Why Do I Have Uneven Cheeks After Fat Transfers and Face Lift? (photo)

The unevenness in your face maybe, do to uneven placement of fat on your face. After 7 months, do not  expect that the results would change to much, and as to the treatment new fat injections and probably some fat suction is recommened.

     It is difficult to make any suggestions from this one photo.  If you posted photos of both sides of your face as well as preoperative photos more helpful suggestions could be made.  Fat grafting to depressed areas is reasonable.  Find a plastic surgeon with ELITE credentials who does hundreds of facelifts and fat transfers each year.  Kenneth Hughes, MD Los Angeles, CA

Fat grafting is not an exact science and the final results depend on many variables, including the quality of the fat harvested, the technique used to process and transfer it, as well as the area it is being placed. Over time the results have improved but not perfected. The areas which are uneven I believe can be treated with either further grafting or off the shelf fillers. Discuss your concerns with your surgeon who I bet will want to help you, and probably give you the best deal. Good luck.

As others have stated, the asymmetries are most likely related to the survival and lack thereof the fat grafts  Although the technique has strong proponents, my preference is to use Sculptra in shaping facial volume in conjunction with a facelift.  Sculptra offers gradual facial volume changes that is safe and predictable  without need for a donor site. Both fat transfer and Sculptra require repeat procedures in order to accomplish the desired result.

At 7 months, what fat is living will remain alive, but the fat that does not survive initially can still be palpable and visible as firm or irregular areas (scar fibrosis). As others have stated, fat grafts to the face can be unpredictable and not 100% of the transferred fat survives; thus, irregularities can indeed occur. Technique is critical for best "take" and results, but even with the best possible procedural details this kind of outcome can be seen in some cases.

At this point, very judicious steroid injection into firm raised or "lumpy" areas can help them soften and flatten, but where there is depression or indentation in the cheeks, further small-volume fat grafting (using low-vacuum syringe harvest and tunneling graft technique) can improve your results. I also assume you have undergone maximum external ultrasound and gentle massage treatments to soften the subcutaneous scar fibrosis (firm or lumpy areas) during the past few months. If not, this could provide additional subtle improvements, though I too feel you will need additional fat transfers for improved evenness. Best wishes! Dr. Tholen

Thank you for this great question. Fat grafting can be a great treatment, particularly when it is paired with other techniques like a facelift. The reality is, however, that not all grafts will "take" (survive), and this can lead to some asymmetry in the result. An additional session of fat grafting, after an appropriate amount of time allowed for healing from your operation, will generally help. Having a open conversation with your surgeon is essential during this process. Best of luck!

Fat grafting has a degree of unpredictability. Asymmetries after grafting are not uncommon. Generally this is dealt with by re-grafting areas that are relatively deficient.

Micro fat grafting helps ensure a smooth contour md avoids any palpable fat necrosis. If you had micro fat grafting done, it’s possible you had variable resorption, in which case more can added to even it out. It’s hard to say from photographs alone

Hello Corbarlin,

Thank you for the question and the photo.  The irregularities that you show can be from the face lift, the fat grafting, or both.  If the irregularities were there from either the beginning or soon thereafter I would suspect that they are a result of the face lift.  If they appeared much later in the recovery they can be from the fat grafting alone or in combination with the face lift.  What needs to be done depends on what improvements are intended.  If additional tightening or other face lift type procedures are needed a revision face lift will likely help correct the issues.

All the best,

Dr. Remus Repta

I ask my patients to wait 6 months before making a final determination, as autologous fat grafting does not survive 100%, and I generally slightly over-correct because of this.  I feel that it takes approximately  6 months for everything to even-out and if, indeed, there are asymmetries, I can address them at that time.