Absolutely Fabulous Facial Fat Transfer at TMB

I have spent a lot of time on realself, which has...

I have spent a lot of time on realself, which has proved to be an invaluable tool for me. Although realself has aided me to research doctors and procedures, most of all it prepared me, mentally and emotionally, for my facial fat transfer (FFT). Reading about people's visceral experiences is what finally convinced me that this procedure was worth the risks involved.

I have decided to provide online parts of my personal diary, which I amended to detail my experience, this may also be posted online as a blog, so as to aid others examining the pros and cons of the procedure. My account is prolix because it was intended as a cathartic exercise initially, not a review. It is supposed to be humorous too. As it is so long and only for those that truly seek detail, I have add review-type parts, useful information on supplements and tried to break the information down into sections and subsections for those wanting to skim-read.

For those patient enough to read this, they might find something of note. I have found that those reviews that are impersonal and of a few lines, are not very rewarding nor useful. Sometimes even one wonders if they are marketing efforts. Whereas those reviewers and bloggers who go into fine details provide rich information and a personal touch that make their genuine experiences insightful, helpful and easy to relate to.

There are few photos as I prefer to protect my personal privacy.

PREFACE:
I decided to investigate facial micro fat grafting following a negative experience with restylane perlane in my nasolabial folds.
WHY I WANTED SURGERY:
I feel that my NL folds are what ages me the most. I am 35 and feel that they are pronounced. Aging is of course inevitable however my NLs have been aggravated due to various factors. Firstly, during my teens and early twenties I was a daily smoker. I am now staunchly against this habit but in my early twenties I lived on the Continent, smoking was not only très à la mode but a key tool in socialising. Secondly, I spent many years playing a woodwind instrument. I have a love-hate relationship with the instrument. It sounds so alluring however the vain part of me despises what the hours of intense facial contraction do to my NL folds. I still would like to discuss this with my Doctor.

Thirdly, I had a large quantity of liquid silicone injected in my lips about 12 years ago in Europe. The weight of this material has surely dragged down my face. I try not to dwell in regret. My husband finds my lips luscious so this is consolation indeed. However injectable liquid silicone is not safe and was banned by the FDA in 1991 and with reason, it does not dissolve and can lead to complications. It is my hope to have the silicone removed one day, but one thing at a time. It seems the procedure is very difficult, requiring meticulous surgical resection which is risky. Removal of silicone may cause destruction of the normal lip contour and function. I would like to get the silicone replaced by fat but have read that due to the high mobility of the lips, it can disappear very fast. If I am happy with the outcome of this procedure I would definitely envisage discussing this with my plastic surgeon in the future.

Finally, for the last 10 years I was involved in very high intensity sports, training at an extreme level. This means I am mostly all muscle, possess very little body fat which entails my face has become gaunt rather rapidly. A hypermetabolism due to my exercise regime makes keeping weight on arduous.

FRIGHTENING EXPERIENCE WITH RESTYLANE
-THE INJECTION
I went to a plastic surgeon of good repute to discuss having my NL folds reduced with fillers. I chose this surgeon based on a friend's recommendation and good reviews on ratemds. I explained to this PS that I had reservations about using fillers since I have numerous allergies, my mast cells behave badly. I am a celiac, allergic to shellfish, penicillin, cats, pollen, iodine and more. I also informed him that I had silicone in my lips. I should certainly have proceeded with more caution but decided to go ahead with restylane, perlane. I later read on realself, that cross-reactivity can occur between some fillers. The Doctor told me most people have no reaction to hyaluronic-acid based fillers and the only way to find out was to try. Unfortunately I am not most people. I truly wish I had opted for facial fat grafting (FFT) at that time. But one cannot press rewind on life's trajectory.

-MOTTLED SKIN AND OTHER MAYHEM
After a couple of weeks following the injection of 3 vials I noted that my eyes were often tearing, I had headaches, pain in my face where the fillers were and my skin began to appear red and mottled around the injection sites and very sensitive. I started taking some anti-histamines which seemed to help. I went to see the PS again, he told me to give the sites some more time to settle and keep taking the anti-histamines. I did so but continued to experience strange reactions. A week or so later, I rose from bed to find a hard cyst the size of a dime in my NL fold. I called the PS who was able to see me that same day. He was professional, promptly dissolving the lump with hyaluronidase at no charge to me. However the problems persisted. A week later, the filler started to feel very hard and swollen under my skin. One day I woke up and the left side of my face was swollen. (I would later develop skin problems on that same side). I called the PS's office again, to have the fillers removed completely but was told he was away and was advised to wait a week or so until he was back. I called some other cosmetic surgeons in my area but when I asked about removing fillers, I was turned away since they told me that they only removed fillers they had injected themselves. I then called a few other locations but no one was able to remove the fillers the same day, many were on summer holiday or fully booked, I had to wait for at least a week I was told.

I decided to go to a dermatologist since one was available the same day, especially as my skin was transforming beneath my eyes, hardened, mottled and rough, especially around and above my NL folds. The dermatologist prescribed me antibiotics and fairly high dose prednisone. The prednisone worked fast. Within a few days my face was no longer swollen. Albeit, my skin continued to change. I used to have what my mother-in-law called peaches-and-cream skin, however I started to develop constant pustules and papules on my cheeks, red marks, rough skin and blemishes on my chin which I never had before. My skin seemed so sensitive to everything. In particular I noted an irritated patch of skin on my left cheek, which seemed red and bumpy. I went back to the dermatologist the following week,who told me to my absolute horror that I now had rosacea and prescribed me some creams to calm my skin. I have never had skin issues before so was devastated to be diagnosed with a life-long skin condition. I asked him whether the prednisone or the fillers might have caused the rosacea and the issues I seemed to suddenly have experienced with my skin. The dermatologist said it was not impossible, so he advised I wean myself slowly off this medicine to see if my skin improved. I was glad to do so as I had many side effects from the prednisone including hair loss, waking up at 3am nightly plus more. But even after tapering off the prednisone the rosacea has persisted. The Doctor told me various medications can be tried, long term antibiotics which I know my stomach might be adverse to or 10-20mg accutane, either way best to wait until after surgery before exploring these options.

I since read a study that conjectures that mast cells activation may cause rosacea. It is my hypothesis that for some reason the fillers in my NLS caused mast cell activation leading to this awful rosacea. The worst of the rosacea is on the side of my face that kept swelling up. I would therefore caution that if you are prone to allergies, be very careful about using fillers. My P.S. later returned from holiday and I requested he remove all of the filler. I did not berate him, ultimately it was my decision to have fillers but I wish he had not been so convincing about arguing that very few people react to restylane and that trying was the best way to find out. In fact his soft sell skills entailed that after this experience I was put off by PSs who opt for such behaviour. It disempowers the patient. More on that below. Meanwhile, at this point, being used to the look of the filler in my face, having my NL folds return plus having to deal with bad skin really impinged on my self-confidence, I decided to seriously investigate FFT.

CHOOSING A PLASTIC SURGEON:

By the time I met Doctor Trevor Born I had seen numerous plastic surgeons. I honestly had very few questions for him, since I had heard the same answers repeatedly and was well aware of the risks involved. My primary concerns were further skin damage and lack of adipose tissue. The PSs I had seen prior to meeting Doctor Born, had advised that the FFT would not cause further problems to the areas of my face and skin adversely affected by mast cell activation caused by the restylane, as described above. In fact one PS explained that the fat aspirated from harvest sites contains substances, which I researched called adipose derived stem cells and regenerative cells, that can potentially improve the condition of one's skin. I can but hope. I truly believe the restylane destroyed my previously unmarred skin.
Most PSs were not concerned about adipose tissue and told me that some can always be harvested, one suggested the area around my knee. When I later checked that area, I could only feel skin so I crossed that surgeon off my list.

I initially had a long index of plastic surgeons to choose from but gradually the list whittled away to one surgeon. I inquired about plastic surgeons online and in Toronto. Doctor Born has acquired an excellent reputation. He has been performing FFT longer than most other Toronto-based surgeons. He was recommended to me at my dermatologist's office. I was also recommended another surgeon. However research online, on ratemds and realself, evinced that the latter had a mixed track record, some rather frightening reviews made me stay away from that surgeon. Secondly, I was in touch with various realself members of the same demographic as myself, one of whom recommended Doctor Born as she had successfully undergone FFT with him. Another surgeon was also initially recommended to me by a realself member. This Toronto-based surgeon offers fat grafting at comparatively cheap rates but I decided not to opt for him when the realself member later told me her results were modest in the end and that she wished he had placed fat in her forehead area, not just cheek and NL fold area.

