Q: I have lipoatrophy and would like to perhaps have my face lifted and cheeks implants placed in order to achieve a fuller, rounder appearance so I am able to appear the age that I am which is age18. I sent in earlier pictures and I was smiling in them and was told they were unusable so I sent these.
A: Thank you for sending your additional pctures. You probably have the most severe case of facial lipoatrophy that I have ever seen in someone your age. Facial lipoatrophy is classified on a scale of 1 to 5 based on its severity. You are clearly at least a 4 if not a 5. You face is completely skeletonized with essentially no fat, thus resulting in hollowing of the temporal, submalar, maxillary and lateral facial areas. This problem is not treated by any form of facelifting. Rather it requires volume addition, most of whcih must be fat not implant. Submalar implants would be helpful in the cheek area but most of the volume addition must come from fat injections due to the size and location of the hollowed areas. The important question is….do you have enough fat to harvest and transfer? Most medically-sound people with severe facial lipoatrophy are also thin in their bodies, thus having little fat to harvest for the procedure. At a minimum, you need about 30 to 35 cc of concentrated fat per facial side (in addition to the submalar implants), which means that 150cc to 200cc needs to be harvested from somewhere, usually the abdomen or thighs. While that is not much and easy to get from most people, your body may be a different matter.
The pictures you sent are not easy to show the results of volume addition, which is virtually impossible to image from the side view. The front view imaging is not great but it demonstrates what happens when your facial hollows are filled in or expanded. Just think of your concave facial regions becoming more even with the surrounding bone structure.
Dr. Barry Eppley