How can you fix fat grafting-created wrinkles without relying on Botox for the rest of my life? (photos)

Question

I had filler under my eyes a few years ago. Soon after, I noticed a dynamic wrinkle that occurs on the inner part of one eye, parallel with my nose. No amount of hylauronaise has fixed this. Clinicians (including a oculoplastic surgeon) are not sure what to do about it. I also had fat grafting to my face for scars. After, I have found deep wrinkles around my brows and temples. I don't want to rely on loads of Botox for the rest of my life. Would adding more fat/filler erase these wrinkles?

Sergei Kalsow, MD · Answer

Hi, unfortunately fillers do not fix dynamic wrinkles (those that occur due to muscle movement).  Botox or alternative neurotoxins are currently the best treatment for it.   You might want to switch the type of botulism you use, maybe a different brand would work better.

Ronald J. Edelson, MD · Answer

I don't know if you had eyelid surgery or just the injections. Either way you would benefit from having both upper and lower eyelid surgery. There's too much skin and maybe that area by your nose can be thinned out surgically.

Rosa B. Lipin, MD · Answer

Thank you for your question and the pictures.
If the filler originally placed in the tear trough was Voluma it can take a lot of Hyaluronidase to dissolve-- and it often takes multiple sessions. The wrinkle you are describing under your eye is from the placement of filler (whether it was HA or fat). If, fat was placed there, it can be removed surgically) and is certainly not easy. I would recommend Dr. Guy Massry for this. 
To answer the second part of your questions-- Botox or Dysport is the mainstay for treating dynamic wrinkles and helping to prevent static wrinkles. But you are right, it does not last that long. For the areas your are describing (wrinkles on the brows) I would absolutely recommend against adding filler. Rather, a moderate to deep chemical peel or fractional C02 or erbium yag laser resurfacing would absolutely help soften the wrinkles that you already have. It will not prevent future wrinkles, but will improve skin tone/texture, and increase the amount of collagen in the deeper layers of you skin which will greatly improve the appearance now and for a while in the future. 
I see that you are in Portland, Or (I went to high school there) and without hesitation I would recommend Dr. Michael Kim to discuss further. 
Best of luck,Dr. Rosa B Lipin

How can you fix fat grafting-created wrinkles without relying on Botox for the rest of my life? (photos)

Answers (3)

Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.

How can you fix fat grafting-created wrinkles without relying on Botox for the rest of my life? (photos)

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.