Distorted my Best Feature (Fat Grafting Under Eyes)

Distorted my best feature (fat grafting under eyes)
In May of 2020 I went and had a consultation with Dr.Sadati about some hallowing in my tear troughs that had been bothering me for a number of years. I thought it made me look tired and under the wrong lighting a shadow would be cast, making the tear trough area very dark. I liked the idea of fat grafting because it was using fat from your own body (in contrast to artificial fillers). I liked the idea of it being permanent and low maintenance. Dr.Sadati sat down and took the time with me explaining how it wouldn’t be symmetrical to just do the under eye lids. He explained that the cheeks and temples should be done as well. He brought up how he’s an expert in the field of fat grafting, how he’s written articles and trains students on his technique. He was very nice, answered my questions and showed me some pictures of his amazing work. He didn’t have too many exclusive fat transfer pictures, in general the pictures were combo of face lifts with fat grafting. I met several of the girls in his office who had work by him and they all looked beautiful. I asked him what recovery was like for fat grafting and he said it was super easy and that I’d just have to deal with a little swelling for a few days. Afterwards, he gave me the time to go home and think about it. I later set up an appointment for the end of August of 2020 to have facial fat grafting.
The day of surgery, the doctor seemed a little hurried. He stuck his head in the door and basically said “ok, we’ll see you in the room,” referring to the OR. This made me uncomfortable and I asked him to be called back into the room. I asked him to please go over the procedure in detail to be sure we were on the same page. He grabbed a pen and started scribbling all over my face, seeming slightly irritated that I was asking questions. He reassured me in a cocky way that he has done well over 5,000 surgeries and that he knew exactly what he was doing. I probably should have left at that point, but thought my nerves were possibly making me hypersensitive to the situation. Andrea, his right hand woman did a great job of calming my nerves at that point. She was very upbeat and reassuring. She herself had work done by Dr.Sadati and looked amazing.
The surgery went well, I woke up from the surgery pain free but was a lot more swollen from the procedure than what was explained to me. At the initial consultation (prior to surgery) the doctor said I’d be “a little swollen,” I think his explanation was far from it. Over the next few days I took it easy, but noticed under the written discharge instructions that were thrown in my purse (no one even went over these instructions with me prior to the procedure) that he didn’t want me lifting for 2 weeks. I wish he would have gone over the discharge instructions with me at the initial consult back in May because I would have definitely not gone through with the procedure (I had 3 small kids 3 years old and younger/the doctor knew this). I had to scramble to find help for my kids. By around day 8 the swelling had come down considerably and I started to notice a lump emerge near my left tear duct, I tried calling his personal cel phone number that was left on the discharge instructions and I got a disconnected number. Just after that I called his office, got an answering service and left a message. The answering service called me back an hour later and told me to email him a picture to the doctor. I emailed him and he emailed back about an hour later that I should massage the ball in small circular motions with a qtip. I felt that the email was somewhat short answered and lacked a human voice that a patient would want to hear should something go wrong. The next few days I massaged the lump and it didn’t help bring down the size. As the days passed the swelling continued to go down and brought to surface an even larger lump under my left eye . I called his office and they had me come in. He came into the room, reassured me that everything was going to be fine. When he looked at my eye, he decided that he was going to give me a combination of 2 medications:Kybella and Kenalog. I’m a nurse and was familiar with Kenalog, but asked what Kybella was. His response was that it was going to help bring the lump down. I took his word for it and sat back in the chair and closed my eyes. I noticed he injected the lump a few times, by withdrawing the syringe and then reinserting it back into the lump a few times. After he was done injecting, he told me to go home and put ice on it and relax. The entire situation seemed off and not what I was expecting. When I got out into my car I looked into the mirror and noticed the entire area under my eye was full of fluid. In other words, he didn’t aim correctly for the lump and the fluid overfilled. I googled Kybella, and was directed straight to the Kybella website. The website itself states: Kybella destroys fat cells, the medication is only FDA approved for submental fat (double chin). If used outside of the submental region it has the potential to cause nerve injury, open sores (ulcers), damage and tissue cell-death (necrosis) around the injection side and a whole slew of other things.Within minutes I was furious and went back into the office to question the medication administration. The assistant put me in a back room and a few minutes later the doctor poked his head out the hall way with his mask off, gave me a blank, wide eyed stare. With his mouth full of food he asked in a cavalier tone if everything was ok. I let him know that I read from the Kybella website it’s drug warnings and wasn’t comfortable with what I read. He let me know that when he runs into fat lump issues he will sometimes resort to using Kybella and that he has used it several times. I asked specifically if he had used it under the eyes and he stated “yes.” He told me to calm down and go home to put ice on it. After I went home the entire area that he injected under my eye swelled up significantly. I later emailed him that night sending him a picture. He never replied back to me. A week later his MA (medical assistant) Maria replied back to me “swelling is normal.” I found it very odd that his medical assistant would reply back. It’s not within a MA’s scope of practice to administer medication, so how could she know what side effects to look out for? Dr.Sadati should not be micromanaging his staff who are not qualified to answer questions.
