Will liposuction to reverse a fat graft cause irregularities or dents?

Question

Hello, I am trying to get a liposuction in the cheeks+midface area after fat graft that was botched. I was told by some doctors that I have thin layer of fat on my face (CT scan evaluation/sono). My face now has a rounded esthetic after the fat graft and I'm looking to remove this. Is having a thin layer of fat more linked to risks of irregularity and dents forming, even if I want a very conservative removal in select areas? Can this serve as a contraindication?

Chad Deal, MD · Answer

Yes, this could be done, but the surgeon needs to have good experience with this and be done with hand suction rather than with strong tube machine suction. Also, the surgeon needs to take great care not to damage any nerves. Another way to potentially treat this is to inject the area with steroids or 5FU with repeated dilute treatments.

Emmanuel De La Cruz, MD · Answer

Liposuction to reverse a fat graft can potentially cause irregularities or dents, but the outcome largely depends on several factors:

Factors Influencing the Outcome:
Surgeon's Skill and Experience:

The expertise of the surgeon is crucial. A skilled and experienced surgeon can minimize the risk of irregularities and achieve a more even result.
Technique Used:

The technique and tools used during liposuction can impact the results. Gentle, careful techniques are less likely to cause irregularities.
Amount of Fat Removed:

Removing too much fat or uneven amounts from different areas can lead to dents and irregularities.
Patient's Skin Elasticity:

Skin elasticity plays a role in how well the skin conforms to the new contours after fat removal. Patients with good skin elasticity are less likely to experience irregularities.
Post-Operative Care:

Following post-operative care instructions, such as wearing compression garments, can help in achieving smoother results.
Potential Complications:
Dents and Dimples:

Uneven fat removal can cause dents or dimples in the skin.
Contour Irregularities:

Variations in how the skin and underlying tissues respond to liposuction can lead to uneven contours.
Scarring:

Scarring from the procedure can sometimes contribute to irregularities.
Mitigating Risks:
Choose a Qualified Surgeon: Ensure your surgeon is board-certified and has experience in both fat grafting and liposuction.
Detailed Consultation: Discuss your goals and concerns with your surgeon. They can provide an assessment of the risks and how to minimize them.
Follow Post-Operative Instructions: Adhering to the post-operative care plan provided by your surgeon can aid in a smoother recovery and better results.
Considerations:
Non-Surgical Alternatives: Sometimes, non-surgical options like radiofrequency treatments, ultrasound, or laser therapies may help address minor irregularities without further surgery.
Expectations: Have realistic expectations about the results. Complete reversal of a fat graft may not be possible, and some irregularities may persist despite careful liposuction.
Ultimately, the success of liposuction to reverse a fat graft and minimize irregularities depends on multiple factors, with the surgeon's skill being paramount. It's essential to have an in-depth discussion with a qualified surgeon to understand the potential outcomes and risks specific to your situation.

Connie Hiers, MD, FACS · Answer

I would avoid trying to remove fail fat from the face. There are some nonsurgical treatments with radiofrequency that might help decrease the fat.

Camille Cash, MD · Answer

It is important to know that a risk of liposuction is contour irregularities.  When there is only a thin layer of fat there is less room for error.  I encourage you to select an experienced board certified plastic surgeon for your procedure.  Make sure you discuss your concerns, ask questions, and review before/after photos.

Mats Hagstrom, MD (license on probation) · Answer

Liposuction is not selective for grafted fat.
It will remove fat whether it’s native fat or grafted fat.
When fat transfer is done through a purely subcutaneous fat layer than liposuction is a fairly straightforward method of reversing the results.
This is not the case in the face.
 In facial fat transfer, fat is grafted through many different tissue layers .
The subcutaneous fat plane is only one of them.
This means that Liposuction is unlikely to remove the actual grafted fat.
Removing the native fat in your face may not have the same result as a revers of reverse procedure.
I generally recommend people avoid facial fat transfer because the procedure it is by its very nature unpredictable, imprecise, and potentially unforgiving if patients don’t like the outcome.Fillers on the other hand are the opposite.
Fillers are predictable, precise, and forgiving if people don’t like the outcome.
For those who opt for facial fat transfer, I usually recommend a conservative approach, recognizing that this may require multiple procedures to slowly build up the volume to a desired degree.
It’s also important to recognize that facial fat transfer because of its nature can lead to unpredictable outcomes and the number of plastic surgeons who approach mastery of this kind of work is quite small. Facial fat grafting should be considered permanent and irreversible though some revision changes may be possible. 
There is no easy way to reverse this procedure.
If someone wants to try doing Liposuction, and then they can do that.
Liposuction in the face has its risks and drawbacks.There is no correct answer to your question.
In the hands of a provider lacking sufficient skill and experience liposuction of your face can indeed make things much worse, causing all kinds of problems.
In the hands of a talented provider, it could potentially make your outcome better.
It’s not yes or no.
It depends on a number of variables.
It is however, a difficult situation that doesn’t have any easy or straightforward solutions.
To make an assessment, we need to see quality before and after pictures.
To find a provider to work with, I suggest having multiple in person consultations with plastic surgeons in your community who have extensive experience with facial fat transfer.
For second opinion, consultations come prepared.
This means having a complete set of proper before and after pictures and copies of your operative report.
 You can obtain these from your current providers office if you request them .
Because this kind of work is difficult and challenging, finding the right provider may require some effort.
This generally means having a substantial number of in person consultations.
Because it’s an unusual situation it’s going to be difficult to vet providers because no one will have an impressive collection of before, and after pictures of Revision work for facial fat transfer.
If they do, then you’re in luck and that would be helpful.
Generally speaking, the best providers at revision work are the same providers who do the best primary procedures.
In other words, you’re looking for plastic surgeons who do facial fat transfer really really well.
Assessing fat transfer outcomes is by its very nature, unpredictable and difficult as well.
Because fat transfer results change over time patients often do not know if before, and after pictures represent early results or final long-term results.
When reviewing before, and after pictures of far transfer results always confirm the timeframe of when after pictures were taken.
In order for after pictures to be representative, they should be taken at least six months from the date of the procedure.
Early fat transfer results can look impressive, but are not representative of final results.
In general, the most important variable is usually provider selection.
To find the best provider start scheduling in person consultations.
Best,
Mats Hagstrom MD

Luis Ramon Sang Vargas, MD - Account Suspended · Answer

You should possibly get a facial re shaping with puntual liposuction on the affected areas. As well as having some indiba (technology) sessions after the procedure.

Will liposuction to reverse a fat graft cause irregularities or dents?

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