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