Can you I reverse fat grafting in my cheeks?

Question

I had facial fat grafting 4 months ago & I'm very unhappy with the results. My face is too full & one side is bigger than the other. It looks like a have a "speed bump" running down the center of my bigger cheek. Also, the corners of my mouth turn downward like a constant frown. Is that normal? Can I have the fat removed? I've had steroid shots 3 times in an attempt to get my cheeks to go down but very little change.

Ivan Wayne, MD · Answer

I am sorry to
hear about your problems following fat grafting. I have been doing fat grafting
for facial rejuvenation for 12 years now and find it one of the most rewarding
procedures for both the patient and myself. It does require the surgeon to have
some awareness of facial aesthetics and the changes that occur with age as well
being very careful with technique.I have treated
several patients that were unhappy with their results performed by other
surgeons. I have not seen great success with steroid shots because the fat is
pretty tough and I worry that the shots may cause problems in the skin
overlying the grafts. What I have found useful is micro-liposuction with very
small precise cannulas. This is done in the office with local anesthetic,
carefully removing excess fat. It often will have to be repeated several times
and we often will do corrective fat grafting after the fact to give the patient
the best cosmetic result. At four months
you may not have given the fat enough time to smooth out as there is a lot of
resorption of fat following grafting (usually around 60%), so there may be some
improvement moving forward.Good luck and I hope
this helps.Dr. Wayne

Jason Emer, MD · Answer

5fu/steroids, and aggressive RF treatments can sometimes help.  Liposuction of the face is dangerous, kybella can be tried.  Best, Dr. Emer.

Nelson Castillo, MD · Answer

Thank you for your question and I am sorry that your results have not been what you anticipated.  Fat grafting can be reversed either by careful liposuction or direct excision of the fat, as steroid injections are more useful for treating swelling but not fat accumulation.  Hope this helps.

Walton Montegut, MD · Answer

This is a good question.  Fat can be removed from areas that is was injected into, and each patient is taken individually.  
I utilize 2 different approaches for this problem.  The 1st is a conservative approach using micro-liposuction.  This is a conservative approach and utilized in areas of the face where a small amount of fat needs to be removed.  The fat can be visualized through the skin and discreet lumps can be palpated.  This can be performed in the office utilizing local anesthesia.  Again, each patient is unique and considered individually.  the good news it can be removed.The second technique is to access the fat via a facelift approach.  In this method, a facelift type incision is utilized and the injected fat can be visualized within the face.  The injected fat can be discerned within the face from the normal anatomical layers within the face. This method is necessary when the cheeks are involved and there is asymmetry to the face.  Lastly, I would not recommend Kenalog injections or steroids of any kind.  Fat that is transferred achieves vascularity and lives as fat and becomes new lining tissue in your face.  It is an integral part of your face now and must be treated as such.
I hope this helps.  Good Luck

Robert Brueck, MD · Answer

You could proably have your doctor suction some of the fat out on the side that is bigger and since you are only 4 months out it will get smoother with time.

Steven Wallach, MD · Answer

it can be quite difficult to try to remove fat from the face as it often is placed in multiple layers. Best of luck.

Stacey Folk, MD · Answer

Dear t2s,Once you are a month out from your last steroid injection you should have repeat standardized photos taken and closely look at the results. Following a facial procedure it is common for someone to become more "hyper aware" and scrutinize their face in a way they never did before. You may find in looking at the photos that you, like most people, had asymmetry that became more apparent to you when swollen after your procedure. It may actually be that you need more on the small side to correct the problem rather than trying to atrophy fat with steroids on the big side. You may also need some around the "speed bump" to smooth the appearance. I prefer fillers in the commissures rather than fat to help with the down turned mouth, but fat lower in the marrionettes may also be helpful. I know the thought of putting more in sounds opposite of what you would expect, but it may be the solution. A very careful review of the photos and exam will help to figure out the solution.Fat transfers are very helpful, but not exact. They provide a more permanent solution for volume replacement, but often the firmness, exact needle placement, or lifting power of fillers is better than fat to certain areas. I would bet most of the surgeons talking about ways to remove fat have rarely done it because more harm can probably come of it. A few patients come to mind that I have treated where their perception of the problems were far different than their photos and my (and my staff's) observations. One very angry patient who took to the internet to express her views complaining of "lumps" that I created on her cheek that was merely a partial correction of a significantly more hollow cheek on one side that was pre-existing. She would have benefitted from a second smaller fat transfer just in this area. She was much more quiet when looking at the photos that showed this than she was at her keyboard. Another very lovely and sweet patient hated a candid photo that was taken of her with a strong smile because her upper cheeks looked too full, and surprisingly it was a little filler in the temples that made her happier. We all loved her result, but that one photo kind of ruined it for her. We did small things over time (short of steroids) to help because I would have hated to create a complication from trying to remove the small amount of fat she disliked only when scrunching her eyes tightly.I am not discounting that there may really be a problem here, but be open to a variety of solutions. Steroids can certainly atrophy tissue (including fat), but one has to be careful not to thin or effect the overlying skin. Lipo may work if there is a large amount of fat, but if the transferred fat was placed well in tiny amounts at various depths it could be difficult. Kybella has recently been released to melt fat in the sub-mental (double chin area) and with experience we my find it helpful to treat other areas of the face as well. There is a definite risk that nerves in the area would stop working for a few months after, so that is a downside. Using products off label like this takes a while before people have the guts to try it.Work closely with your surgeon, and you may want to get a couple of opinions if you have decided to take an aggressive approach. If people are trying to talk you out of it, listen.Best of luck,

Can you I reverse fat grafting in my cheeks?

Answers (7)

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