Reversing Fat Transfer Results?

Three days ago, I had Liposuction done on my hips and back area. Then, at the same time, I had a fat transfer (graft) into my cheeks and folds of my nose area (which I really didn't have). After three days, I still look like miss piggy. I look distorted, and I don't even look like myself. I had full natural lips which now look thinner, and the corners now go downward. I have a tiny nose which now goes up in the air, and fullness in the middle of my face. I'm very disturbed by the results. I was told I would look normal in 4-5 days, but I don't see how in two days i'll look like myself. Is it possible to have the fat transfer removed or reversed? Is there a procedure that can melt or dissolve the fat in my face? The plastic surgeon also said he added more because a lot of it will dissolve. Will it really dissolve, and how long will it take? I'm desperate to have my pretty little features back. Help!

Doctor Answers 20

Reversing Fat Transfer Results

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It is terrible to read about the people who have had less than ideal, and in some cases awful results with fat transfer. In the right hands, on the right patient, the results are natural, beautiful and lasting.

It used to be that "bad" facial plastic surgery was characterized by people with hollows above and below the eyes and windswept cheeks. I have done a lot of fat grafting to correct those results. The new trend in "bad" plastic surgery are faces stuffed full of fat, silicone, volume or some other kind of filler. It makes people look bizarre and unnatural.

With the transfer of any living material, whether it is fat grafting or the grafting of solid tissue like dermis/fat or fascia/fat, it is intended that some of the transferred material gets revascularized and survives. The majority of the transferred living tissue that does not get revascularized is broken down by the body's natural scavenger cell system.

Meticulous surgical technique, patience and attention to detail are required on the part of the surgeon to maximize the proportion of the grafted tissue that persists as living tissue, regardless of what type of tissue the surgeon is transferring. I have seen no cases of palpable oil cysts or chronic inflammation in any patient for whom I have performed structural fat grafting, and have had no cases of postoperative infection.

As with any cosmetic surgery, meticulous technique and attention to detail on the part of the surgeon can produce beautiful, natural-appearing results - whether it's a facelift or fat grafting or a breast augmentation. In the right hands, structural fat grafting of the lower lid / cheek junction can produce a natural-appearing, and youthful contour.

In inexperienced or impatient hands the result can be lumpy and even disfiguring. So make sure that the surgeon you are seeing is board-certified, has a lot of experience with fat grafting, and can show you photographic examples of the surgery in which you are interested. The lower lid / cheek junction is a challenging area, as the skin is thin and the orbital rim (bone) is immediately below. So there is less margin for error compared to thicker soft tissue areas like the cheeks and jawline. It is certainly not an area for a surgeon to start with if he/she is just learning fat grafting surgery.

With lower lids a surgeon cannot afford to 'overdo' it, for if you overfill this area (because you expect that some of the fat will not persist) you may be left with excessive fatty fullness if most or all of the fat survives. So when treating this area I feel it is critical to add fat up to the point where the contour looks ideal, then stop. If most of the fat survives, great; if it does not then you come back 3 to 4 months later and add some more (by 3-4 months any non-vascularized fat has been reabsorbed).

I let all patients having lower lid / cheek fat grafting know that there is a pretty good chance that they will need/want a secondary fat grafting procedure to enhance the result in this area. I have never regretted taking a cautious and conservative approach with this area. For any of you who have experienced unfavorable results with fat grafting, there are plastic surgeons who can help you. Take your time in your search and ask a lot of questions. Start by looking at lots and lots of before and after photos. 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Some good news!

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Fat injections when done well is a great technique for volume replacement. The way you had it done, by taking your own fat by liposuction is a common technique that kills the majority of fat cells being introduced. Thus, the fat cells die and the doctor has to overfill the area. In your case the fat should resolve in a short period of time. There is nothing to do at this time except to have patience.
Fat can be removed later on, just as it was introduced - by aspiration with microcannulas. But DO NOT CONSIDER THIS FOR AT LEAST 3-6 MONTHS.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Do not panic! You are only three days from facial fat grafting.

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Do not panic! You are only three days from facial fat grafting. Of all the facial surgical procedures I perform, I see more facial swelling and bruising following fat grafting. This is due to the number of passes of the blunt needle that is required to distribute the grafted fat cells evenly into the facial tissue.

Be patient…keep your head elevated on a couple of pillows and continue to ice. It is most imperative that you continue to stay in contact and be seen by your treating physician. You may wish to inquire about various medication that you can take to help alleviate the bruising and swelling.

In general, I would not consider removing the fat this early post-operatively. Keep in mind that only 35-40% of the fat graft will survive.

Thanks for your question.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Must give it more time

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Swelling after fat grafting can be significant, depending on where it is placed, how much, and the technique used. At minimum you need to allow 2-3 weeks to get  a reasonable idea of the appearance, and 2-3 months to have a final assessment of the amount of fat that survives the grafting procedure. Try not to panic at the moment. I find that the toughest thing as a surgeon who performs fat grafting routinely, is reassuring fat grafting patients as they go through the first few weeks of swelling. It's just way to early to make an assessment of the final result.