I scratched yet another plastic surgeon off my list after I was sent a private message warning me that one member and her best friend had had a bad experience with a young plastic surgeon who left them with lumpy skin. I also received a note of caution about a surgeon whose office entourage were highly unprofessional and made fun of patients behind their back. Whether or not that surgeon did a good job is not at question, apparently his staff are incapable of professionalism.

I met with my remaining list. Many of those surgeons told me that they had a lot of experience with FFT but yet they had no photos to show. I understood that for privacy reasons they might not display these on their website however hoped that they would show them to me in person, which they did not. Given that they had no evidence of their work, I had to doubt the veracity of their claims.

Some other surgeons gave me unclear answers, hesitating about their replies to questions such as how long they had been performing FFT and how many times they had undertaken the procedure in the last year. 'I do it all the time,' or 'surgeons have been performing FFT for years now' is not what I wanted to hear, that is not what I asked! Yet others gave me odd answers. When I asked one surgeon what one of the main risks was he replied 'body dysmorphic disorder', which I found rather odd. I also got very tired of the hard sell approach of many of the surgeons I met, who I felt were literally cajoling me into choosing them. Once bitten twice shy. Some also feigned too much interest in my personal life, it did not seem genuine but an attempt to endear me. Others tried to play the artist and tell me that they had a unique eye as they painted, sculpted etc.

-LONG TERM PLAN
I did look into surgeons performing FFT in the USA. There are numerous experienced surgeons there but I decided I do not want the hassle of flights and the possible predicament of a long-distance imbroglio if anything goes wrong. I concluded that since I plan to live in Canada for a while, I needed to find a reliable surgeon in Canada that I can trust, not just for now, but as long term investment to as we say in French ' preserver le capital beauté'. I will only need more work as I get older and I really want to look into having the silicone fillers removed from my lips.

-DOCTOR TREVOR BORN
I have to confess to finding the wait at Doctor Born's office inexorably long however once I finally managed to sit down with the chap I really enjoyed his no nonsense approach. I also found his staff to be accommodating, congenial and professional.
There are multiple reasons I decided to choose Doctor Born. I will summarise here and then detail below. Doctor Born's experience, expertise, rational approach, brutal honesty and professionalism plus his staff's competence and civility. Andrea, the surgical coordinator has been efficient and patient since the outset, providing me with pricing and any other details I requested about the surgery.

TMB EXPERIENCE:

Doctor Born has a proven track record. He has more FFT photos on his website than any other surgeon I encountered in Canada. Personal communication from one of his FFT patients on realself.com also convinced me of his expertise, plus the endorsement from my dermatologist's office. His multiple recommendations on Linkedin attest to the fact that his patients seem willing to publicly commend him.
During our first appointment he displayed immediate lucidity plus a methodical and rational approach, which I really appreciated after all the plastic surgeon salesmen I had encountered!

Doctor Born did not try to peddle his procedure, did not embroider his answers, he just replied coolly to my questions. I did not at any point feel pressured into thinking he was my only choice, nor feel that he was trying to persuade me to have the surgery, thereby leaving the decision entirely in my hands. He just gave me the facts. He also did not try to play the creative card on me. Although it is very nice to meet charming surgeons who assure one of their artistic predilections, if something goes wrong on the operating table I would rather have a rational, cool-headed PS with numerous years of experience in charge of things, than a hot-headed 'artiste'.

When I told Doctor Born of my desire for NL filling, he immediately told me that I would rejuvenate my appearance dramatically by adding fat to the area beneath and around my eye, plus in the temple. When I asked him if this was really necessary, again he did not pressure me but left the choice in my own hands. Most plastic surgeons, when I told them that I wanted NL fat filling, immediately acquiesced but made no insightful suggestions. When I inquired what specific areas should also be filled in they took a while to think and pointed out obvious areas like my eye hollows. However Doctor Born's rapid suggestion suggested to me that he had already determined what my face would require from the second he laid eyes on me. I appreciate a man with a vision and a plan. He obviously has a keen eye.
Doctor Born was very professional in handling the fat analysis part of our appointment. It is important to feel comfortable with one's PS. He made me put a gown on over my bra and knickers, then examined my body to see which areas he could harvest fat from. Although nudity is our natural state, civilisation and culture have of course rendered it taboo and taboo is necessary, as Claude Lévi-Strauss has commented, for the sanity and well-being of our species! Being semi-naked in front of stranger can feel awkward. I had previously visited another surgeon who had made me feel very uneasy with his rather leery physical exam and made me think I would not want to be unconscious on his operating table. A surgeon should have respect for his patient.

Doctor Born did not hesitate to tell me that I needed to put on weight in order to have a successful result. I was initially a little affronted by this comment, given that my exercise regime is highly intense I did not at first comprehend his suggestion as my only goal has been to be as physically fit and strong as possible. Later, after some reflection, I appreciated Doctor Born's frankness. No other surgeon had highlighted as he did, the vital importance of this in my case. This finalised my decision to opt for Doctor Born. He pointed out this necessity to ensure my satisfaction with the outcome and was telling me this for my own good. I needed a voice of reason.

Lastly, Doctor Born's appearance convinced me that he has a good eye for aesthetics and is a perfectionist. They say you can't judge a book by its cover but I feel one can certainly evaluate the work of some PSs by looking at their face. One may presume that many plastic surgeons practice their work on themselves. I met a couple of PSs whose somewhat odd appearances attested to the latter in the worst of ways. Overly botoxed brows replete with preternaturally arched eyebrows in faces puffy with fillers like gluttonous chipmunks dissuaded me from selecting those persons as my FFT surgeon. Such an appearance in a PS concerns me. I extrapolated that these individuals were more focused on erasing every wrinkle as opposed to creating a natural, graceful look. Doctor Born has a pleasant, balanced appearance.

SECOND MEETING WITH DOCTOR BORN:
I met with Doctor Born once more before my surgery. This was following the removal of the restylane. He ensured that it was fully dissolved by examining my face. He also took a look at my love handles to see if I was putting on the fat required for a successful operation. He was happy with my progress.
I reiterated to Doctor Born the importance of reducing my NL folds. Of course, Doctor Born was the voice of reason, as he has been since the start and which is why I chose him. He told me that having met a well-known Hollywood actress in person at some fancy 'do' in NY, he had observed that her NL folds had a very odd appearance particularly when smiling because they had been over-filled and that he did not want to create the same awkward aesthetic for me. Apparently this actress's airbrushed photos systematically camouflage this fact.

PRE-OP FATTENING DIET AND SUPPLEMENTS:

-DIET
As mentioned, at my initial appointment Doctor Born convinced me that I needed to fatten up prior to surgery. I had about 5 weeks to do so. I stopped exercising, taking taxis or the car everywhere to minimise burning calories walking. I refused to walk up stairs and took the lift every time. I began to eat very fatty foods and lots of carbs, eating on a very strict schedule, every two hours, 4 large meals and 2 fatty snacks daily. I found some easy ways to increase my daily intake of calories, for example, I incorporated a whole can of full fat coconut milk into my daily shake. One can contains over 1300 calories and is loaded with fat, over 225% of one's daily needs. Sometimes if I had a busy day and felt that I had burned too much energy I consumed 2 cans of coconut milk in two sittings. I also put large amounts of butter on everything that I ate and had sugary drinks with most meals. I used myfitnesspal.com to keep track of my calories, with a goal of over 4,000 calories daily. I even googled the sumo-wrestler diet to inspire myself! I have to say my skin started to look really bad from eating a lot of very rich food. If the restylane had already transformed it, the fatty fried foods did me no favours at all. I think my organs had a hard time filtering out all the nonsense I was eating. It was not easy. Sometimes I felt rather nauseated from chugging down so much food.

