Paranasal Augmentation by Dermal-Fat Graft
Q: Dr. Eppley, I am looking for solutions to improve my paranasal area. I have quite chubby cheeks for my age and with my paranasal area slightly sunken in, it gives the illusion or shadows of nasolabial folds, thus making me look quite older.
Where I live, fillers are quite expensive compared to that of Asia and the US and it’s a maintenance cost I can’t afford forever. Mores o, I have heard many nightmare stories regarding the more “permanent” or “long-lasting” fillers, so I would like to stay way way clear of those.
In regards to paranasal implants, I’m not interested in having any foreign materials in my body as I am scared of infections. I have also heard that they can augment a person’s smile due to their rigidness. These honestly are not common in my country either. Moreover, fat grafting in areas of movement in the face don’t seem to last long at all.
Then I came across a dermal fat grafting post on Real Self by you, while I was surfing through Q&As regarding the matter. With your experience of the surgery,
1. What are the pros and cons of using dermal fat grafting to project the paranasal area and get rid of nasolabial lines?
2. Is this a more long lasting and permanent solution to my matter?
3. I understand that some tissue needs to be harvested from somewhere, and that’s something I’m okay with if this is a good solution to my matter. Is the buttocks the only viable area of harvest for someone of my age or is there a more hidden area of harvest available?
A: A dermal-fat graft is a well known procedure that dates back over 100 years. While injectable fat grafting is better known today, there are still roles for dermal-fat grafts for small amounts of augmentation such as in the face. Dermal-fat grafts actually survive better than injected fat grafts on a volumetric basis as long as their size does not become too big. As long as the patient can tolerate a harvest site (the lower buttock crease is just one potential harvest site), such a graft is an option for paranasal augmentation. Given the restrictions you have imposed on material options (no fillers and no implants) fat grafting would be your only option. The debate then becomes should it be an injected fat or a dermal-fat graft? There are pros and cons for either fat grafting approach in the face.
Dr. Barry Eppley