Is fat transfer a good option to get a more symmetrical face?

Question

After an accident tree years ago my face have become more and more asymmetric. My left side looks shorter and more oval and my right side that is where I got hurt looks like it has fallen down and it also look flatter. My nasolabial folds also look totally different. So I wonder if fat grafting could be a good idea?

Stephen M. Krant, MD, FACS · Answer

Autologous fat transfer is one approach to correct your
asymmetry. It must be explained to you pre-op that it may require a
second fat transfer months later if there is not a 100% “take.”
 Another
option is to “fill” the defect and to correct the asymmetry with Voluma. This
is injected deep to the skin and placed into the subcutaneous space as well as
into the muscle. This can last twelve months or more and can be repeated as
necessary. My patients like this approach because if is non-invasive. 
Good
luck!

Jason Emer, MD · Answer

Facial sculpting and contouring can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Phillip Chang, MD · Answer

A facial fat transfer is definitely an option to address your concerns.  I would first meet with a Board Certified plastic surgeon to weigh all of your options.  Facial fillers would be a good place to start to get an idea of what your endpoint will be after a fat transfer to the face.  Facial fillers offer very little downtime as compared to a fat transfer.  Best of luck!

Fernando Colon, MD · Answer

I can see your concern in the photos.  Perhaps youcan try another type of filler as the HA types prior fat grafting and see how you like the correction. I would suggest a consultation with a board certified plastic surgeon experienced in this field and discuss your risks and options.  Best wishes.

Barry L. Eppley, MD, DMD · Answer

Before doing any corrective surgery the first thing to determine is whether your facial asymmetry is primarily from the bone or the soft tissue. A 3D CT scan would answer that question.Then based on that information it can determined whether a bone based surgery, soft tissue surgery or some combination may be best.

Mats Hagstrom, MD (license on probation) · Answer

we don't know what the actual injuries were so we really can only go by the pictures you've posted. 
 In general asymmetry whether it be of the face or the body should generally be met with acceptance rather than seeing it as a fault or something undesirable. 
 There is no symmetrical person.  There is no symmetrical face other than once generated as computer images or perhaps drawn. 
 Or facial shape and this includes a symmetry is primarily based on skeletal structures.  Manipulating soft tissues to compensate for skeletal asymmetry will by definition  create a new asymmetry which is now soft tissue asymmetry. Since skeletal asymmetry is normal and natural it looks more appropriate in my opinion than soft tissue asymmetry.  Having thicker layers of soft tissue coverage on one side of your face will look just like it's described.  I don't think you will appreciate this being an aesthetic improvement. 
 When I have personal patients who discuss concerns over asymmetry I sometimes showed them computer generated images of symmetrical faces.  There are lots of these floating around on the Internet. You can see the face as it is naturally than two left sides put together followed by two right sides.  What is always striking is how drastically different the two symmetrical faces are from each other when made up by two different sides.  What's also unique is that the symmetrical faces look somewhat strange.  They look strange to the human eye because we're not used to seeing symmetrical faces.  Our eye and mind is trained to see asymmetry as normal, natural and part of aesthetic beauty. 
 Most plastic surgeons don't share my view on the topic. I believe it's a lack of thinking this through and looking at things from a critical perspective. There are of course severe cases of asymmetry that border upon disfigurement.  That's a bit of a different topic. 
 I'm not sure if your injury caused soft tissue deficits, facial fractures or what it was but it doesn't seem normal that the asymmetry should progress from an accident in the past. 
 You can try soft tissue manipulation with fat but for most people presenting with your concern I would prescribe lots of reassurance, point out your aesthetic beauty and focus on overall aesthetics rather than a symmetry.  I'm also not a big fan of facial fat transfer. The procedure is inherently unpredictable and imprecise.  I would absolutely start with the use of fillers. If you're thrilled with the results from the use of fillers then consider letting the same person who did the fillers do conservative fat transfer if he or she has expertise with this procedure.  Because facial fat transfer is unpredictable it's generally better to stay conservative and have a second procedure slowly building up volumes appropriately.  There's no shortage of the dissatisfied people who've had facial fat transfer now desperately asking how the fat can be removed which is far more difficult than it is putting it in. 
 Best, 
Mats Hagstrom MD

Is fat transfer a good option to get a more symmetrical face?

Answers (6)

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