-SUPPLEMENTS
Doctor Born sells pre-op supplements however since I possess a plethora of vitamins I decided to concoct my own regimen. I was told by Andrea to avoid fish oil and vitamin E in order to minimise my bruising.
I took the following supplements: Vitamin C+ Quercetin (the Twinlabs formula which is high quality), zinc, vitamin B complex, High Vitamin Butter Oil (for the vitamin K which is excellent for bruising), probiotics, magnesium, Great Lakes collagen (excellent amino acid profile) and trace mineral drops.
I also took homeopathic arnica prior to the operation.

On the healthy side of things I decided to cook my fatty meals, high carb meals with foods containing: luteolin, rutin, quercetin and other bioflavinoids which help with bruising and inflammation. I drank a freshly made apple juice daily for the quercetin and rutin content, with added carrots for vitamin A and Acai. Other good sources of quercetin that I ate: dill, blueberries, chives, red onions, tarragon, celery and broccoli. I also seasoned my food with thyme and rosemary, rich in luteolin.

MENTAL, PHYSICAL AND METAPHYSICAL PREPARATION:
The physical preparation was easy, it entailed gorging myself on fatty foods, doing the blood work that Doctor Born had requested and not going to the gym. The mental and metaphysical preparation involved readying my mind and being. I perused as many written reviews, recovery accounts, blogs, vlogs of FFT as I could on realself, youtube and elsewhere. This readied me for any potential pain, made me aware of how much swelling might occur and how long recovery might take plus more.

-TO FFT OR NOT TO FFT, THAT IS THE QUESTION
I believe that we are mind, body and soul. I had to spend time cogitating on why I was doing the fat transfer and whether I felt comfortable with this at a deeper existential level. I had already gone through this with the fillers and then decided I needed to have a good think again as the price was quadrupled, the price to satisfy my ego! At heart I am an academic and very happy in my introspective world of books, writing etc. I would like to think that I could immerse myself so deeply in that cosmos that my physical imperfections, especially relating to ageing would not concern me. However ultimately, every time I remove my nose from a book, I have to acknowledge that we live in a material world. We have no choice but to experience our lives on a physical plane in a vessel that can sometimes fall short of our expectations. One part of me felt very guilty for even envisaging spending so much money on my physical appearance. I have travelled extensively in Africa where I have experienced children fight over my empty plastic water bottle or a ball point pen. The money I spent on my procedure could feed their mouths for a year. It is sometimes hard in a world of such monetary disparity to justify one's choices. I have spent a lot of time improving my mind through study, improving my body through sports and wise nutritional choices. I have attempted to expand my soul through meditation and introspection. I had to wonder whether opting for the fat transfer negated the latter. On the other hand perhaps I should not judge myself for wanting to be beautiful. After all, it is not as if I am spending my money on Kalashnikovs or snuff films which would add to the darkness of our planet. I am not Gautama Buddha and able to divorce myself from my corporeal self however. Perhaps this makes me a superficial person but so far no amount of meditation or cogitation has been able to dislodge the trepidation I have about becoming a dowdy old maid. Perhaps I am experiencing a post-modern, North-American version of Baudelaire's 'Spleen de Paris'. I actually can arrive at no conclusion on the subject. Before the operation I sat down with the husband and we chose a charity for me to donate some money to.

GHASTLY PRE-OP FLU:
I spoke to Andrea, the surgical coordinator and Yolanda, the nurse, prior to my op. I told them that I was very concerned as I had an awful flu, a fever and a very sore throat that commenced 5 days prior to my surgery. Yolanda told me unless I was very ill and still had a fever on the day of my surgery, I should be able to go ahead since I had chosen twilight sedation not general anesthetic.
When I first fell ill I decided that very night to take some antibiotics in case it was bacterial but I knew it was just as likely viral. I really did not want to have to cancel my surgery. The antibiotics really upset my stomach and made me much less hungry. I was very worried about this as I had spent time ensuring I was eating significant amounts of food so as to have body fat to harvest. I did not want to lose my precious gains.
I had a fever for about 3 days. I decided to have a sleep marathon to allow my body to heal. I slept about 5 hours every day and 10 hours at night, only waking to eat. Luckily the day before my surgery my fever broke and I felt much better.

OPERATION:
Andrea called me the day before my surgery to remind me to shower and wash my hair in the morning, not to put on any lotions or make-up and then to don comfortable clothing. My surgery was at noon. Andrea advised me not to eat nor drink anything prior to surgery. I was allowed to eat something light and drink a little water, but only 6 hours beforehand. I chose to eat a big meal and drink lots of water the night before. I initially slept very fitfully, probably because I had been sleeping so much and was nervous. As I had been so ill, I chose to sleep until literally a couple of hours before I had to leave.
It was hard to leave the house without make up! I looked and felt absolutely bedraggled after being ill. I had planned to rest and pamper myself before the surgery, do some superficial maintenance (like get waxed, have a facial) so I need not worry about it post surgery as I knew I would need to rest. I also had to cancel my acupuncture appointment the day before, which normally proves very calming and restorative. I won't even go into the state of my appearance after all the fatty food and flu!

The whole experience was very seamless once I entered the surgical suites. I have to admit to it being a little surreal, no doubt because of the drugs. I arrived and sat in the waiting room until the nurse came to get me. I was quite amused by the carpeting that leads to the operating area which added to the surrealism. It looked like red and black tiger print. I imagined that something similar might grace the artist formerly known as Prince's lover's boudoir. The nurse came to fetch me and escorted me to a changing room with a locker in it. I put on the garb provided: a hospital gown and a plush white dressing gown with some slippers. The soft dressing gown was a very nice touch. Well done TMB.

I was then taken to an area close to the operating theatre, to await my surgery. I had my own private curtained area with a hospital bed that had a lovely warm heated blanket. A kind, motherly nurse made me sign a rather scary consent form that featured some possible complications that I did not even want to think about. After that the nurse took my blood pressure, which I warned her is always low, and my temperature. Luckily all signs of the fever were gone. She fed me some pills that she told me were for pain and asked if I wanted an ativan to calm me. I said no. I knew Doctor Born would come to see me prior to surgery and I did not want to be non compos mentis.

The nurse kept coming in to talk to me and see if I was alright, she made me feel very safe. I forgot about how sick I had been and bedraggled I was. Instead I focused on quiet meditative breathing. It was very quiet. I occasionally heard a low moan from the lady in the curtained section along from mine but I heard the nurse going in to check on her frequently and cooing soothing things to her. That made me feel reassured.

Doctor Born came to see me. I felt very nervous as I knew surgery would commence soon. He did not try to crack any jokes or make cheery conversation as Doctors sometimes do. I appreciated that as I was not in the mood. He was calm and serious, as usual. He drew some markings on my face outlining where he would place the fat. I knew I could ask for a mirror to view his handiwork but decided not to, I did not want to see my face. He also examined the fat harvesting areas and drew circles on those. I reminded him for the umpteenth time to focus on eliminating the NL folds. Patiently, Doctor Born explained to me for the umpteenth time that if he over-filled them I would look preternatural. Shortly after the nurse led me to the operating room. I lay down on the operating bed. The nurse put an IV in my arm and I really don't remember anything else.

-DEAD DUCKS
I woke up feeling blissful and with no pain at all. Whatever drugs I was given really took me to a xanadu of euphoria! I don't think I've been that relaxed and blissful in a long time. The nurse kept coming to check on me and asked if I had pain or if I wanted her to call my husband who was due to collect me. I told her that I felt fine and that I wanted to sleep more. I wish I remember her name but I was quite drugged when she told me, she was such a darling throughout the whole experience.

We had a little laugh and I felt rather mortified when the nurse told me I was talking the whole time during the recovery room, asking Doctor Born odd questions which he patiently answered, such as: what colour was the duck he ate? I have absolutely no recollection of this at all. When I told my husband he said 'I hope you did not divulge any of our secrets!' Well if I did I hope Doctor Born will be silent as a tomb!

Yolanda came to see me after the surgery. I had not met her before, only spoken to her on the phone and was confused since I was still feeling the effect of the drugs. 'Who are you?' I asked. She seemed a little surprised by the question. She explained to me that she would be taking care of me next week and gave me a card with our appointment times on it. She also gave me a prescription for painkillers in case I needed them. She was sweet and reassuring.

