Your Questions

Q: Dr. Eppley, I am interested in getting a chin implant but had radiation for a sarcoma on my chin as a teenager which was over thirty years ago. I have read that you like to inject fat prior to placing an implant in an area that has previously received radiation. But doesn’t the fat just go away?

A: The purpose of the fat injections is not to create the augmentation effect, although it may have some mild benefit in that regard. Their purpose is to improve the blood supply and healing potential of your chin to eventually withstand the effects of placement of a chin implant. Fat injections are well known to help reverse the effects of irradiated damaged tissues through a process known as neovascularization. The fat may indeed partially or completely resorb but it will have improved the blood supply of the tissues through various stem cell and growth factor effects. With your history of facial radiation treatments with the chin as the direct recipient of them, placing a chin implant into these damaged tissues could be fraught with wound healing and infectious problems afterward. At the least, fat injections will help soften the chin tissues in preparation for the stretch effects of what an underlying chin implant will create.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an indented scar on my cheek that needs some type of scar revision. It started out getting an injectable filler treatment (Restylane) that got infected. After antibiotics cleared the infection a few months later the area appeared indented and became a samll atrophic scar.  It then had V-beam treatment for the indentation several months later but only became more indented. It lost whatever fat it had. It is an area under the eye where the cheek fat pad starts where there is a circle that is indented. One surgeon said there is no fat there and that is why it is sunken. I want to know if there a full thickness fat graft or some type of soft tissue implant that can be used to fill it?

A: The scar revision to which you refer is really the need for fat volume restoration. It sounds like you have a distinct area of fat atrophy with scar contracture on your cheek. While this is water over the dam so to speak, the use of a V-beam treatments was ill-advised for that type of depressed scar and did exactly what could have been predicted. That issue aside, options include fat injection or the placement of a small dermal-fat graft that treats exactly what the problem is…lost fat volume. Fat injections involve no incision or harvest site but are somewhat unpredictable in terms of volume retention and do not do a good job of releasing and scar contracture. A small dermal-fat graft would be more effective but it has to be placed somehow through a small incision and requires a harvest site which could be behind your ear.

Dr. Barry Eppley

Indianapolis, Indiana