A face that looks larger after fat grafting: is removal alone enough?
Anterior cheek fat removal may cause bleeding, infection, pain, skin adhesions, surface irregularities, depressions, and asymmetry.
A mini facelift may cause bleeding, hematoma, infection, scarring, altered sensation, skin necrosis, and nerve injury.
The likelihood and severity may vary with individual tissue condition and surgical extent, so thorough preoperative consultation is necessary.
Some people feel their face looks wider or heavier after anterior cheek fat grafting.
This may reflect not only the volume grafted but also the location and distribution of remaining fat, overall facial proportions, skin elasticity, and soft-tissue sagging.
The patient in this case underwent full-face fat grafting at another clinic about 10 years ago. They then underwent liposuction at another clinic about 6 years ago to reduce anterior cheek volume, but attended our clinic because improvement did not meet their expectations.
After assessing residual anterior cheek volume and overall facial contours, we used our non-incisional approach for anterior cheek fat removal and performed a mini facelift together with it.
Why anterior cheek fat can make the face look larger
The anterior cheeks affect not only central facial projection but also apparent facial width from the front and the overall facial impression.
Appropriate anterior cheek volume may help fill hollow areas.
However, excessive residual fat relative to overall facial proportions or volume concentrated in certain areas may make the anterior cheeks look thick and the facial contour wide and heavy.
Changes over time must also be considered. It cannot be assumed that grafted fat simply flows downward with time.
However, years after fat grafting, natural aging may also reduce skin elasticity and cause facial soft tissue to sag.
When residual anterior cheek volume coexists with sagging skin and soft tissue, the face may look larger and heavier regardless of its actual size.
Assessment should therefore consider not only fat volume but also its location and distribution, overall facial proportions, skin elasticity, and sagging contours.
Anterior cheek volume remaining after liposuction
After full-face fat grafting, this patient underwent liposuction to reduce anterior cheek volume but felt that the reduction fell short of expectations.
However, without confirming the exact extent, volume removed, and technique of that liposuction, the reason for an unsatisfactory change cannot be established.
For revision, reassessing current residual fat and the condition of skin and soft tissue is more important than speculating about the previous surgical result.
Surviving grafted fat becomes part of the facial soft tissue together with surrounding tissue. The approach should therefore aim to adjust currently excessive volume rather than selectively remove all previously injected fat.
Excessive anterior cheek fat removal may cause hollowing, an uneven skin surface, skin adhesions, or asymmetry.
Reduced anterior cheek volume may also reveal skin and soft-tissue sagging previously obscured by fullness.
It is therefore important to reduce excess volume while preserving tissue needed for normal facial contours.
Non-incisional anterior cheek fat removal and mini facelift
In this case, our clinic's non-incisional removal approach was used for anterior cheek fat, together with a mini facelift to refine the overall facial contour.
Here, 'non-incisional' refers to the anterior cheek fat removal step. A mini facelift requires separate incisions, so the overall operation including both procedures cannot be described as non-incisional.
The specific removal method and extent may vary with the location and amount of remaining fat, skin condition, and previous surgical history.
Tissue in an area previously treated with liposuction may differ from that in an untreated area.
However, prior surgery alone does not establish the extent of adhesions or scar tissue; each patient's current tissue condition must be assessed individually.
Why fat removal and mini facelift were combined
Anterior cheek fat removal and mini facelift serve different purposes.
Fat removal reduces excessive residual fat volume. A mini facelift adjusts sagging skin and soft tissue to refine facial contours.
A mini facelift itself therefore does not remove grafted fat, and anterior cheek fat removal alone does not necessarily resolve all skin and soft-tissue sagging.
In this case, the procedures were combined to reduce excessive anterior cheek volume while refining the overall facial contour.
However, not everyone whose face looks larger after fat grafting needs a mini facelift.
If excess anterior cheek fat is the main issue and skin elasticity is relatively well preserved, fat removal alone may be considered.
If both excessive volume and skin or soft-tissue sagging require correction, combining a lifting procedure such as a mini facelift may be considered.
Mini facelift incision location and surgical extent may vary with sagging severity and the correction required.
How should before-and-after photographs be interpreted?
When comparing this case's photographs, assess anterior cheek volume and contour changes together rather than overall facial size alone.
Visible changes reflect a combination of fat removal, mini facelift, and changes in postoperative swelling.
They should therefore not be attributed exclusively to either fat removal or mini facelift.
Differences in timing, expression, lighting, facial angle, and camera distance can also change apparent cheek volume and facial width.
Check when postoperative photographs were taken and compare photographs taken under as similar conditions as possible.
Consider overall facial contours, not just fat volume
Improving a face that looks larger after fat grafting is not about removing as much fat as possible.
Excess anterior cheek volume should be reduced while preserving tissue needed for normal contours and considering skin elasticity and soft-tissue sagging.
Whether fat removal alone is sufficient or a mini facelift is appropriate depends on previous surgery, current fat distribution, skin elasticity, and facial contour condition.
The necessary technique and extent should be determined through thorough examination and consultation.
If you are concerned that your face looks larger after anterior cheek fat grafting, contact 02-545-3700 or 'UVOM Plastic Surgery' on KakaoTalk.