fat transfer . Beverly Hills, CA

Writing a separate review for fat grafting procedure I had with Dr. Motykie.
I originally underwent profile balancing with chin and rhinoplasty and have my review posted for those as well. He did an excellent job with the chin. The nose is an ongoing review .
I underwent fat grafting at the same time. The reason I underwent grafting was because I'm 24 and in the past year nearly all my baby fat dissipated for whatever reason. I ended up with a very sunken midface since I already had a concave midface due to a deficient maxilla. The sunk in look made me look tired and hagged and I wanted this area filled with fat.
On consultation I told dr Motykie I wanted to look rested and fix the sunken appearance I had. And also VERY subtly add some to my anterior cheekbomes and in particular my left one since it was assymetric to my right . I EXPLICITLY told him I did NOT want to be overfilled and he assured me he wouldn't. I also asked in regards to lumps etc. he also morphed more pictures to show me how the grafting would look but it all looked the same it was basically a picture of me with my midface blurred out using a blur tool on photoshop. Not very helpful.
I awoke from surgery swollen with huge cheeks. I figured it was normal swelling but by day 4-5 I started worrying and panicking about the enormous size of my cheeks despite my nose and chin decreasing in swelling but my cheeks staying huge. Dr. M told me at cast removal that my face would return to normal as swelling went down and I would look more like me after a couple of weeks. Well, the nightmare continued for an entire month and a half. My cheeks were enormous. I did not tell anyone I was having fat grafting I only told them I was getting a nose job and the ONLY thing that everyone would nose was my enormous cheeks and would all ask if I had cheek implants. I went through an identity crisis and had multiple breakdowns because I was completely unrecognizable to not only myself but to friends and family for nearly TWO months. As a young 24 year old who was generally considered attractive before, this has had a severe impact on my mental health and quality of life. I literally shut myself in for the entire month and a half and only went to work and home. It also did not become apparent to me until a month or so that he Injected fat ON TOP of my cheekbone under my eye. I did NOT want any fat added there. I did NOT want any fat detracting from my angular masculine cheekbones but that's precisely what he did. I NEVER had much fat on top of my cheekbones and neither does my MOM or other family members that have the same cheekbones I do. This added length on top of my cheekbones not only masked their masculine angularity but completely distorted my face making my midface area LONGER and undefined. Worst still, the fat on top of my cheekbone bunches up and distorts my smile completely burying my eyes completely. I am a happy person and always smile and laugh but I am now conscious of even doing that because it looks so UNNATURAL. I'll also add that the transfer is constantly puffy and since it covers all boney definition my eyes are left looking like a rag doll/puppet (i.e. No proper bone definition around the eye, just blended fatty area ). Also, the lumps are completely noticeable when I smile. You can see and feel "tracks" where the fat was placed. If you read up on grafting you will know that fat is inserted in a spaghetti noodle fashion with a bunch of little droplets lined up together in rows. The body encapsulates these and that's why you are left with lumps. You WILL have lumps it is not a risk , it's a REALITY. You WILL have contour irregularities. Nature does not form cheek/ soft tissue Ina "spaghetti" noddles fashion, having someone insert things in this fashion is Not natural and will be noticeable.
I am now exactly 2 months post op and although I look more like my old self my cheeks are still far too big for my face. Prior to grafting I already had high/strong prominent cheekbones . These were angular, well defined and masculine. Now they are huge, feminine and distorted when I smile. I AVOID pictures completely now, I am concious of smiling/laughing and I feel completely depressed and angry at myself for having ruined my face at such a young age.
I also can't help but question what kind of doctor would be so willing to inject so much fat into a young persons face given the knowledge that this procedure can be PERMANENT and will retain the properties of its donor site (i.e. Will grow if you gain weight, or may grow regardless of weight maintenance). Truly, given the facts at hand I don't know who in their right mind, much less a physician would take such course of action.
Given the following, what would YOU do:
- young patient, 24, male
- strong, masculine cheeks, "aesthetic" /in line with male attractiveness
- wants to look "refreshed" with fat grafting , particular attention to sunken midface
- fat graft may be permanent, patient will likely gain weight throughout life
-fat graft may be irreversible
Would you overfill? Would you add fat where it could be emasculating to a male patient? Would you disregard facial expressions prior to grafting? Would you even consider this patient for grafting or would you perhaps suggest other alternatives first before proceeding?
Sadly, Dr. M ended up overfilling me, emasculating me, and distorting my facial expressions. I cannot understand why any competent surgeon is still overfilling with fat grafting given the often irreversible nature of the procedure. I'm angry at myself for not doing my due diligence with this procedure and letting myself be misled by pretty pictures on the doctors website as well as the idea that a "celebrity doc" featured on various media would do a good job. I am also upset that not enough information was disclosed or clarified to me in regards to WHERE the injections would be . I was not even marked . All I was given was pretty photoshopped pictures. I was also not told this could disfigure / contort my facial expressions the way it did. Dr. m did not even take these into consideration. I was not told to smile or laugh to see what areas the grafting could affect. I was also not properly informed of the (overfilling) method the grafting would be done by other than technique: "through the mouth and under the muscle".
I reached out with my concerns to Dr. M's office and was told I had the option of RF treatments or kenalog injects at 2-3 months post. I was also peddled other non effective solutions from their spa like some infrared sauna to help "reduce the swelling" .I'm an out of town patient and I will be flying in for my 3 month post op and have requested kenalog injections at that time to reduce the volume and hope the fat atrophies though I'm nervous given prior feedback on forums and real self with this Dr. Motykie's prior botched/unhappy patients and his unprofessional behavior of not taking responsibility for fixing his work or promising patients a solution only to bail on them last minute. Adding to this, the story of Dr. M making a grab at Heidi montags Plastic surgeons' patient base immediately after he passed away in a wreck..
I will use this review to Detail my journey to now fix this fat graft overfill. I only hope that most of this either gets absorbed or the kenalog injections make it go away. Fat grafting can be an extremely costly nightmare to reverse so please please beware and do your due diligence if you are considering this procedure. Also, I would urge you to look elsewhere for fat grafting unless you want to risk being overfilled. Dr. M uses the Overfill approach so you are taking a gamble on your face should you retain a large amount of fat. Please be careful. I think this also highlights the fact that patient and Doctor communication is key and while a doctor might be young and have good technique or results at times, communication is paramount do avoiding botching or leaving your patients unhappy. I think although he produces some stellar results at times, there's still much learning /experience he must gain as a surgeon in regards to patient communication/bedside manner. Also, bad reviews/botched patients do highlight questionable ethics. Some doctors think it's unethical to be fat grafting/overfilling patients under 30/40 . I've seen some patients on his website that are 20 (!!) years old getting fat grafting. I think given his media appearances and behavior it might point to someone who is very early in their career and is trying to make a name for themselves: overbooking patients, botching some and shrugging them off, etc. also I've noticed some questionable reviews on here for Dr. Motykie and I know for sure that some of his staff or one of his colleagues in office has an account on here that reads his reviews or promotes his work. Nothing wrong with that but I just hope that they take into account that for transparency sake and for accountability purposes some of us can and will disclose every detail of our experience on forums like this , not to "bad mouth" the doctor but to genuinely help others . I think if a doc goes good work the reviews and results should speak for themselves. You can only live off a TV persona for so long before a next celebrity doc comes along. ..
Also - apologies for any typos as I typed my review on my iPhone.

