Loss of Volume in Temples, Cheeks and Under Eyes - Fat Tried Two Times and Disappeared?

There are a number of fillers that can be used in the face.  Fat is a nice one because it is your own natural filler and everyone has a few cc's of fat they don't mind using elsewhere.  The trouble with fat is twofold.  First, it is very fragile stuff and how much of it will survive may be unpredictable.  Second, it is living tissue.  It grows and changes as you grow and change.  I have had two patients in my office in the past week who had fat taken from their abdomen years ago and placed under their eyes.  As they gained weight over the years, the fat under their eyes, thinking that it is still abdominal fat, also gained weight.  Now they have puffiness under their eyes that they don't like.  Other fillers such as Juvederm and Restylane are nice for filling in volume deficits.  The downside of these is that they are NOT permanent.  They last six to nine months at best.  With these, you have to replenish them periodically.

Loss of volume of the temples cheeks and under eyes can be improved with fillers such as Juvéderm or Radiesse. The best treatment for the loss of volume especially in the cheek area is to have cheek implants done. Photos would allow me to give a better answer to your questions

These fillers work well to lift some wrinkles and to add volume to the face, but they are not permanent.  They tend to last approximately 6 to 9 months, as long as enough filler is used.  As far as fat transfer is concerned, the longevity of transferred fat can be variable.  The age of the patient, the manner in which the fat was handled, how much fat was transferred to a given area are just some of the variables that can effect outcome. 

Fat is quite good and I am surprised to hear of your problems.  There is no guarantee with fat but it should substantially survive if properly done.   Fat is not easy.  The harvest needs to be gentle.  The fat must be centrifuged.  Only the lower portion of fat carries the preponderance of stem cells.  Gentle technique is a must.  The injection must be in a snowstorm pattern.  Swelling is considerable and bruising takes 3 to 4 weeks to dissipate. So the timing is considerable.  Harvesting fat and transfer to facial area takes 3 to 4 hours in an isolated surgery.   Generally 30 to 120 cc of treated fat is needed.  I believe areas of stable fat are the best donor sites and this excludes somewhat the stomach.  I prefer arms or flanks and feel take is better.   So here are a few ideas.   Juvederm and Restylane are temporary always.  My Best,   Dr C