Micro fat grafting for large facial scar (photo)

Question

Hi I have a scar on my mid cheek that feels very large to me. I have had 3 rounds of c02 laser on it, but I am wondering if I would see any improvement from doing a microfat transfer?

Anna Chacon, MD, FAAD · Answer

Micro fat grafting (fat transfer) can be a good option for improving the appearance of a large facial scar, especially if the scar is atrophic (indented or depressed). Fat grafting involves harvesting fat from another area of your body and injecting it into the scar to add volume and improve skin texture.

Since you have already undergone CO2 laser treatments, fat grafting may help further refine the scar by:

Filling in any volume loss for a smoother appearance.
Improving skin quality due to the regenerative properties of fat and stem cells.
However, results can vary depending on the scar’s depth, skin type, and healing response. Some patients require multiple sessions for optimal results, as some of the transferred fat may be reabsorbed over time. If the scar is still prominent, other treatments like microneedling with PRP or additional laser sessions may also help.

A consultation with a dermatologist or plastic surgeon can help determine whether fat grafting is the best next step for your specific scar.

Nelson Lee Novick, MD · Answer

Unfortunately, I am not at all surprised by the lack of success with the laser treatments. I have been cautioning my regular followers for years to exercise a whole lot of "buyer beware" when being offered these expensive gizmo treatments, since the hard science to support their use lags woefully behind the heavy marketing hype and social media buzz to hawk them. Sorry.
I have been performing subcisions for elevating and smoothing indented scars of all kinds from all causes for thirty years. Unlike so many of the expensive, here-today-gone-tomorrow "bells and whislles? light and energy-based devices out there now,  subcision has a proven, several decades' long track record for both safety and efficacy. 
Traditional subcision can be supplemented by the additional use of an appropriately robust HA filler, which can serve two purposes:: one to provide immediate elevation and smoothing of the indented scar and second to actually help to directly stimulate new collagen and elastic fiber synthesis (to complement the neocollagenesis and neoelastogenesis effects of the subcision) for a more permanent correction.
The problems with fat grafting, despite the claims for being natural and yielding permanent results, are two-fold. Number one, fat from the donor area separated from its original blood supply in the recipient site largely does not survive, and second, any fat that does survive retains the characteristics of the area from which it is taken. So, for example, if the fat is harvested from the belly, buttocks or thighs, when those areas develop midlife fat bulges (eg.  "love handles"), the fat transferred into the face can also do so. And since there is no easy way to dissolve fat (as there is to dissolve HA fillers), it can become a difficult problem to treat in an area so highly visible and important as the cheeks. 
You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Micro fat grafting for large facial scar (photo)

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Micro fat grafting for large facial scar (photo)

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