After that appointment I went to three oculoplastic surgeons in the area and told them my story. They were shocked by my story and said that they’d never consider using Kybella under the eyes because there’s too many nerves, muscles and blood vessels making the drug too high risk to use. I searched on Real Self the administration of Kybella being given in the tear trough, and was able to pull up well over 30 responses that said it wasn’t advised because of the potential for a multitude of complications. None of the doctors advised of giving off label usage around the eye. As the weeks went by a track mark and hallowing appeared as the swelling went down, it extended horizontally across the entire length of my tear trough, where the medication had been sitting for a few weeks. Roughly a 2-3 inch arched line carved out in my left tear trough/under eye area. I felt so sick to my stomach, knowing that it was the Kybella that had caused it. As the 2 month appointment rolled around, I thought about canceling the appointment because I no longer trusted this doctor. But I thought about it some more and as a nurse (patient advocate), thought it would be important for him to see the result of this medication so that he wouldn’t make this same mistake to future patients. During the appointment I had pictures taken by his assistant and he later walked in the room. I let him know that I wasn’t happy with the medication administration, let him know that it was considered dangerous by oculoplastic surgeons and that it ultimately resulted in a very large irregularity under my eye. He was unapologetic and started rationalizing to me that he’s done well over 5,000 surgeries. He looked at me straight in the eyes and told me that the “track mark was there before the surgery.” I told him it was never there and asked him to show me on my before picture. He pointed at my before picture, started fumbling over words and pointed at a region on my eye that had no track mark on it, and said “see look it’s right there.” I corrected him letting him know that it wasn’t. I also let him know that the lump under my left eye was still there and he just gave me a blank stare and said “no it’s not.” The assistant that was in there that day looked just as baffled as I was. At that point I realized this guy was totally unethical and slimy. I had nothing further to say to him. I asked for my records and left (never to see him again).
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A nurses interpretation:
I graduated with my Bachelor of Science degree in Nursing and research. I’ve been a practicing RN for 16 years at some of the best hospitals in the nation. I’m well aware of what went on and how to interpret my case. To interpret this situation a little better to the nonmedical person, Kybella was given OFF LABEL. Medications are sometimes given off label, but when they are, the doctor/nurse will explain that it’s being given OFF LABEL, give full disclosure of potential HARMFUL SIDE EFFECTS and get the patient's written consent. The doctor did none of these things. When I later brought it to his attention he rationalized it by saying, people were giving botox off label for a number of years before it was approved for other places. “Off label” is not a loose knit, umbrella term to be thrown around lightly for a medication such as Kybella. If it were ever to receive FDA approval for use on places outside of submental fat, I’m certain that there would be a black box label warning attached to it because of its potential to cause- NECROSIS, NERVE DAMAGE AND BLINDNESS. The doctor can downplay this situation all he wants by saying he just administered a “micro dose” but the one of the many questions that needs to be asked is “did the Kybella have a harmful outcome to the patient?” Yes- THE KYBELLA ULTIMATELY DISTROYED THE FAT IN MY TEAR TOUGH, LEAVING MY EYELID HALLOW AND DEFORMED. He failed to get written consent for what is considered a procedure (administration of Kybella). In the records I obtained from Sadati’s office, he charted under the 2 month follow up appointment that the “lump is resolved.” His 2 month post op pictures show the lump is still there. My personal pictures showed and still showed the lump. His pictures use a lot of good lighting and a flash that mute out the lump and the track mark left by the Kybella. Even with the good lighting a portion of the lump can be seen. The track mark cannot be seen on his after photo. I have several hundred before and after pictures that show the track mark wasn't there before the surgery and it’s there post Kybella injection. I feel awkward posting these pictures being that I live in this zip code and will likely be recognized by some people. At the same time I would feel horrible if someone else went through what I did, or potentially encountered something worse (blindness, necrosis or nerve injury).
Would I recommend this doctor?:
I hope this review isn’t coming across as totally shaming Dr.Sadati. He DOES do beautiful work outside of fat grafting under the eyes. As far as the under eye fat grafting procedure itself, I can’t unrecommend this procedure enough. I researched this procedure for years and was aware of the potential complications. The key element for a successful procedure is injection technique. This was Dr.Sadati’s signature procedure that he’s famous for and has written articles on. Considering it went totally wrong, it’s safe to assume his margin for error is large. Not ideal when dealing with faces. This was my first ever cosmetic procedure and likely my last (with the exception of a revision I’ll need). My goal was to preserve my best feature, my eyes. Everyone has always loved my emerald green spanish eyes, a replica of my mothers. I just wanted to look rested and refreshed. At the time of the fat grafting procedure my twins were 13 months old, my toddler 3 years old and my tween 11, needless to say I was exhausted. I was also in the midst of working the front lines as a nurse and dealing with major extended family stressors. My stress and workload was over the top. I wasn’t getting good sleep. I wish I could go back in time and just tell myself to get some actual SLEEP, that probably would have fixed a good portion of my issue I was seeing at the time. As for the fat grafting on the better eye, it has a lot of irregularities to it.There are a lot of mini dents that can be somewhat seen in the after picture but actually look worse in person. It looks like someone took an icepick to my eyes and chipped away groves, dents and irregularities (if you don’t see the pattern google “lumps bumps and contour irregularities under eye fat grafting”).
