Can Injectable Fat Grafting Be Done Over Cheek Implants?

Q: Dr. Eppley, I am interested in your facial fat grafting procedure.  I am a fairly young guy, 38 years old and in good physical shape.  I have always had a very tired look under my eyes.  I had cheek implants and orbital rim implants placed.  They helped, but the problem is still there. I could also use more volume in the upper cheeks, and help with rounding out the edges of the implants. My questions are as follows: 

1) How many facial fat transfers do you do per year?

2) Can fat grafting be done on someone with orbital rim and cheek implants?  

3) Have you personally operated on many people with cheek/orbital rim implants?

4) Is there a chance of your needle touching the implant and causing an infection?

5) Is the procedure done under general anesthesia or would I be awake?

A: Fat grafting to the face today has become very popular and is commonly performed despite the reality that the survival of the injected fat is far from assured. It has reached the current state of widespread use because of its easy introduction to nearly any facial area, its natural composition and the potential benefits of some cellular survival particularly its stem cell component. In answer to your questions:

  1. I perform fat grafting as part of many facial procedures, either done alone or in combination with more invasive procedures. I would estimate that it exceeds over fifty facial fat grafts per year.
  2. Fat grafting can be done on someone with any indwelling form of facial implants and may be placed in the soft tissue overlying them.
  3. I have placed fat grafts in patients with indwelling cheek and infraorbital rim implants and at the same time as the placement of the same implants
  4. Fat grafts are placed by blunt cannulas, not needles, so there is little chance of injecting into the actual implant pocket. I suspect that even in the rare instance where fat may have been injected directly into the implant pocket no adverse sequelae would result.
  5. I have performed facial fat grafts under local, IV sedation and general anesthesia. The choice between the anesthetic type depends on the patient’s preference, the amount of fat to be injected and the location and size of the donor site.

Dr. Barry Eppley

Indianapolis, Indiana