I have actually changed my technique over the years to use smaller amounts of fat at any one time to cut down on the swelling and allow a quicker recovery. With the availability of our own FDA registered lipobank, we can store fat in small amounts to allow repeated procedures to be done without the need for more liposuction.


Too early to tell about your final fat transfer results

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Three days is way too early to tell what you are going to look like. Fat grafting, depending on the technique that you use, creates a lot of manipulation to the tissues. This is a consequence of having to layer the fat into multiple separate layers in order to help the fat survive. This manipulation can create a lot of inflammation after your procedure and this can lead to the swelling that you are experiencing right now.

Sometimes, this swelling and bruising can take several weeks to go away. I would definitely not do anything this soon. This could be a big mistake. If you do anything now you can have other effects that you weren't intending to have. You should definitely bring these concerns to your doctor. Your doctor will help you through this. There are a lot of amazing doctors out there and your doctor, I'm sure, is one of them. Just make him aware that you are concerned.

When all of the swelling goes down, you will then be able to tell if you need anything else done. Don't worry, there are always options to help your situation. You can always add more fat to make the fat that is causing your concerns blend into the surrounding area. You can always remove fat through an incision, or through micro liposuction. Steroid injections can also be an alternative to consider. One thing you could consider is oral steroids at this point in your recovery. This could help your swelling. But make sure that you know of the potential risks involved with steroid use.

Consulting a Board Certified Facial Plastic Surgeon would be something that I recommend. We specialize in the face and are highly qualified to help you with this.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Swelling after facial fat grafts may last months

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When fat grafting the face, it can take months for the swelling to go down. After 6 to 12 months, if you still have significant swelling or lumps, I would recommend micro-liposuction of the fat grafted areas. Micro-liposuction involves very small suction tubes (much smaller than the normal liposuction cannulas) with small openings to remove the extra fat.

If you still have concerns after 6 months, I recommend that you have a consultation with a Board Certified Plastic Surgeon who has experience with micro fat grafting and micro fat liposuction.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 51 reviews

Too early to judge fat injection results

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As most of the other surgeons have stated, three days after fat injection is far too soon to comment on the results. The good news is that most of the fat placed will be gone.

Can fat transfer be reversed? Yes, but it is very difficult in certain area. Any facial filler, be it fat, Radiesse, etc. is difficult to reverse with the exception of Restylane (HA family).

The fat which has been placed was most likely placed in multiple layers throughout the face with very small amounts (microfat graft, FAMI, etc). Trying to remove a small amount of fat that has become integrated with your body is very difficult.

Frequently patients do not complain about the amount of fat but small hard areas which they can palpate. Steroid injections may be a good place to start, but not earlier than one year.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Please be patient

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Only a few days after surgery, you are maximally swollen and really won't know what the final results of the fat injection will be until 3 months have passed. By that time, you will probably be much happier than you are right now. Best to wait and see! Good luck!

Fat transfer results

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I agree with Dr. Moelleken in that time is an important part of your progress. When you posted this question you were three days out. You were likely at the peak of your swelling at that point. The swelling should begin to resolve and you should begin to see differences at 2-4 weeks.

The final result will likely take about 6 months to achieve. If, at that point, you feel like fat has been over-grafted, you can have micro-lipo suction through the same incisions to remove some fat.

However, right now, time is your friend. Give your body the time it needs to heal and the results to settle.

As always, contact your surgeon if you have concerns about your post-op course.

I hope this helps.

Steve Williams, MD

Postoperative swelling

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Three days after any procedure is far too soon to assess any results.

Fat injections do typically reduce greatly over time, often altogether. No doubt your doctor has told you about cold packs and elevation, and waiting it out until the swelling from surgery reduces. If the swelling is abnormal or you have any doubt, obviously check with your doctor to make sure there is no abnormal bleeding in the tissues that causes undue swelling.

Once typically 6 months have gone by, that is usually the time to assess critically to see if any revisions need to be done, rarely before that time point. Specifically with the technique of fat injection, some of the retained voloume may consist of nonviable fatty cysts, so it may be possible for your doctor to "smoosh" some of them with direct pressure, causing rupture of the fatty cysts. Obviously you should not try this yourself.

In my experience, fat injection fat can be tough, like gristle, and can be quite difficult to remove with liposuction or from certain areas such as the lower eyelids (we do not do fat injection techniques in the lower eyelid area). Revisions in the nasolabial area are generally much more straightforward.

Patients may also want to consider nontraumatized fascial fat grafts (LiveFill), which have greater viability when they are placed and therefore do not require overcorrection.

But again, 3 days after surgery the mirrors in your house should generally be taped over and you should be catching up on your reading and DVD collection!

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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.