I've paid over $8,000 to have mid face fat transfer. Can I get a refund? (Photo)
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Doctor Answers 2
A plan for creating the midface improvement you desired
The 'before' image you have provided demonstrates areas of midface soft tissue atrophy (hollowness) and soft tissue excess (fullness) that are immediately adjacent, and these changes represent a very typical pattern of midfacial aging. The areas of fat atrophy and excess fatty fullness need to be managed together but in very different ways to produce a youthful and natural-appearing surgical result.
The 'before' photo shows fat atrophy at the 'tear tough' which extends obliquely across the entire lower lid / cheek junction. This demarcation between lower lid and cheek due to fat atrophy (and gradual atrophy of the underlying facial bones as well) generally starts in a patient's 30s and is often very obvious by the time one reaches their 40's or 50's.
A simultaneous, adjacent change with aging is an increase in fat volume in the anterior lower cheek, immediately above the nasolabial folds. This creates a heavy appearance in the lower cheek and deepens the nasolabial folds. The increase in anterior lower cheek fullness creates a situation where no amount of fat grafting in the nasolabial folds will actually improve the appearance of the nasolabial folds, unless some of the excess fat is simultaneously removed from the area immediately above. If one tries to improve this by fat grafting alone, then you unfortunately end up with a big lump at and above the nasolabial folds.
Based on the appearance of the 'after' image you have provided, it appears that primarily your lower cheeks have been augmented with fat, rather than the upper cheeks and the area of the lower lid / cheek junction. This makes your central face appear heavy and out of balance with the upper 1/3 and lower 1/3 of your face. Ideally, the surgical plan for your rejuvenating your midface would have been:
1. Structural fat grafting of the tear troughs, the lower lid / cheek junction, and the upper / lateral cheek (directly over the cheekbone or 'malar' bone).
2. Manual fat aspiration of the fat excess in the supra-nasolabial fold area.
3. Limited (low-volume) fat grafting of the nasolabial folds.
There also appears to be hollowness in the area between your brows and upper lids, which also benefits greatly from volume enhancement by means of structural fat grafting.
So what to do now: essentially the same procedure that I outlined above can still be performed. Both naturally-occurring and surgically-placed fat can be removed from the area immediately above your nasolabial folds, using fat grafting cannulas (of slightly larger diameter than those normally used to place fat in the face) to aspirate the excess. This is done painstakingly and by hand, and does not employ a liposuction machine (aspirator) which would be far too aggressive. While manual fat aspiration can be done effectively, it requires some patience, finesse, appropriate instrumentation and ideally a bit of experience with the technique.
Regarding the timing of a secondary procedure, I personally am comfortable performing secondary fat grafting procedures as early as three months postop (as it generally takes three months to determine the degree of fat graft survival) and secondary fat aspiration procedures as early as four months postop (depending on whether or not there appears to be residual swelling present from the initial procedure).
Fat transfer to the face
- This is a touchy subject and fat transfers can change over the first 9 months post op
- Have you lost weight recently? If you have lost weight, it will reduce in the face as well
- I would express your concerns to his staff as well, very calmly and politely
- You can ask what will happen in 8 months to get an idea of what to expect
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.