Reversing Fat Transfer Results?

Question

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!

Michael Law, MD · Answer

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.

Afshin Farzadmehr, MD · Answer

I have never needed to do this on my patients as I never over correct with fat.  It may not dissolve.  However micro lipo and sometimes to the extreme of direct excisions have been done to remove these fat

George Volpe, MD · Answer

Hi, I would suggest discussing your concerns with your plastic surgeon. After three days, one would still expect swelling and possible bruising which may play a role in your concerns. There is the initial swelling and bruising which can take two or three weeks to subside although full results may not be apparent for 3 to 5 months. Sometimes waiting is the best solution.  You may find that you like the results! However, it is sometimes possible to remove fat through liposuction or direct excision. But be sure to check with your surgeon to make sure that there is not another issue. Hope this helps.

Raffy Karamanoukian, MD, FACS · Answer

The swelling is most likely related to swelling, but I have reversed fat grafting performed by others using microcannula aspiration. Raffy Karamanoukian Los Angeles

Ron Shelton, MD · Answer

Fat injections always involve a certain amount of fat cells that will not live in the recipient area. Doctors often compensate for this by adding more volume than would be needed when using an off-the-shelf filler such as Perlane, Juvederm Ultra Plus or Radiesse. Also, there is some local anesthetic in the fat cells after they're harvested, even if the mixture is centrifuged to decant off the unwanted liquid. Swelling is expected for several days to a week or more in some patients, depending on how the injections are done and in which plane the material is deposited..

Trevor M. Born, MD · Answer

It has been a good period of time since your treatment. Most of the swelling should have resolved. 
Ultrasound, oral prednisone, Homeopathic medications and topical Traumeel can help with swelling.  
If the area is still full, then I would consider micro-liposuction or dilute steroid injections, depending on the degree of deformity.

Daniel Reichner, MD, FACS · Answer

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.

Anil R. Shah, MD · Answer

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.

Steven H. Williams, MD · Answer

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

Brent Moelleken, MD · Answer

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!

Reversing Fat Transfer Results?

Answers (20)

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