Can asymmetric fat graft on nasolabial folds be removed by liposuction or a facelift? (photo)

It is difficult to say whether your concerns are the result of a misplaced or asymmetric fat graft or simply the result of normal age-related sagging in the lower face. A single two dimensional photograph is difficult to accurately assess. It is indeed possible to safely remove a small amount of fat by syringe liposuction using a very small micro-cannula, although minor irregularity is a potential complication. In some areas of the face it may be safe to use a fat dissolving agent such as Kybella, although this is an off-label usage and caution is advised. Finally, I would suggest that you step back from the situation and consider an overall re-assessment of your face. It may be that the treatment was simply inadequate to address your aging concerns. Best wishes, Dr. Ridenour

It is not uncommon to see patients coming with excessive fillers or fat in the nasolabial area. If the retaining ligaments that form the nasolabial folds are not released properly by a subcision, the injected fat can displace in the lip or the cheek and create an unnatural bulging. The HA fillers can be dissolved and fat can be removed very carefully with a micro cannula. The question is how much to remove or to dissolve to correct the problem and not create another deformity. If the fat injection was done by a qualified and experienced plastic surgeon, he or she could remove small amounts of fat with a micro cannula, incrementally and you would have to understand that this might have to be done more than once. This could correct the excess without producing an unfavorable result. This is why all these simple procedures should be done by the most qualified and experienced plastic surgeon who can take care of these types of complications.

After reviewing your photo, I will have to answer your question based on my thoughts about your question only. Yes, fat can be removed with a microcanula and I have performed this several times as occasionally the fat transfer procedure work "too well" and more fat remains then was expected.

Gosh I wish you had included more photos!   The short answer to your question is that, yes,  grafted fat can under some circumstances be removed with liposuction.  But the results would not necessarily be perfectly gratifying in all cases. It all depends on your very specific presentation. You do not specify your age, or if you have had a facelift, etc.  One important point is that nasolabial folds are universally rather asymmetrical.  Look at some models in magazines.  One side is typically shallow, the other is deep.  One side is typically straighter, the opposite more curved.  If one of your side is truly overcorrected with fat grafting then removal seems your only option.  But is it possible your concern could be addressed by some other procedure such as grafting the other smaller side, grafting your cheeks more to make the surrounding area more full, lifting the jowl with a lift, or even perhaps buccal fat pad excision.  If you provide more photos we could provide a better answer.

Thank you for your question. Unfortunately, it is impossible for me to advise you on this concern based on a single image. I can tell you generally that it is very difficult to remove fat after a grafting procedure. It is likely that your best option for adjusting the asymmetry will be injections of dermal fillers to the area that is lacking fullness. Liposuction is not a good choice for this area. I recommend you schedule an in-person assessment with a board-certified plastic surgeon who can perform a full examination and then advise you accordingly. 

It is entirely possible to remove excess fat grafting with needle liposuction which has a minimum downtime. Alternatively, you could have some additional fat placed into the other area to balance it out as well. Either way the procedure should have minimal downtime.

It is difficult to tell by the photo what exactly the issue is.  You do seem to have some laxity at the corner of the mouth and nasolabial fold. If this is the case a facelift would provide a better result and would also provide improvements to other areas of the face.  You could try lipo if the area but it could leave a dent or loose skin.  Then you would have to have a facelift to improve that so you would be paying twice.  It may depend on whether you or the surgeon feels you are ready for a facelift or will be soon in which it makes no sense to pay twice.

Only on the basis of in person evaluation one could make the best decision how to correct asymmetry. Very likely correction using liposuction with small cannula (1 mm)  would be the safest way. Good luck.

Asymmetric results after fat grafting is one of the not to uncommon problems when autologous fat is used as an augmentation technique. When your own body fat is injected under your skin, you do not get a 100% take of the fat graft. In some areas you may get 20% take and in other areas you might get 0% take. This is the rule not the exception. Management includes dilute serial Kenalog injections, HA fillers around the bump, attempted liposuction and avoidance of the technique in the first place.

Thank you for your question.It is difficult to provide an accurate assessment of facial asymmetry from a photo alone.   However, I can speak in general about some possible treatment options for patients who have nasolabial fold asymmetry.  One of the most common ways to treat nasolabial fold asymmetry is with injectable fillers.  With proper technique and the right choice of filler, this could be a non-surgical option to consider.  This option is temporary and depending on the choice of filler will last between 6-18 months.Adding additional fat grafting to the smaller area is another option but requires additional surgery to harvest the fat.  This is a more long lasting option but it would depend on which side you currently like best.  If you like the smaller side, than adding additional volume to the side you like would not be the right option for you.Liposuction is a common way to remove fat in unwanted areas on the body.  However, the smaller the area of unwanted fat the more challenging it becomes to get an accurate amount removed.  This procedure is less commonly performed on the face.A facelift is a surgical procedure that doesn't actually remove the additional fat deposits in the nasolabial folds but rather tightens the overlying skin and re positions the cheek fat pad that has slid down the cheek causing the nasolabial fold to become more prominent. Another option that is less invasive and more accurate for removing small areas of fat deposits and also tightens overlying skin is a procedure called ACCUtite.  This procedure is a minimally invasive procedure performed in the office with local anesthetic.  It utilized radio-frequency energy in a temperature-controlled device to melt the unwanted fat deposits and heat the overlying skin creating skin tightening.  The procedure is very similar to sister procedures, BODYtite and FACEtite, but utilizes a smaller hand piece that allows for more accurate treatment of smaller areas.  It would be best for you to have a consultation with a board certified plastic surgeon who has experience in all of these options so that you both could decide which option, if any, is best for you.I hope this helps.  Best of luck!William J. Vinyard, MD, FACSPort St. Lucie, Florida