I need something big! Major change..tired of doctors not giving me the solution (Photo)

Question

I’m very unhappy particular with eyes/cheek area - I had that since a child. I had filler in the past which was not good for me because I got swollen - had to dissolve - went to different doctors that told me I don’t have enough fat to get fat grafting - what can it be done then? I want the area go be flat

Rajaie Hazboun, MD, MBA · Answer

Dear Isabella,Thank you for posting your question here.It is hard to assess your cheeks and eyes based on the one picture posted so I will give a more generic answer in the hopes it will give you some insight.
- if hollowing under the eyes or pronounced tear trough ligament is your major concern , this can be addressed with a lower blepharoplasty with fat re-draping or excision with fat grafting to the skin (you don't need much fat for this one), this can be paired with a midface lift ( should droopy cheeks and minor jowls be another concern) if done together those procedures will result in a significant change.
- if your cheeks are your only concern (again it's hard to assess based on this singular photo) and it's only an issue of not having enough volume there and if fat grafting and filler are not an option then cheek implants can be considered, their effects are usually more pronounced than either fat grafting or filler.
-In certain individuals with lower face fullness that gives the impression of a deficient mid face , buccal fat removal can be considered , again it's hard to assess here , but it will give some shadowing under the cheeks and makes them look more pronounced. this can also be paired with other procedures. - and finally if the volume is there and it's just a matter of a droopy midface/cheeks then midface lift can be done with minimally invasive techniques such as endoscopically.
- Each of those options has it's own benefits and potential complications that your surgeon can go over.
- some of those options can result in dramatic changes especially when paired, This should be taken into consideration when making the decision to proceed as you might not look like yourself anymore. 
In any case I would recommend that you discuss those options with your surgeon in person as they will be better to assess your needs after an exam.
I hope this answer helps, Good Luck!

Ivo Gwanmesia, FRCS(Plast) · Answer

Hello,

Thank you for your question. Are you able to post quarter and profile view photos as well? This will allow better review of your facial structures.

Fat injections should help the depression in the lower eyelid areas. I suspect fat can be found on your arms, thighs and tummy areas.

Mats Hagstrom, MD (license on probation) · Answer

Facial aesthetics are primarily to underlying bone structure.
It is facial skeletal structure that gives each person their unique facial appearance, whether desirable or not so much.
Soft tissue coverage tends to be much more consistent from person to person.
For that reason changing your primary facial appearance is not easy or straightforward.
Soft tissue solutions to problems that are based on skeletal structure are typically going to give partial improvements.
 to start with we need to have a clear understanding of what you’re trying to achieve which really isn’t clear from your post.
Fillers can give very good results, but the biggest variable is provider selection.
You may want to consider taking a look at the website of Dr. David Mabrie in San Francisco.
He is a facial plastic surgeon who has devoted his career to only working with facial fillers pad.
Is work is the best I’ve ever seen.
I’m not suggesting people fly to San Francisco to get fillers twice a year.
Seeing his results can be an educational tool to understand what can be accomplished using this fairly straightforward treatment in the hands of the right provider.
 You’ll probably find a fair amount of subjectivity for this kind of work.
If there was a single easy treatment, then we would all be doing it.
I’m not a big fan of facial fat transfer because the procedure tends to be unpredictable, imprecise, and unforgiving if patient don’t like the outcome.
 It is unlikely you don’t have enough subcutaneous fat on your body facial fat transfer.In my opinion, fillers are far better than facial fat transfer though obviously fillers need to be maintained.
Changing someone’s facial skeletal structure is really involved and usually reserved for those who have obvious defects.
To get an assessment regarding cranial facial structure, consult with oral surgeons who do this type of work.
Plastic surgeons tend to be more soft tissue oriented, and will generally rely on soft tissue solutions, though some plastic surgeons also have formal craniofacial surgery backgrounds.
Best,
Mats Hagstrom MD

I need something big! Major change..tired of doctors not giving me the solution (Photo)

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I need something big! Major change..tired of doctors not giving me the solution (Photo)

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