Removing Fat Transfer Through Facelift Cuts

 If fat grafting is done conservatively and in the proper dept, the results are good. When there is excess fat graft, one has to wonder. Did that fat grow excessively or was too much grafted there. If fat needs to be removed it could be done through a face lift incision. The alternate procedure is to do additional fat grafting or fillers for the deficit areas. a face lift itself can improve the irregularities.

Fat transfer rarely results in lumps if done carefully and conservatively.  Some of the irregular contour seen initially may be caused by swelling, and or deep bruising, in which case the issues will resolve with time.  However, resolution of the irregularities can take over 6 months, so I would advise waiting at least 6 months before making any decisions about future treatment.  I am not a fan of steroid injections, as these may lead to atrophy (thinning and weakening) of the normal tissues , and may cause unpredictable outcomes.  Likewise, liposuction in the face can result in unsightly grooves, so I would advise against that course of treatment.  Direct excision of lumps may work , but may leave scars at the skin surface.  Facelift incisions are well hidden, but it may be difficult to achieve a satisfactory contour with this approach.   In conclusion, I would be extremely cautious using any method to remove the grafts, as the end result may turn out worse than the actual lumps themselves.   

Fat transfer involves moving fat cells from the belly to areas in the face that have lost volume and is generally a very satisfying procedure for patient and surgeon.  Those fat cells that survive the transfer process live as long as the patient does.  However, one of the rare risks of fat transfer is a lumpy appearance.  This can occur if the fat is injected to close to the skin, or if a large area of the fat doesn't survive for some reason. 

The best first course of action is to inject a very dilute steroid to try to kill the bothersome lump of fat.  However, this may not work or it may leave the patient with a depression.  Microliposuction of the fat is another option, but is more of a procedure, which some would like to avoid.

There is a role for a facelift-type procedure in this scenario, though it is of limited value.  I was referred one patient in whom I tried this.  In her case, she underwent fat transfer to the lower eyelid region and was left wtih a lump.  The surgeon then tried both microliposuction and dilute steroids with no success.  When she came to me, I opted to performed a midface lift in an attempt to push down the lump of fat by tightening the skin.  Intially, this provided a modest improvment, but after several months, there was only a mild change.

Obviously, avoiding this problem in the first case is the best option!

 Ok, let me see if I can explain this:  Fat that's transferred does not all live and it can and does result in areas that are lumpy and bumpy as some of the fat dies.  Injecting steroids and performing micro-liposuction to remove the fat may not remove all these lumps and bumps.  In fact one of the worst , most lumpy faces that I ever saw in consultation was a women that went through that very scenario elsewhere.  Her face literally looked like the cratered surface of the moon.

 A Face Lift allows the surgeon to lift the skin off from the underlying fatty tissue layer so that he/she can literally shape away all the lumps and bumps...I prefer to melt these fatty lumps with the electrocautery paddle tip.  This is the main reason, I am against fat transfers to the face.