28 years.  at the present time microlipo is the best treatment, It is not perfect but things are improved and it is safe if well done.  Steroids just don't work.Kybella is new and there is not enough  experience with this in the face to be able to make a recommendation. I have heard anecdotal evidence that it has worked in the cheeks though I have no experience myself. .