-BRIDE OF FRANKENSTEIN, BARBARITY AND BANANAS
The nurse called my husband when I told her I felt ready to leave. Again the nurse was very helpful and aided me in getting dressed so I would be ready for him. Andrea kindly escorted my other half into my room. Darling husband - bless his heart- seemed completely perplexed, bewildered and shocked when he saw me. I don't think he was expecting me to be quite so bashed up! I had warned him, many times but sometimes it goes in one ear and out the other, especially if he has just been reading a review about the latest V12 sports car.

The other half was very quiet the entire drive home. I said 'I did tell you I might look like the Bride of Frankenstein.' Hubby barely spoke, only asking once: 'are you alright Frankenbaby?'

Once we got home, I immediately ate a big plate of food, I was ravenous and felt woozy from not eating. I gave poor darling another shock. I noticed my t shirt was wet with fresh blood on one side. Hubby took me to the bathroom to take a look and get the medical kit. We took off the bandage and indeed the wound was still seeping blood. Hubby disinfected it and placed new bandages on the site. I have to say I had not been told this might happen but luckily we had everything we needed at home to replace the bandage with. Hubby told me I should go and lie down in bed. As he led me there I momentarily fainted. The poor man grew even more worried! I told him not to fret, I had not eaten all day and had lost a little blood. He kept coming to check on me after that with very wide eyes. This experience reminded me why it is vital after any surgery to have someone lover, family or friend to check on you.

My husband was quite worried for the next day. After realising that his worry was unwarranted, he told me he does not understand why I would inflict what he believes is barbarity on myself. He thinks I am beautiful enough already and apparently a bit bananas but apparently never boring. I reminded him that body and facial modification in the name of beauty has always been a part of human existence since time immemorial. Plastic surgery is very civilised, sanitised and safe compared to many other body modification traditions. Across the African subcontinent ethnic groupings have practised and still practice tribal scarification. Amongst some peoples of Africa and Amazonia the lip plate has long been worn. Neck rings in Thailand, nose plugs in India, the list goes on.

DAY 1:
I was, as to be expected very swollen when I woke up, the most affected areas are my cheeks and NL folds. I am actually very happy that my NL folds are so inflated as I kept reiterating to Doctor Born my profound desire to have these eliminated although he cautioned me repeatedly that the face is dynamic so he did not want to overfill the area.

The inflammation in my face prompted my husband to spout 'good bye my little puffer fish' as he left the house for work. I have a feeling it will be a while before this pet name becomes obsolete. I had some trouble eating my breakfast as I could not manage to open my mouth very wide. I ended up putting my breakfast in the blender and then eating it with a teaspoon. I need to keep on as much weight as possible to ensure the success of the FFT and try to replenish the adipose tissue lost from my love handles and now in my face. I did feel a little nauseous after breakfast. I expect my system is a touch unsettled after all the meds yesterday. It was nothing serious.

My face felt very sore so I did not want to wash it with soap and water but instead used very gentle products: Eau Thermale Avène's micellar lotion and H2O spray with cotton pads. The spray is very soothing, especially if you keep it in the fridge, I discovered. Although I was told I could use a very gentle lotion I opted not to. I think it will be good to give my skin a break after the last few weeks of using heavily medicated creams prescribed by the dermatologist to try to soothe my restylane-ruined skin.

A lot of green stuff came off my face. I was not as bashed up as I thought. A lot of what I presumed were bruised areas were actually left over pen markings from where Doctor Born had drawn on my face. I was surprised the nurses did not remove this post-operation.

My facial bruising is truly minimal, much less than I expected. I do believe that the consumption of supplements and foods rich in quercetin, rutin and other bioflavinoids may have aided me. I have 2 tiny bruises in the center of my forehead, in my chin. The only place the bruising is more visible is around my eyes. My eyes feel rather uncomfortable due to this and the fact that my cheeks are so swollen that my view feels a little impeded. As I mentioned in the earlier part of this review, I believe that restylane somehow triggered rosacea to develop. I never had any skin problems prior to those injections. The rosacea areas are obviously inflamed, perhaps a touch more than the rest of my skin, but it is hard to tell and the skin still looks somewhat uneven, yet very shiny right now from the FFT. As I stated above, it is my hope, following a conversation with a surgeon about the Adipose Derived Stem Cells and Regenerative Cells contained in fat, that this might be much improved if not eradicated by the FFT. However

My most visible bruising is on my love handles in the areas where the fat was harvested. These areas are very tender indeed. I have to be a little careful getting up and sitting down etc. I also cannot lie on my side. This made last night's sleep rather restless. I am usually a side sleeper but for obvious reasons, forced myself to sleep on my back however I kept inadvertently trying to turn onto my side and then would wake up with a small squeal and move back onto my back. I really like the milliard memory foam pillow I bought which due to the wave shape reduces compression of the face whilst sleeping. I was worried that since I often sleep on one side of my face, which usually gets quite crushed against my pillow, that this would cause me pain or cause uneven results in the healing process. The pillow has ensured that this has been avoided.

I had a liquid lunch for the sake of ease and by the evening my mouth area was much less swollen and I was able to eat the delicious, fresh thyme-stuffed chicken roast I cooked for the husband and I with no problem. Roasts are my comfort food and I feel that healthy servings of gravy might be excellent fattening food for keeping weight on.

The only unexpected consequence of the FFT that I had not foreseen is I have many little marks where the needle went into my face. They look like little linear scabs but I have no doubt they will clear up with time.

-FOLLOW UP
Yolanda, the nurse at TMB, called me early this morning at home. Initially I ignored the phone as I did not recognise the number but when the caller rang a second time I thought I better pick up in case it was important, I give few people my home phone number. I was not expecting anyone to call. Perhaps Yolanda mentioned it when she came to visit in the surgical suite after the operation but I have very little recollection of our conversation. I later noticed she had also attempted to call my mobile twice which I have been keeping off or on silent.

It was a pleasant touch that she called so early on in the day to check on me. She was very supportive on the phone, eager to answer any questions I might have. She said I could remove my bandages at the harvesting sites and should gently commence massaging around the incision area from now on. I later did as she instructed but only managed the most pathetic massage as the area was very tender. I used rosehip oil with a few drops of the essential oil helichrysum as I read it was beneficial for bruising. I also have arnica gel to hand but thought I'd alternate with that tomorrow.

-PAIN
The pain has really been very bearable. Yes my face feels uncomfortable and my sides are sore but not immeasurably so. I have not felt the need to take any pain killers at all. I really have no issue with pain as long as I have chosen to inflict it on myself in the name of something I believe in, like beauty or sport ;-) Enduring pain one has not elected to withstand is another subject.

DAY 2 :
Last night I was a bit restless again. I just find it arduous falling asleep on my back. I was particularly aware of odd sensations in my face such as tingling.
I glanced at my mobile phone this morning and saw I had a missed call last night from an unknown number and also a text. It was Doctor Born. He sent a message checking up on me. Again a very nice touch from TMB. The follow up has been impeccable.

My face is still very swollen. The swelling seems to have shifted somewhat. I have less on the sides of my face and forehead, now it seems to be concentrated towards the middle of my face, around my nose and in my NL folds. The bruising is much reduced on my face apart from around my eyes. My incision points are much less red and look calmer. The bruising on my back has shifted from green to mauve.
I still look like a puffer-fish . One of the many info sheets I received from Andrea mentioned pulling feelings in one's face. I felt some strange twinges today especially around my temples, mouth and near my nose. I also feel pulling around my incision sites. I managed to massage them quite well today. The areas feel somewhat raised. They still hurt but the pain is manageable. They only really bother me if I lean over to pick something up.

DAY 3:

My face is gradually becoming a touch less swollen, but I am still very puffy and sensitive around my puffy eyes where I am most bruised. Today the bruises are starting to shift to a pea soup and forest green colour.

I went out with my husband to do a spot of shopping in the evening. Although a burqa would have done a better job, I felt that my bruised eyes and puffer-fish appearance were quite well concealed by large sunglasses and a wide-brimmed cap.

Pain is minimal. My face does not hurt per se, rather it just feels uncomfortable. My incision sites and the bruises on my back are a little sore but not insufferably so.

In the evening, my face seemed less swollen and I thought I saw a glimmer of what it might look like in a few weeks. At that moment, I felt so grateful to be in a position, physically, financially and otherwise, to improve my appearance thanks to the skills of a Doctor whose priority has always been my safety and well-being.

