Fat transfer to lips & under eyes didn't stay, worth trying again?

Having done lots of facial fat transfer in the past and having met a lot of patience, I’ve had the procedure I’ve come to the conclusion that facial fat grafting is inherently, unpredictable, imprecise, and potentially unforgiving, if patients are unhappy with the outcome.
For these reasons I generally always recommend patients work with fillers, because fillers while not permanent are the opposite.
Fillers are highly precise, very predictable, and quite forgiving if patients don’t like the outcome.
The problem with grafting fat is that fat graft survival is based on the abundance and quality of host tissue supporting the grafted fat.
In order for grafted tissues, to survive, they require a period of immobility, minimizing pressure and movement.
This is more or less impossible in the lips.
I’m not a big fan of PRP with or without fat grafting.
The survival of grafted fat and highly dependent on technique and especially the abundance of host tissue.
The thickness of subcutaneous tissues change, quite radically from the midface to the lower eyelid area. This makes the area inherently difficult to treat with grafting fat. Too many people treat fat grafting like they’re injecting fillers.
ThisToo many people treat fat grafting like their injecting fillers.
This tends to lead to high percentage of graft failure.
If the grafted tissue is viewed more like tissue grafting, using concepts applied for skin grafting, bone grafting, or cartilage grafting survival rates may be higher.
Without including proper before, and after pictures, we can’t begin to make an assessment.
If it didn’t work, the first time, it is unlikely to work by doing the same thing again.
Some variable needs to change.
Either find a different provider or better yet work with fillers.
For those interested in facial volume enhancement I usually like to refer people to view the results of Dr David Mabrie MD in San Francisco. I’m not suggesting everyone fly to San Francisco to get facial fillers. Seeing his before and after photos on his website can be highly inspiring and can serve as a reference so people can understand what can be accomplished with the right provider. I can’t leave links to websites but I think if you search his name you will find his website. Look for local providers who also have impressive portfolios with a proven track records. For fat transfer realize that early results can look very impressive but early results do not represent final long term results. Alway confirm what the time frame is for when after pictures were taken. In order to be considered final post op pictures should be taken at least 3-6 months from the date of the procedure.
When having consultations ask each provider to show you their entire collection of before and after pictures of previous patients who had similar facial characteristics.
Being shown a handful of pre-selected pictures representing only the best results maybe insufficient.
How many before and after pictures did your provider show you?
Best,
Mats Hagstrom MD