Volume has suddenly decreased after 6 months. How is volume loss possible from mites/rosacea? (photo)

Question

I had a full face fat transfer just over 6 months ago. At 6 months, my volume looked great, however, it suddenly almost all vanished within 2 weeks. My weight has not changed. Six weeks ago, I started Tacrolimus ointment on my face for some dry skin. Being that this is an immune suppressant topical, it lead to me breaking out with Rosaceiform dermatitis which is caused by infestation of demodex mites. How is volume loss possible from mites/rosacea?

Zoran Potparic, MD · Answer

Unfortunately, unpredictability of take and volume retention is big problem with fat grafting, in particular in the face and periorbital area. It takes an average of 8-12 months for fat grafts to stabilize and result to mature. In same cases it may be necessary to add more fat grafts in a secondary procedure 12 or more months after first transfer. Hope this helps.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Mats Hagstrom, MD (license on probation) · Answer

This is the inherent nature of facial fat transfer. The loss of volume is most likely unrelated to your newly diagnosed medical conditions or treatment. For most cases, the majority of grafted fed will not take, and during that process until results are final, there’s swelling from an inflammatory response, and it takes time for the necrotic fat to be reabsorbed.
Facial fat transfer is inherently, unpredictable, and precise, and can be unforgiving if patients don’t like the outcome. It’s not uncommon for people to need a couple of rounds a fat transfer to get ideal, long-term results.
Mastering this procedure is difficult, and even the hands of the best providers results are still unpredictable.
That transfer is not a procedure or what you see is what you get. Long term final results should never be judged within the first six months.
When reviewing before, and after pictures, always confirm the timeframe of when after pictures were taken. Early fat transfer results can look very impressive, but do not in any way represent final long-term results.
Follow up with your provider or schedule in person second opinion consultations. I suggest always including a complete set of proper before and after pictures to get an assessment on the outcome of a procedure. If you don’t have before and after pictures and ask your surgeon to forward the pictures they took.
Best,
Mats Hagstrom, MD

Volume has suddenly decreased after 6 months. How is volume loss possible from mites/rosacea? (photo)

Answers (3)

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