DAY 4:

I am glad day 4 is drawing to a close. I felt quite exhausted and a touch irascible today. I think the reason for this is that I sat at my computer for 9 hours for work. Doing so with swollen, sore eyes and a tender back entailed that I felt about as jolly as a dyspeptic rattle snake by the end of the day.
I am glad to be turning in for a good night's rest.
I have included a snap shot of one of my healthier days of caloric loading prior to the surgery.
I hope tomorrow my eye area will be a little less inflamed.

DAY 5:

Today I went to see Yolanda, the nurse at TMB, for an evaluation of my progress. I was happy that there was no wait time.

Yolanda said my bruises had healed rapidly, they are already yellow which is the last stage. I attribute this celerity not merely to the quercetin supplements I took, but also my daily consumption of quercetin-rich foods such as apples, dill, spring onions etc. as well as other bioflavinoids. For those who wish to minimise their bruising no matter the procedure this chart is a most useful resource. http://www.quercetin.com/overview/food-chart

Yolanda took my photo from various angles which she shall send to Doctor Born, as he is on holiday. I appreciate that he continues to take an active interest in patient recovery despite the fact that he is enjoying dolce far niente.

Yolanda then treated my face with yellow LED light. This stimulates collagen production and shall further help my healing. You can read more about it here: http://www.tmbcosmeticsurgery.com/med-spa-services-toronto/gentle-waves/

Yolanda looked at my incision marks and showed me how to perform a proper massage which was rather painful but most necessary.

My face is much less swollen and my eyes more comfortable.

DAY 7:

I have been in my post-surgery cocoon now for 7 days. Tonight, from beneath the fading bruises and needle marks I thought I saw a glimpse of a butterfly.

My husband did not call me pufferfish when he came home, but beautiful. My face is only the tiniest bit yellow with a few small purple marks, here and there and very much less swollen. The shape looks fabulous but I know it is still early days though, so I must be patient as each day my face evolves.

Observations:
Previously my face felt rather wooden, difficult to move, it was painful to laugh and smile. However with every day that passes I am regaining facial mobility. Only my upper cheeks and orbital area still feel a little stiff.

I noticed my skin has been peeling, just like when you have had a sun tan. It is sloughing off to make way for new skin below, I presume. I have not exfoliated but only used a gentle face cloth to remove it. I am keeping my routine very simple and soft as I want to baby the fat in my face and not indulge in any abrasive gestures, just in case these should impinge upon my fat cells. Fat is a scarce resource for me.

Speaking of which, prior to surgery, I was discussing with Doctor Born future options for those of us who do not have ample supplies of adipose tissue for fat transfer. He stated that scientists are working on removing the reactive protein from fat cells. If they succeed, fat could be potentially harvested from people undergoing liposuction and then used in other patients wanting fat transfer. However this is only 5-7 years in sight, yet it is wonderful to think this might be possible one day.

Furthermore fat stem cells are pluripotent. This entails that they could be useful not only cosmetically but for treating a wide range of medical conditions.
http://www.esf.org/hosting-experts/scientific-review-groups/biomedical-sciences-med/news/ext-news-singleview/article/liposuctioned-fat-stem-cells-to-repair-bodies-60.html
http://www.usnews.com/news/articles/2013/06/05/scientists-find-stem-cells-in-liposuctioned-fat

DAY 8:

I went to see Yolanda again at TMB today for another post-surgery check up. I did not have to wait but was shown straight in. She was very pleased with my progress, I barely have a bruise or mark left on me. I told her how delighted I am with Doctor Born's artistry. My face looks so youthful, round but with angles in all the right places and my skin looks plump, it feels very soft too.

Yolanda warned me not to get too attached to my current appearance, as my face will morph and swelling shall further dissipate. All I could think was 'drat and double drat' as I adore what I see, but I have to be pragmatic.

Normally at this point Doctor Born would evaluate me in person. Since he is holidaying Yolanda once again took photos and sent them to him which I appreciated, even if it is probably unnecessary since I am healing well. Yolanda also gave me another gentle wave treatment.

I took uber home. I did not have even a touch of make up on.

I had a female driver who immediately asked me if I was a model. She thought I was around 27 - I am 35- and told me I had beautiful fresh-looking skin. My skin truly looks rejuvenated.

The lady driver is the third person in the cosmos (apart from the staff of TMB who of course know) who I confided to as per having had surgery.

The lady told me that she is lonely. She said that she has not been on a date in years because she feels so terrible about looking old and haggard, but that she has so much love to give and share with someone special.

I felt so moved that she confessed all of this, and more, to me. I also felt so grateful for my surgery. Yet I simultaneously felt so sad that this lady feels she looks too inadequate to go on a date. Our physical vessels, and above all our perception of them, can truly be such an impediment to our happiness and the human connections we seek.

She told me she has long been contemplating a facelift but she feels very scared. She asked for more details about my FFT and wanted to see my incision marks. I explained to her and showed her one of my tiny love handle scabs, describing how my safety and well-being have always been prioritised at TMB. She asked me if I would recommend my doctor. I gave her the TMB number. Perhaps she will never call or perhaps she will get the facelift she says she has long wanted. Either way I hope that she will find that someone special she is seeking.

A few old photos

NL folds, bane of my face...

A few new photos

Day 7 barely visible folds and a much less equine-looking chin since Doctor Born placed fat in my chin area too.

DAY 16: before photos, with filler photos and after facial fat transfer photos ---» plus fillers vs. fat transfer

In our world of instant gratification I can see why fillers get a higher rating on realself and in general than facial fat transfer. This post aims to give a brief overview as to my reasoning on this topic, based on my recent experience. I detail my satisfaction with facial fat transfer and describe some of the pros and cons of fillers and facial fat transfer .

Fillers give you immediate predictable results that are instantly palpable and the price tag in the short term is less than facial fat transfer (FFT). Furthermore if you do not like the results, you can return under a fortnight for touch ups etc.

I truly loved the way fillers (restylane) looked in my nasolabial folds, they literally made all the despised lines disappear in a way that facial fat transfer has not accomplished. The 3 vials injected into the folds ensured that instead of hollows, the NL part of my face stuck out, making me look very youthful however, for reference, I was allergic to them which is why I opted for FFT. Initially I was not happy with the look of the fillers, as I only had 2 vials in my NL folds but returned shortly thereafter for my 3rd vial and was delighted to immediately get the look I wanted. Due to the allergy I had them removed.

I wanted to replace the filler with fat and after discussion with Doctor Trevor Born, my surgeon, I opted to having fat injected not only into my NL folds but also into my cheeks, malar area, chin, jaw area and above my temples so as to truly rejuvenate my appearance.

I was hesitant for a while, for many reasons. It is not a simple in-office procedure. You have to undergo either local or general anaesthetic. You have to acquiesce to liposuction and for this you need sufficient fat to harvest. You can not expect instant results. It is a very long process to see your results. On top of this FFT has a significantly higher price tag than fillers do.

To add to this, if you do opt for FFT, you may well crave a fuller look following the erroneous expectation that the first week or so gives you. I had read and was later told by Yolanda, the nurse, at Doctor Trevor Born's office not to get too attached to the way I looked at Day 7 and the reasons for this are now apparent to me.

With FFT, the first 5 days you look bruised, puffed up and pretty ghastly. However at Day 7 (it could be later for others), I hit a sweet spot. My bruising was mostly all gone but I had a lot of residual swelling plus my skin looked dewy from the fat stem cells. This meant I looked about 10 years younger than I am, I did not have any lines on me and my nasolabial folds (which are the most important concern for me) looked wonderful.

DAY 16:
At day 16 however my residual swelling is now gone. My cheeks look much fuller, my eye area is very youthful and I am highly satisfied with these parts of my face, albeit the lines around my mouth, my NL folds, that appeared to have vanished, have now returned. They are much softer but they are still visible and they could become more so with time because with fat transfer it takes 3 - 6 months to ascertain how much fat the body has metabolised. In order for the fat injected into the face to survive it needs to acquire a new blood supply which will ensure it remains as living tissue.

