Do I need facial fat transfer under eyes & to the midface? (Photos)

Question

I had a deep plane face&necklift , with endoscopic brow lift 4 moths ago … I feel my under eyes and midface would be enhanced with fat transfer .. looking for advice please ?

Mats Hagstrom, MD (license on probation) · Answer

For facial aesthetics we generally need really high-quality pictures. for people who have had previous procedures it’s generally best to show proper before and after pictures. If you don’t have the formal before and after pictures your surgeon talk and ask them to forward all of your before and after pictures.
It’s especially important to have pictures without emotional facial expressions
Smiling lifts your cheek and changes facial contour significantly.
Based on the pictures you’ve included I would say on your preop picture it looks like mid face volume it would be appropriate but I see less needed in your postop pictures.
Fat transfer is technically more difficult when it comes to getting predictable outcomes. Grafting fat is inherently imprecise unpredictable and unforgiving in relationship to using fillers.
Fillers can be both diagnostic and therapeutic in that you’ll get an answer to your question without ever having to deal with the dissatisfaction of a permanent facial procedure. whenever contemplating having that grafted you have to ask yourself what the treatment is if you don’t like the outcome.
Removing grafted fat in the face is not at all straightforward.
Grafting fat is unpredictable because the graphs survive based on the number of different variables. One of those variables is the amount of host tissue available to support the graft. The availability of host tissue is sometimes much more important than the amount of fat grafted. The thickness of the soft tissue layer changes drastically in the mid face. It tends to be very thin at the orbital rim then gradually become thicker.
The graft despite how they are injected will often mimic the distribution of tissue available to support the graft more than where the graft was placed.
Studies of the survivability graft take in facial fat grafting has been shown to be between 10% and 90%. The procedure is inherently challenging for numerous reasons.
Fillers are simply a much better option and give you the ability to go back to baseline if you’re not happy with the outcome.
If you consistently like the results of added mid face volume using fillers then you’re probably in a better position to sign up for facial fat grafting and solid footing.
This is especially true if the chosen provider to do the fat transfer procedure is the same person who was doing the previous fillers.
The same provider knows exactly what volumes in what areas gave you the results you’re happy with.
Simply finding a sufficiently skilled and talented provider for this procedure is challenging.
Before and after pictures are not always reliable because fat transfer results change so much overtime.
After pictures should never be taken before at least three months. ideally after pictures should be taken six months or longer from the date of the procedure. Early results can look very impressive but early results do not represent final results for this procedure.
What do you see is not what you get when it comes to fat transfer and you have to rely on providers that are sufficiently honest and ethical to only show you honest final results when interviewing and vetting the plastic surgeons.
Male facial aesthetics find hardly different than female rejuvenation.
The majority of patients seeking these procedures tend to be women and the approach needs to be adapted for male clientele with a solid understanding of the male aesthetics.
I’m curious how do you feel about the outcome of your previous procedure?
For reference and obtaining a good idea of the impact of mid face volume consider checking out Dr. David Mabrie‘s website in San Francisco. he is a facial plastic surgeon but only does facial fillers.
His entire practice is based working with fillers. his results are some of the best I’ve ever seen. He doesn’t do facial fat transfer but you can get a very good idea of the impact that midface volume can have when done correctly using fillers.
Grafting fat is inherently different than working with fillers.
I would say fillers are hands-down superior in every aspect except for permanency.
They are certainly a very good place to start for those who are not sure.
If you’re sad I’m fat transfer then I recommend interviewing multiple providers in your community vetting each one very carefully before moving forward.
During each in person consultation bring pictures of your own face to use for reference.
Ask each provider to open up their entire portfolio and show you all of their before and after pictures for the procedure you’re interested in.
Perfect transfer it is imperative you understand the timeframe between the before and after pictures. You need to ask specifically how much time has gone by since the results that are being shown.
Being shown a handful of preselected images representing the best results of the providers career especially if it includes early results is totally insufficient to get a clear understanding of what average results look like in the hands of each provider. for reference and experience surgeon should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures.
In your case it will be difficult to get someone to show you that number of pictures for male patients because facial aesthetic procedures are far more common among women.
Still, someone who is truly on top of their game and have sufficient skill and experience should be able to show you an impressive portfolio of quality before and after pictures including a variety of outcomes.
Ask providers to show as many pictures of previous patients who have similar characteristics to yourself in regards to gender, age, body fat and indication for mid face augmentation. Ask providers to show you a variety of results including excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped. ask them specifically what their revision rate and revision policy is. do you need to ask exactly how the surgeon is going to remove grafted fat if you’re unhappy with the outcome. ask them specifically how many times they’ve done this in the past and if they can show you pictures of those patients.
Providers maybe apprehensive to do this. A sufficiently experienced confident provider should have no difficulty showing you any of these type of images in my opinion.
Generally speaking the most important decision is finding the right provider. That is sometimes more important than which procedure you choose.
Be very selective and schedule multiple in person consultations.
Avoid virtual consultations whatever possible
Best,
Mats Hagstrom MD

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