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Canfield Imaging Case Study, Dr. Lambros

Complications of fat injection/grafting


It is very clear that certain faces age mainly by getting thinner with time. The use of fat or other volumizing agents in the face has become very popular in the last few years. I was on the forefront of using these treatment in the face since the early 1990's, first with fat injections  and then with other fillers as well.  Doctors, mainly dermatologists and non-surgeons  have marketed "liquid facelifts"  for the purpose of filling out the face to make it look better. These products have included Restylane/Perlane, Juvederm, Radiesse and Sculptra. The volumes of these products are usually small and Restylane/Perlane and Juvederm can be dissolved if they make lumps. This is a common  problem around the lower lids.

A bigger problem is the use of fat grafting. In the right hands,  fat injections can be a hugely valuable component of making an older face look better. I do some in nearly everyone I do a facelift on. Smoothing the skin is not enough. Young facial curves need to be added otherwise you are just pulling skin closer to the bone and making the face look more old  (on the other hand if you fill up an old loose face with fat you will get a face the size of a basketball..... which is why you still need facelifts)

Unfortunately many newbies are beginning to do more and more fat grafting in the face and complications can occur. The most common complications of fat grafting happen when it is used in the lower lids. Fat takes here very efficiently and can make lumps in this very noticeable location (there is an article on this on the website). These are difficult to treat; the first thing I try to do is camouflage the lumps with a hyaluronic filler like restylane.  But they may come to surgery or an attempt to remove the fat with a small liposuction cannula. Fat in the lower lids is a difficult problem, and best avoided. Even experts get problems here.

As people are placing more volume of fat in the face I have seen patients come in with overfilled faces. As people tend to gain weight with time the grafted fat can grow, making the face look heavy, or just odd. A little volume is good, a lot is not.

I have been doing this long enough to know when to stop, which is the difficult part of plastic surgery as well as the rest of life. I have also created a few problems myself in the years of experience which taught me how to do this procedure.  

Overdone fat in the face can be removed. It can even be done under local anesthesia though I prefer to add some sedation. In the face it is usually doable  without a great deal of swelling. The lips are an exception, removals here have considerable swelling.


Though uncommon, these problems are treatable.

Dr. Lambros has made substantial contributions in understanding how the face ages, and the role of volume in the aging face.  He has presented these studies for the last 10 years around the US and in Europe. This article on aging around they eye has become a classic already in the sense that it is quoted by all other article in the field. 

The new found appreciation for filling, and not just pulling on the face is in large part from his research and presentations.

Click here to read his article, "Observations on Periorbital Aging."


This following article shows the benefits of filling some upper lids and brows. The old techniques here took away skin and fat and made some eyes look better, and some look considerably worse, overly defined, hollow and old. Dr Lambros has been filling the area with fat since the late 1980's with fat. Hyaluronc fillers, like Restylane or Juvederm work as well or better, last 2-3 years and can even be reversed if need be.

Click here to read the article : "Volumizing the Brow With Hyaluronic Acid Fillers"

"In Your Face," Aging Eyes & Barbara Walters with Colin Stewart

Melville, Nancy A.
, "Stable Landmarks" in Cosmetic Times, July, 2009, pg. 31 - 32.

Lambros, V.S. "The Mirror Has Two Faces" in Healthy Aging Magazine, March/April, 2006, pg. 23.

Lambros, V.S.Lambros, "Observation on Periorbital and Midface Aging" Plastic and Reconstructive Surgery, 120(5) 1367-1377, October 2007.

V.S., “Fat Contouring in the Face and Neck”  Plastic and Reconstructive Surgery,  19(2): 401 - 413,  April 1992

Connell, B.F., Lambros, V.S.,  “Facelift for the Active Male”  in Russell, R., (ed),  PSEF Instructional Courses,  Vol. 4,   St. Louis,  Mosby,   September 1991

Connell, B.F., Lambros, V.S.,  “The Forehead and Eyebrows: An Alternate Approach”  in Vostnes, L.  (Ed),  Procedures in Plastic and Reconstructive Surgery: How They Do It,  Boston, Little and Brown,   April 1991

Connell, B.F., Lambros, V.S., Neurohr, G. H.,  “The Forehead Lift: Techniques to Avoid Complications and Produce Optimal Results”  Aesthetic Plastic Surgery,  13:217 - 237,   1989

Lambros, V., “Fat Contouring in the Face and Neck” Clinics in Plastic Surgery,  19(2): 401 – 414, April 1992

Lambros, V.S., “Fat Injection for Aesthetic Facial Rejuvenation” Aesthetic Surgery Journal,  17(3): 190 – 198, May/June 1997

Lambros, V., “Fat Injection For The Aging Mid-face”, Operative Techniques in Plastic and Reconstructive Surgery,   5 (2): 129 – 137, May 1998

Lambros, V.S., "Aging, Facial Shape and Fat Injection",  in The Art of Alloplastic Facial Contouring,  St. Louis, Mosby,   Chapter 15: 221 - 238,  June 2000



Val Lambros, M.D., F.A.C.S. © 2006

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