Although I love the look of the fat in my malar, cheek and temple area and I truly see how fat looks so much more natural than a face full of fillers would, I can already see places, especially on one side of my face, in my NL fold where I feel a little touch up would perfect that area. From touching the area I can feel that it is not as filled as it was with 3 vials of restylane and I conclude that more work is needed to achieve the same look I had with the fillers.

One side of my mouth has always had a tendency to look less full than the other and I recall it needed a little more filler when I initially had my restylane injections. Hence there is a high likelihood of having to repeat facial fat transfer to correct this and other little concerns that may crop up with time. But I must be patient as FFT is not a quick fix procedure. I will need to wait many months before any final results can be comfortably determined. My doctor warned me that approximately 1 in 5 people feel it necessary to have a repeat procedure. I fully accept this and can already see why. Rome was not built in one day.

Does this mean I regret facial fat transfer? No, absolutely not. I certainly look better than I did before facial fat transfer but I do feel that my NL area does not look quite as perfect as it did with fillers.

From my experience, it is my belief that facial fat transfer is not for those wanting instant gratification. Fillers, for those who tolerate them, comprise an easy and predictable solution. With facial fat transfer you have to commit to a much longer route and a more involved process to get results.

I personally found the surgery to be relatively pain-free and downtime was minimal however I know this does not apply to everyone. I feel ready to commit to another procedure in the future to ensure that I get the look that I want. I understand from my research that numerous surgeons advocate that the optimal approach for excellent long term facial fat transfer results - that ensure volume is replaced as it is lost over time - is to have multiple procedures so that numerous layers of fat are superimposed gradually. These can then potentially build up to the ideal sought by the patient and surgeon.

There is good news from the scientists beavering away in their labs vis-à-vis fat transfers. For those of us forced due to allergies or electing to opt for fat transfers, in the future fat transfer methods shall be improved, meaning that success rates for facial fat transfer should by correlation, increase. Evidence on this subject is available in the research papers penned by Fraser et al. also see also Kakudo et al. These scientists describe new methods being developed that allow for cell-enriched fat grafting. The technology involved, they state, increases the number of adipose-derived regenerative cells in the fat grafts. Fraser et al. and Kakudo et. al conclude that these cell-enriched fat grafts entail improvements in angiogenesis and decreased fat absorption.

Note on photos -

The photos seem to be absolutely miniscule! I will try to fix the photos as I know many of you have written to me asking for updates. Thank you for your messages!

Day 23

I am still seeing changes and I say this somewhat reluctantly. My cheeks and eye area still looks lovely and youthful however my nasolabial folds just don't look half as good as they used to. It is the outer lower portion of them that I notice appears once again downward turned, almost droopy and lacking in volume. Furthermore, I have been massaging my face daily to increase circulation so as to encourage blood flow to the fat and I have noticed my NL area feels less 'thick with fat' (for lack of better words) than before.

When I had the fillers and in the 19 initial days of the fat transfer that area was satisfyingly full, so when the light fell on my face, even though the small lines were there, they were not noticeable at all. Having a touch more fullness in that area really changed the way shadows formed on my face and took many years off my face. The fillers did not look that good initially, the PS added extra filler to the outer portion so that the area would appear more full which made a monumental difference to my appearance. I really hope that the surgeon who did the fat transfer will be able to do that.

I am once again including photos of before, with fillers and with fat. I hope they will be large enough to see this time. They may be quite pixellated as I had to increase their size.

In retrospection and from looking at the photos I note that something about the texture, the consistency of the fillers lifted my mouth up, kept my large lips in place. The fat obviously cannot do this, it seems to be a much heavier material, I am therefore reminded of the imperativeness of having my silicone lips dealt with, reduced or otherwise and I am thinking about other measures to correct this. Of course the weight of my lips is dragging my face down and without correcting this problem I will have more issues.

Of course my NL folds still look better than at the outset but as you can see from the pictures the filler reduced them much more. However I reiterate that facial fat transfer can be a lengthy process, one cannot predict at the outset how the fat will sit and how much will remain. I am hoping that repeat procedures over time will allow me to arrive at the result I want.

Day 29

Jean Cocteau asserted that “mirrors should think longer before they reflect.” I felt the timeless and pitiless veracity of that statement today when faced with some of the harshest lighting and mirrors I know of. At my gym, every wall is covered with mirrors that stand beneath glaring fluorescent light tubes that show as much mercy to the lines and furrows on one's face as the inferno did to Dante.

I have not worked out in innumerable weeks, but felt that enough was enough of babying my face and attempting to keep on as much weight as possible. Seven Gianduja chocolates later I arrived at the sports complex for a work out and I decided to take the pictures that follow. These are preceded by a couple of before shots and some filler shots for comparison.

Observations on Facial Fat Transfer:
I reiterate my previous assertion: my nasolabial folds although less dire than before, are not nearly as softened as they were initially. They still have the appearance of two horrible handlebars that pull my lower face down.

My cheeks still look rounder than they were but are visibly less plump than in the initial post-op halcyon days. I wish they had just a tiny touch more volume. On a positive note, my skin is looking very dewy still and fresh. I am not the type of lady who ever likes wearing a thick layer of foundation and powder, especially not to the gym where it is entirely out of place. The facial fat transfer has omitted the need for anything but the lightest touch of concealer in my under-eye circles. My skin looked particularly radiant today, even beneath the bright lights.

Arbitrary Afterthoughts:
I am a perfectionist, it has served me well and on that note, it struck me, as I 'worshipped the Iron' that one can be born with intelligence. But through discipline and dedication one can perfect and improve upon a discerning mind so as to reach the apex of academic accolades, excel in one's job and so on.

One may be born with decent genetics and through a committed sports regime one can attain an excellent physique, physical strength, dexterity and flexibility. However no matter how hard one works, tries to perfect, one can do nothing for one's face in terms of averting ageing through one's own physical, mental efforts. The only thing you can hope to rely on, and this only to somewhat delay the ageing process, is to use your financial capital to hire the skills of a meticulous surgeon who hopefully shares your vision of how you wish to look. Or of course, you could give up the combat against the ravages of time but I think anyone who is reading this decided long ago that this one is a battle worth fighting.

Day 50: Facial Fat Transfer with Doctor Trevor Born

It may be the end of an era. After assiduously exercising for over 10 years, lifting twice my own bodyweight on a triweekly basis I have now reduced my work outs to sporadic, impromptu sessions of no longer than 45 minutes, lifting paltry weights as compared to previously. This is because having noticed a gradual decrease in volume in my face since my facial fat transfer with Doctor Trevor Born on 12th August, I am determined to maintain as much weight as possible to ensure my results are not adversely affected by my penchant for sports and my metabolic propensity for svelteness.

Outcome:
As regards the outcome of my facial fat transfer, I would assert that much as my face is improved and overall I look less long-faced and hawkish than before, I consider myself to be a work in progress and not a finished oeuvre. Doctor Born judiciously added a tiny touch of fat to my chin which looks less equine than before. My jawline seems less gaunt as Doctor Born added fat to the outer jaw area. The fine lines I had below my eyes seem to be erased due to fat placed high in the upper malar zone. My cheeks are improved in appearance, however I have lost some fat in them. Most of all I have lost volume in my nasolabial folds, which have been an area of concern for me. One side in particular is looking more droopy than the other and the lines which for the first few weeks were considerably softened are once again visible. This is another reason why I seek to maintain weight as I do feel that a repeat facial fat transfer will be necessary in order to acquire the look I desire so I am trying very hard to build a spare tyre.

Overall I would say that my results are subtle. My husband was concerned that I would look 'done' but this is very far from being the case. He and I miss the way I looked during week 3 when the amalgamation of swelling plus freshly injected fat entailed results that were much more obvious. I would be dishonest should I not admit that I pine for the look that the fillers produced, significantly softening my nasolabial folds, they gave me the exact result I wanted, filling out the area around my mouth which is very grooved. I encountered a friend recently who had been away for much of the summer. She was aware that I had planned a facial fat transfer but did not know the date, I felt disheartened as she presumed I had not had my operation yet and was surprised to hear that I had, no doubt as my results are so subtle. That being said, choosing a surgeon who has a conservative facial fat transfer technique is justified. I have read in numerous reputable, peer-reviewed cosmetic surgery journals that with facial fat transfer it is preferable to proceed prudently and perform repeat facial fat transfers every 4-6 months according to need, each time grafting additional small layers of adipose tissue onto the face as opposing to slapping down a thick slab of fat in the first instance.

