When should I see the final results from fat transfer to cheeks?

Question

I had small amounts of fat transferred to my cheeks (8 cc in total: 5cc in one cheek, 3cc in other cheek) and am currently 3 weeks post surgery. Most of my swelling is gone except for some swelling near my upper left lip and left nasolabial fold. What surprises me is that I don't see increased fullness in either cheek now that swelling is down: Is that normal? Does the fat need to settle down before it "takes" and I see the fullness? When can I expect to see final results?

John J. Martin, Jr., MD · Answer

AT 2-3 weeks a lot of the swelling is usually gone.  Some more fat will possibly be resorbed over the next 2 months.  It is possible you needed  more fat initially.  Sometimes we get so used to the new look that we forget the pre-op appearance.  So take a good look at your pre-op photos.  If not much difference, you can have additional fat added in the future.

Scott W. Vann, MD, FACS · Answer

The swelling and early temporary changes are usually mostly gone by 2-3 weeks. However it is usually 3 months before you know how much of the graft is now "taken" and healed. There is usually little change after 3 months.

Robert M. Freund, MD · Answer

In y practice, I do not overfill the fat because of the high percentage of viable tissue. So my patients experience about 7-14 days of swelling and then they can see the final results. Some physicians anticipate a large amount of fat loss after the procedure (Up to 50%), and therefore overfill that graft. When overfilling occurs, that swelling may stick around for up to one year.If yo see no volume improvement after the procedure, you cannot expect it to get fuller later.God luck!

Steven Wallach, MD · Answer

Fat grafting can take a few months to settle down.  So give it time and you will see the final results in 2-3 months as the swelling subsides.

R. Stephen Mulholland, MD (retired) · Answer

Dear Curious_Inquirer,

Fat grafting to the face is a very
common procedure and an excellent way to achieve restoration, volume and contour.  There are different methods of fat grafting
and, in general, the fat graft will include mature fat cells that need to pick
up a blood supply to survive, as well as stem cells that will need to pick up a
blood supply may differentiate and add subsequent volume at a later date and
period.

8ccs in total – 5ccs into one
cheek, 3ccs into the other – is definitely a small amount of fat volume to be
transferred.  In general, in reading the
literature and my own personal experience of 20 years of aesthetic facial
surgery, including fat grafting, I tell most patients between 50% and 60% of
the fat that is grafted will resolve. 
Therefore, when judging how much fat will be needed to create the type
of volume, contour and shape, one should often add a significant amount of fat
over and above that desired to be achieved in order to minimize the risk that
the fat graft will dissipate and not pick up a blood supply and the patient
will not get the desired volume correction.

At three weeks, it is too early to
tell what the final result will be. 
However, you are likely at your most swollen point right now and it is
unlikely you’ll get enhanced volume over the subsequent weeks.  There is some small likelihood that stem
cells will pick up a blood supply differentiate and enhance contour and volume,
but this is unlikely.

I would wait approximately three to
six months and make sure you visit your operative physician for reassurance to
ensure that nothing has gone wrong, but there may be some volume enhancement
techniques and procedures that may be required.

I generally do not go back earlier
than six months following fat grafting with enhancement, volume and contouring
and generally I will use off-the-shelf products such as Juvéderm® Voluma&trade; to seek
the contour and shape the patient is desiring.

I hope this information has been of
some assistance and best of luck.

Sincerely,

R. Stephen Mulholland, MD

Certified Plastic Surgeon

Yorkville, Toronto

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