Not happy with results - Should I do a second fat transfer? (photos)

Question

In the past two years I have had a mini lift, facial fat transfer and one fraxel laser treatment for under eye area. I considered lower lid surgery but suffer from severe dry eye and most Doctors I consulted were against it and no one was on the same page regarding technique. My doctors goal was to add some fat to cheeks and lower face including lips. I was pretty happy at first but to me the results were so short lived I feel I've wasted my money. Im not certain how to proceed from here.

Tim Neavin, MD · Answer

Thank you for your photos.  Without knowing how much fat was injected it is impossible to know how much you retained.  The swelling after surgery can last for months.  So it is possible you have mistaken fat for swelling.  Based on your photos now, assuming that the last picture is your current picture, I would recommend fat transfer to the face.  Not all fat transfer is created equally.  A lot of it depends on the technique involved in both harvesting and injection including the depth and technique of injection.  I recommend he go to a skilled plastic surgeon who performs a lot of fat transfer.  I think you are a very good candidate based on the image.

Thomas A. Mustoe, MD, FACS · Answer

You have a long thin face and in general the best approach Woukd be lifting the deeper SMAS layer ( deep plane approach) and fat grafting or fat grafting alone.  However there are limits to amount of fat that will survive because it has to regain a blood supply and it is not unusual to benefit from more than one fat teamfer. I would seek out very experienced surgeons based on credentials reputation reviews and before and after pictures.  You do have a challenging case.

Edwin F. Williams, III, MD · Answer

Thank you for your question. The procedure that is best for you really depends on your goals of treatment. Adding more volume with fat alone is likely not the answer. The most important thing is finding a board-certified facial plastic surgeon for an in-person examination. At our practice, we use imaging software that can show patients what we are able to realistically achieve through various procedures. Best of luck!

Mats Hagstrom, MD (license on probation) · Answer

In order for grafted fat to survive and give it the intended long-term results certain variables have to be present.

Number one is an abundance of host tissue to support the graft.

Normally I ask people to include before and after pictures but in your case we can use your final after pictures as your before pictures since the procedure in the end didn’t do much.

In your case the true thickness of subcutaneous fat in your thinnest areas is very very thin.
Having had to facelift may have heard the fat layers to some degree. It sometimes does.

When patients have thin layers of subcutaneous fat on the moderate amounts of fat should be grafted and if someone needs more volume than that then they should expect to repeat the procedure multiple times.

With fat transfer soft tissue volume can be increased by about  25-33%.  If that means your subcutaneous fat layer is 3 mm thick then it could be brought up to 4 mm.  based on your pictures your subcutaneous fat layer may be less than 3 mm thick and then your early postoperative pictures and I fed was added to triple the thickness of this layer.  perhaps this is all a bit technical but people who have very little fat will not have a big improvement with a single round of fat transfer I need to plan on having several around so fat transfer to get impressive results.

Sellers on the other hand are not at all dependent on how much fat is there and can give results just like your early results but they are inherently temporary because of the use of fillers and substantial volumes will be needed so it will be expensive.

You could with time and enough sessions of fat transfer build up to your desired results but don’t expect it to happen with one procedure.

Best,

Mats Hagstrom MD

Not happy with results - Should I do a second fat transfer? (photos)

Answers (4)

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