A word of warning:
I would reiterate as I have stated previously, for those researching facial fat transfer, take heed: this procedure requires a lot of patience and sang froid on the part of the patient. It does not give immediately palpable results like fillers do. With fillers, what you see upon injection is usually what you get. Facial fat transfer is not predictable, repeat procedures are often necessary. Although experiences vary I have read similar accounts to the one I provide below.

What to expect:
In the first week you are a pufferfish, swollen, bruised and a little battered so you wait patiently for your results. The next few weeks are absolutely ideal; your skin appears dewy and fresh, lines are invisible, your face looks plump as well as extremely youthful. You enter the sweet-spot, excess inflammation has disappeared, needle marks and bruises are gone, your skin is as smooth as a newborn babe's. You have a fresh, as yet unabsorbed, layer of fat in your face which makes you glow and lines remain almost invisible, you look ten years younger. At this point I looked like I had stepped out of a pre-Raphaelite painting.

Thereafter, especially in the month that follows, it is easy to feel disappointed as the weeks drift by. Gradually swelling dissipates and fat reabsorbs giving the impression that all results will evanesce. You no longer look a decade younger. Day by day, in fact you look older. The exact look you dreamed of and possessed for about 3 weeks, suddenly appears to melt before your eyes. It is not that you have lost all your results but that you grew accustomed to more facial volume, looking very youthful and it is hard to see the subtle improvements in your face following the dramatic difference you first witnessed. I now understand why so many patients who undergo facial fat transfer choose to repeat the procedure, often numerous times.

Photos:
I have added new photos, there are also some old ones from prior to the procedure, when I was young, before the development of NL folds and a few shots with fillers. As is visible, my lips were injected with silicone many years ago, obviously this is an area that may well need to be addressed but this constitutes an onerous decision for many reasons. It is not within the purview of this review for me to make any further remarks.

Day 57

I went to see Doctor Trevor Born for my follow up yesterday.

I must praise the level of patient care at TMB. Each time I have been to the office, I have been attended to with conscientious kindness by every member of the TMB team. This fact has become more apparent to me since joining realself, as reviews and private messages from several realself members have described how some Doctors and their staff have neglected to follow up on their patients' progress and shown little concern post-operatively. TMB are truly meticulous vis-à-vis their commitment to ensuring customer comfort and satisfaction.

As soon as I arrived at TMB I was offered a bottle of water and a pleasant smile by Mary. I was immediately whisked by Mandy into one of Doctor Born's rooms. Yolanda, the nurse, who is always a ray of sunshine, as well as being attentive and caring, took some photos of my face and inquired about my outlook as per the procedure. I informed her that I saw improvements overall but found my nasolabial area still wanting.

Yolanda and I perused my pre-surgery photos and contrasted my facial features. The sunken area I had a little below my eyes, in the very top of my cheek area, is improved. A couple of realself members have inquired as to whether I had fat injected into my tear troughs, also known as nasojugal grooves, the answer is no. Doctor Born injected fat high up in the malar area. It was also noted that my brow area does not look as concave. Furthermore as I have previously averred, in the past my chin was rather horse-like, this is no longer the case.

Doctor Born arrived. He also analysed the pre-surgery photos with me; noting the improvement in my facial features. As usual I blitzkrieged him with innumerable questions, which he replied to with apposite foresight. We discussed my fervent desire to have further fat injected into my nasolabial folds and I am absolutely elated to relate that Doctor Born said that we could proceed imminently!

We also discussed how to reduce the size of my anomalously large, silicone-injected lips. For now, as excision is a rather drastic solution, we are proceeding with steroid injections, in the form of triamcinolone, a 10% solution to begin with, sold under brand name Kenalog-10. The reduction of my lips does not fall within the purview of this review so if you have any more questions on this kindly message me. Nota Bene: my lips look particularly puffy in the photos as they were injected yesterday.


Today, Andrea, Doctor Born's surgical coordinator contacted me as per the touch up for nasolabial folds. I was furthermore delighted to be told that Doctor Born will waive his surgeon's fee. I know that once my nasolabial folds have been injected with more fat, I will be fulfilled and thrilled.

------» SECOND FACIAL FAT TRANSFER: The Return of the Pufferfish «------

Yesterday I underwent my second facial fat transfer with Doctor Trevor Born. Today, as can be seen from my photos, my face is swollen and I have numerous needle marks. Bruising is slight, apart from on my chin where it is rather ghastly. My stomach, the harvest site, is a touch tender and also distended but overall pain is minimal. Any unpleasant sensations or horror upon facing the looking glass are mitigated by anamnesis of the adage my mother hammered into me as a young girl: 'you have to suffer to be beautiful.'

On a side note, to clarify as I have been asked this repeatedly, I have not had fat added to my lips. I had silicone injected into them over a decade ago, which I do not recommend as it carries numerous health risks not to mention esthetic complications. They look particularly puffy and misshapen due to swelling in the area. I definitely need to address them permanently in the coming year.


Pre-surgery:
My procedure took place as before, at the surgical suites at 199 Avenue Road. I find it assuaging that Doctor Born's operating room is in the same building as his office. It is easier on the nerves to go to a familiar location and the facility is quiet, comfortable and intimate. I speak from experience. When I had my rhinoplasty and breast augmentation many years ago, the surgeons did not have onsite surgical facilities. I had to traipse out to unknown hospitals which seemed bustling, noisy and impersonal. I would never do that again now that I have been treated to the TMB experience.

As soon as I arrived a kindly nurse, Callie, greeted me. I went to the dressing room where I disrobed, stored my clothes and donned the hospital gown, comfortable dressing gown and slippers provided. Callie took great care of me from start to finish. She even offered to fetch my book from the dressing room when I was getting anxious prior to the procedure and needed to distract myself. I felt ravenous as I had not eaten for 8 hours, as per instructions.

Doctor Born came to see me prior to the surgery. He examined my body so as to find a suitable site to obtain fat from. It was not an obvious decision, I am a slender lady. I was hoping that we might be able to take it from my love-handles as previously, however this was not possible due to lack of adipose tissue. Doctor Born concluded that my stomach was the only feasible location. As you can see from the photo of my incision marks, the fat was harvest from sites on each side of my belly button. The area is rather swollen today.

Above and beyond expectations:
I had presumed that Doctor Born was merely going to be re-filling my nasolabial folds as per my request, however he surpassed my expectations. To my surprise Doctor Born suggested not only placement of fat in the folds, but also to add more to the area above my eyebrows and around my temples, as well as in various parts of my chin. This denotes how dedicated and diligent Doctor Born is in his desire to achieve a perfect result for his patients. I am grateful for his wise recommendation and willingness to spend additional time filling in these areas.

Surgery:
I had twilight sedation. I do not recall the surgery. I had some pain when the fat was first suctioned from my tummy however I asked to be further benumbed and the drugs, to quote Shakespeare, steeped my senses in forgetfulness.

Post-surgery:
I slept deeply for an hour or so. Once awake the drugs I had been given during surgery led me to spend the evening in very merry spirits. I had no discomfort the entire night. Nurse Callie took excellent care of me, checking my temperature, blood pressure and gently cleansing the blood from my face. When I was ready to depart she helped me garb myself, gave me some gauze to take home for care of my incisions and called my husband. She accompanied me from the surgical suite down to his vehicle. There was not a nanosecond when I did not feel taken care of, my safety and well-being were ensured in every possible way from the moment I arrived, to the time when I left the building.

I had a restorative dinner when I returned home and shortly thereafter Doctor Born phoned me to ensure I had no pain and that all was well, which it was. When a surgeon works hard all day presumably operating on multiple patients and takes the time to personally call their patients it does commend their commitment, compassion and care. Furthermore nurse Yolanda also rang me this morning to inquire as per my well-being.

My husband, who was aghast following my previous facial fat transfer, has been significantly less harrowed by my bruised and battered appearance this time. I might even venture to say that he curiously awaits the esthetic outcome.

