Q: Dr. Eppley, I had a fat transfer to remedy malar crest. Now there is still a prominent dent across the upper line. What do I do now?
A: I would have to see some pictures of your concern, which I assume is a residual malar crease that was unlikely to be improved by fat grafting alone. Malar crescents are rarely completely eliminated by fat grafting alone because there is a tissue sag component to it. It is not just a volume depletion issue alone.. Ballooning the crescent up with fat may be helpful in some cases but often can lead to a fuller crescent but one that still has a visible crease or dent. If you are more than 3 months after your fat grafting procedure, you may need to consider a cheek lift which can be done multiple ways depending on the aging condition of the lower eyelid. Cheek lifts are most effective in middle-aged to older patients who have a more significant aging component to their midface. A combined lower blepharoplasty with cheek suspension can work well in these patients. Cheek lifts in younger patients are more problematic because the lower eyelid is tighter and less aged. This leaves little eyelid skin to be removed with the cheek lift.
Dr. Barry Eppley