The left side is asymmetrical to the right, because of the Kybella. Not much fat retained, I notice my left cheek is slightly more deflated than before the procedure (from the Kybella). In general all these irregularities are not noticeable unless you're about 2 feet away from me. My cheeks and temple area, I don’t notice any difference. So basically I only have distortions that remain noticeable in my lower eyelids. They aren’t very noticeable unless I point them out or people get close to me. People reading this may think I’m making a big deal out of nothing, but my eyelids were literally flawless prior to this procedure (I just lacked volume). I didn’t pay 7K to have irregularities injected into my lower eyelids. In addition to fat grafting I had CO2 laser done to treat fine lines. It did absolutely nothing except leave me with hyperpigmentation that I’m still struggling with 9 months post procedure.The hyperpigmentation is muted out in the picture by the good lighting/camera flash, but you can somewhat see redness from the Triluma cream he prescribed that I was on for months. Originally I asked him if CO2 laser was right for me considering my Spanish background and he reassured me that it was fine. Aside from all this, I don’t think he has the true reasoning skills of a doctor in terms of safety. It’s basic common sense that fluid disperses and when it does disperse the medication (Kybella) will do what it’s labeled to….. destroy fat. If he was willing to inject something as caustic as Kybella under my eye, chances are he’s overlooking safety in other areas of his practice. When doctors have dared to give Kybella off label it’s generally in a stubborn fatty pocket on the body (abdomen, love rolls, lower back, above knees), NOT the face and definitely NOT THE EYES!!
Lastly, he’s dishonest- the follow up note stated “the lump has resolved.” Also, without skipping a beat he told me that the track mark was “there before.” This tells me that this is his go to line and that he’s likely told other patients this in the past. He’s very quick to destroy the patient/doctor relationship and he could care less because he knows the next out of town instagram follower is waiting to pay outrageous amounts of money to this greedy man. He’s someone completely different on camera/instagram than he is in real life. When things go wrong he makes zero effort to resolve anything. There are other doctors in this zip code with actual Ivy league degrees who will charge less and do beautiful, HONEST work. Looking through the lens of perspective, someone who markets themselves as hard as Kevin Sadati on social media/their website should be a big red flag.
In terms of prognosis- I’ve had 5 oculoplastic consultations to date. All of them are shocked by Kybella being injected into my tear trough and said they do not recommend the administration of even a micro dose around the eyes. All of them say that they do not recommend fat grafting in the tear trough area. They’re saying that fillers will probably be my best option to address the hallowing in the left eye and all the mini dents/irregularities. I had a lead doctor in Beverlly Hills who has been on the TV show “Botched” tell me that the fat lump was injected with poor technique, way too superficially into the muscle (yes, by Dr.Sadati) and would involve a lot of risks that I’d need to consider before stepping into surgery. There are a lot of nerves within the area of muscle that was injected into that control blinking. Incisions in the muscle could damage the nerves involved with blinking. As for the 3 inch track mark under my eye left by Kybella, the Beverly Hills/ Botched doctor told me that he’s never seen anything like it in his 24 years of practice and wouldn’t feel comfortable attempting to revise it. He also said that I could probably find a doctor that would attempt the revision but that I likely wouldn’t be happy with the end result. Other doctors have told me that Kybella has the potential to cause scar tissue to form. It’s difficult to operate on scar tissue as well, adding yet another variable into my equation.
In the end, I wish I would have known about oculoplastic surgeons. It wasn’t even a specialty that I knew existed until I became distorted. After dealing with Dr.Sadati, I can say without a shadow of a doubt that he has no business working on eyes. I wish I would have paid more attention to Sadati’s photos, there were never any close up pictures of eyes. If you look up any oculoplastic surgeons instagram photos you’ll see what I mean (my favorites: Kami Parsa, Jeffrey Joseph and Guy Massry). Almost all oculoplastic surgeons will not inject fat into the tear trough area because of catastrophic situations like mine. Only trust your eyes to an oculoplastic surgeon.
To Dr.Sadati-
My only question to you is where are you obtaining your educational resources? Both Allergon and the FDA have no safety studies on Kybella use around the eyes. I wasn’t able to find any safety studies with my searches of peer reviewed articles. If there are any such studies can you please reply and attach the article here?