Indubitably, like thousands of husbands across Canada who tentatively confer their wives' well-being and beauty to a mysterious, almost mythological Doctor Born, whom they have never met, my husband has seen me emerge previously from the chrysalis of healing, rejuvenated and refreshed, now thus he trusts.

Second Fat Transfer Post-surgery Update

Just a quick update:
My face feels a little uncomfortable, tight and irritated as it is swollen but I do not have as much inflammation as last time. Although this is not the most pleasant feeling it is not painful. Also my stomach where the fat was harvested from is not one jot bruised, even if tender to the touch and distended, it does not hurt, so I am gloriously pain-free! My surgeon did prescribe pain-killers just in case, but I feel no need. My facial bruising is slight apart from on my chin. I seem to have the energy levels of a sloth this evening, but know that is just my body relaying the message to rest for optimal healing.

Nearly 1 week since second fat graft

Today someone thought I was 25, which I just cannot abide. ;-)

I went to TMB for my follow up yesterday. Everything seems to be progressing most smoothly.
I expressed my concern to Nurse Yolanda as per a little hard lump on my chin where I had my worst bruising. She advised me to massage it gently and assured me that it would surely dissipate. Doctor Born seemed content with my healing thus I need not return for 2 months time.

I still have some yellow bruising and as is visible my skin is flaking in the areas where the fat was grafted. Much as I am tempted to, I have avoided any harsh exfoliation of these areas since I prefer to treat my face with utmost delicacy so as not to disturb the grafts. My only area of concern is my chin, as mentioned, but certainly with time this tiny lump will resolve itself. I still have swelling but feel delighted with my results thus far.

Thank you for the messages in my inbox, these are most appreciated and I hope to reply to you soon.

Almost 2 weeks Post Second Fat Transfer

This Thursday it shall be 2 weeks following my second fat transfer. As of this moment, I could not be happier with the seemingly perfect results of my surgeon's work.

It remains of course to be seen how well this second grafting shall take, especially in the area of my face that I vehemently despise, my nasolabial folds.

Currently my face looks so much less gaunt, not only due to the fat in my NLs but also due to the additional grafts that Doctor Born placed in my chin, around the sides of my nose and in my brow. These sagacious additions have made a vast difference to my appearance.

I truly look younger. I am so grateful that I was fortunate enough to be able to undergo this procedure once more. Inevitably, the external changes have had an inexpressible impact upon my inner being. There were days prior to both facial fat transfers that, upon glancing in the looking glass, I felt like I was observing the gradual withering of a flower.

My bruises have vanished, they disappeared entirely 5 days ago. I have no lumps nor bumps. My skin looks plump and dewy in the areas that were injected with fat. I experience occasional tingling sensations in my face, which I had last time, it is the grafts settling. My tummy is still sometimes a touch sensitive, yet this is no bother to me. Any discomfort undergone has been but minor, and a miniscule price to pay to not have to look daily upon a wilting visage.

I am refraining from sporting activities as I want to keep as much fat as possible and would not wish anything to prove detrimental to that process.

Almost One Month Since Second Fat Transfer plus a Note on Integrity

It will be a month tomorrow since my second fat graft. I have added some new photos of my face, plus the harvest sites which have barely noticeable scars due to Doctor Born's excellent work.

I continue to be content with the results of my second fat transfer. Doctor Born's grafting of my nasolabial folds still remains impeccable. Although the lines are no longer flat like they were initially and more visible, they are not disturbingly so. Doctor Born cleverly placed a thicker layer of fat at the bottom of the fold, entailing that to my delight, I no longer possess a droopy handle-bar shape to this part of my face. Furthermore my chin and forehead area are improved due to the additional grafts. My face looks younger and somewhat rounder. The effects on my mental outlook are also spiffing. Doctor Born's tenacious meticulousness, perspicacious skill in producing a lovely result, pertinacious desire to ensure I was happy with the result, as well as his integrity have demonstrated that he is a topnotch surgeon.

Anecdotally to illustrate Doctor Born's integrity, when I first commenced exploring the option of facial fat grafting, following my dismal experience with fillers, I met with numerous surgeons to ascertain who would be the best for me. One of the doctors I consulted with, previously to contacting Doctor Born, advised me that fat grafting might not resolve my fold. I asked this doctor therefore whether I should consider a facelift. The doctor advised me that I was a little young for such a procedure and should I need another facelift later on in life, that numerous rhytidoplasties could be damaging to the skin. Nevertheless, he advised that we should consider it and that he would prefer I undergo a facelift with him as he could do a proper job, whereas other surgeons would not. His staff were prepared to provide me with pricing for a facelift and had I said yes, I have no doubt that they would have booked a date for the operation.

Fortunately, I did not feel right about that option. I thereafter met with Doctor Born and chose him as my surgeon. Following my first fat transfer with Doctor Born, when I was not entirely satisfied with my nasolabial folds, I asked Doctor Born the very same question: 'should I have a facelift?' Doctor Born did not judge me for my barmy enquiry but kindly advised me that I was too young. He said 'let's do the second fat grafting and take it from there.' I think he knew that I am mule-headed and did not want to point blank tell me no, but knew I would not need it once he had worked his magic.

I am grateful to have found a doctor who is not only skilled but has also demonstrated his moral rectitude. I have extrapolated from conversations in messages with numerous fabulous members of realself, as well as from my experience in daily life, that we women are often self-confident when it concerns our intellectual, career, artistic or other achievements. However when it comes to our appearance we are supremely sensitive, often racked with self-loathing over minor details, hence agonisingly demanding of ourselves. I am sure that Cleopatra, Boudicca, Zenobia, Lady Godiva and Joan of Arc were not as insecure about their appearances as we are today. Surely because they did not have to compare themselves with, nor be constantly bombarded by, pictures of youthful flash-frozen beings who only exist within the cosmos of the airbrushed pages of Cosmo and other such media.

All of this makes us extremely vulnerable to surgeons who have their bank accounts rather than our well-being in mind. Our tendency to fixate on, and magnify our physical faults entails it is easy for an unscrupulous surgeon to peddle unneeded procedures to us. This is why finding a doctor whose talents are tethered to probity is crucial. Evidently Doctor Born possesses this essential coalescence.

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Thank you for all the lovely private messages sharing your doubts, fears and questions. I will reply soon but I am extremely busy with work so forgive me if I am tardy.

Update: 1 year 2 months later

My initial facial fat transfer took place 1 year and 2 months ago, albeit in April 2016 I underwent a third facial fat transfer, this comprised of a minor touch up on my nasolabial folds, in particular my right side as this proved harder to correct, due to an inherent propensity for a marked line and concomitant indentation.
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I continue to be contented with Doctor Born's work. In particular I have noted my cheek area to be significantly enhanced and my face to possess an overall fuller appearance. If I have of late been called 'young lady' by various members of the general public then it is thanks to Doctor Born. I recommend this surgeon to those seeking facial fat transfer. I believe his technique for this procedure is second to none.
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In April I additionally underwent a lip reduction, for those interested you may peruse my review here https://www.realself.com/review/toronto-silicone-lip-reduction-doctor-trevor-born#comment-4473312
Toronto Plastic Surgeon

TMB is the apogee of plastic surgery in Toronto and peerless in Canada. My reasons for choosing Doctor Born were multifarious, these were predicated upon evaluation of his: numerous years of experience, well-honed expertise, impeccable reputation, rational approach, brutal honesty, excellent eye for detail, aesthetic vision and professionalism plus staff competence and civility. Andrea, the surgical coordinator was efficient and patient from the outset, providing me with pricing and a plethora of other details I requested as per the surgery. Every step along the path was seamless, from the pre-op, the operation itself, as well as follow up. Doctor Born was consistently the voice of reason. All the necessary measures were taken to ensure my safety, well-being and the success of my surgery. Small details always make the difference and at TMB all the details are taken care of. Personal caring touches -such as a plush dressing gown to don over the hospital one when I arrived for surgery, the nurse who constantly cooed reassuring words to me prior to and after the surgery, a call from Yolanda the morning after my surgery and a text from Doctor Born that evening checking on my status- ensured that my experience was topnotch. I was delighted with the results of my procedure, sine qua non I would look and of course, feel considerably older. I highly endorse Doctor Born and his exceptional team at TMB. I would encourage those seeking aesthetic procedures in Canada, and even further afield, to consult him.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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