Wel I'm about 2.5 months post fat graft now and the more the swelling subsides the more I realize this procedure accomplished a whole lot of nothing and caused so much more headache and problems. I'm furious that I paid for something that was absolutely unessecary, that I was not properly informed of what would be done and where, and that only caused issues that I did not have before.

The swelling has gone down and continues to go down I don't know if the aggressive massage and heavy exercising is helping but honestly my face still sinks in like before which was the whole reason I even considered this. The more the swelling subsides the more I notice that the areas I wanted addressed got hardly any fat put in and the bulk of the fat that was put in was in areas I never had much fat in naturally and I did not want any fat added. I had completely smooth contours undereye and over my cheekbone but now I get ugly puffy bulges there . My undereye has a ton of lumps I'm constantly having to smash to smooth out. I even have what appears to be malar bags/festoons over my cheekbones which I never had. I look puffy all the time under my eyes. In pictures it's horrendous I look like I weigh 300 lbs and my eyes look so squinted from the fat bunching up. My face just looks all kinds of wrong now. My cheekbones are now just masked under all the puffiness and fat. Horrible horrible horrible . Not worth the money, the problems, and the disfigurement/recovery time that you have to endure looking disgusting. If a doc ever tells you you willbe swollen for months from fat transfer you need to run, if a doc ever tells you he will overfill to account for fat atrophy you need to run, if he does not take into account your facial expressions or natural fat distribution you need to run, if he does not specify or mark where he will inject you need to run. Proper fat transfers are done progressively with small volumes and swelling should not be so prolonged and exaggerated. This procedure is completely worthless to be entirely honest . Stick to fillers. Not worth the risk or expense or problems. I'm just hoping most of this fat goes away in the ensuing months and that my skin returns to its persisting tone.

Forgot to add that he injected fat so high up my cheek in effort to create this " infra orbital rim augmentation" effect that the inner portion of my right cheekbone has about two pea sized lumps that go past the bone into the lower lid space and look like I have eye bags which I never had. Ive been trying so desperately to smash these two pea lumps with. I success because they're so mobile and in such a sensitive thin area. They are not decreasing in size. I've read that the undereye area is very difficult to address when fat graft goes wrong and the fat tends to stay because this area is so rich in blood supply so I'm desperate to have these lumps go down or go away otherwise I'm going to have big undereye bags at 24 years old and I do not want to have to undergo a lower kid blepharoplasty at such a young age to fix this mess. It's beyond me why a doc would even do this to someone my age. I didn't even have eye bags to begin with. My family has a flat cheek undereye area . I have friends/models that have pronounced undereye bone/orbital rim area and that is all BONE when they smile the fat/cheek does not go past this area into the eye. The doc tried to create this effect using FAT and I'm now left with undereye bags and distorted eyes when I smile from the fat moving up when I smile. I'll add that a prior surgeon I consulted who does bespoke/world reknkwn surgery did not want to touch my undereye area with rim implants because he said my skin was too thin and it would be visible so I don't know why my ps injected the fat there and worst still on my cheek that was NOT flat to begin with. What a nightmare .