Q: Dr. Eppley, can micro iposuction remove lumps from fat injections or it can only help removing the natural fat that is already there? The problem in that I have fat lumps (10 lumps n both cheeks varies which vary size between 5-10 mm) mainly found near the mouth, along the nasolobial folds and two lumps in the bottom of the cheeks. If these lumps can’t be removed by micro liposuction, what would be the way to remove them? Does radiofrequency help melting the fat? I already took 3 sessions and will take three more (machine is Endymed, temp used was 40C and 37 Watts) Would it be effective in melting the injected fat whether it’s lumpy or soft?
A: Certainly removing undesired fat collections (lumps) is more challenging than the original fat injection procedure. Any technique for facial fat removal (small cannula liposuction or any energy-based external therapies) are more effective for general fat removal rather than discrete fat lumps. Either surgical and non-surgical methods have their advantages and disadvantages. Small cannula liposuction (aka microliposuction) can access all your involved more central facial areas from small incisions inside the corners of the mouth. It would also be somewhat effective at breaking up the harder fatty lumps and likely removing some of their mass effect. (probably more effective at breaking them up than removing them) Conversely, topical energy-based devices are non-surgical and require no incisions but they will have a heat field effect, meaning they will create an overall fat reduction in the fat not necessarily just the lumpy area. I would be somewhat concerned with these energy-based devices that you might trade off one problem for another.
Another option would be injection therapy right into the fatty lumps if they can easily be felt from the outside. Very low dose steroids and old-style ‘lipodissolve’ (deoxycholic acid) solutions can be effective and I have used them successfully in the past for the exact problem that you have. The better ‘lipodissolve’ solutuion, ATX 101, has recently been FFA approved for facial fat reduction (technically submental/neck fat) and would be the best injectable solution as soon as it becomes commerically available later this year
Dr. Barry Eppley
Q: Dr. Eppley, I had facial fat grafting six months ago with 30 cc of on each side of the face into the bottom of the cheeks, smiles lines, nasolobial folds and near the mouth! This has unfortunately lead to a very bad new look! Fat lumps develop in the above mentioned areas as fat was injected too superficially. I read a recommendation from Dr Eppley on RealSelf that fat can be surgically excised! Would like to know more about this procedure! is it done from outside the cheeks or from inside the mouth?
A: There are numerous methods to try and reduce excessive fat contours after facial fat grafting. Surgical excision is rarely used unless the fat is located in an area that is easily accessible through a facelift or blepharoplasty incisions. Small cannula or microliposuction is the most effective method near the central face and mouth areas. This is usually done through a small incision inside the corners of the mouth.
Other non-surgical options to get rid of fat grafting lumps include steroid injections (low dose Kenalog) and the use of deoxycholic acid solutions. (originally known as Lipodissolve injections and now under clinical trial investigation as ATX101 by Kythera)
Dr. Barry Eppley