Question: I have heard that fat grafting is great but that in the areas where fat was removed, if you later gain weight, the fat is deposited very unnaturally.  Is this true and, if so, what can be done to reduce this undesirable side effect?

Answer: For the most part, when fat harvesting is performed for facial fat grafting, there is not enough fat removed to cause any contour irregularities in most patients.  It is true that, if fat is harvested from a single location and then a patient gains weight, that there can be an undesirable irregularity to their volume in that area.  I personally prevent this from happening by harvesting fat from a broad fanlike area, typically across the abdomen and, in very thin patients, I will occasionally harvest fat from the inner aspect of the knees.  By harvesting fat in a fanlike or flat area, even if a patient later gains weight, the weight should be distributed across this area quite evenly, and it should not create any sort of visible abnormality.

As you may already know, fat cells do not divide but only get bigger, and we essentially have the same number of fat cells for all of our adult life.  If we, therefore, remove fat cells from one area via liposuction, whether it be for body contouring or for harvesting for facial fat grafting, that area will never have as much fat as it would have had this fat not been previously removed.  Therefore, if patients do gain weight in the future, they will tend to place less volume of fat in the area that had been harvested than they would have prior to the removal of that fat and they will, therefore, tend to place fat in areas that have not been treated.

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Question: I am an African-American female and want to have a nose job so that my nose will not be broad and flat anymore.  My husband is worried it will no longer fit my face.  Can I see in advance how it might turn out?

Answer: Yes, I virtually demand that my rhinoplasty patients see a computer-generated image of their expected new nose on their own face so that we can assure that the patient’s expectations will be met by the planned surgical procedure.  I feel that this not only allows the patient to approve the expected result but it also allows me as a surgeon to create a nose that fits the patient’s face and overall improves their aesthetics, and then I can customize a treatment plan to achieve the desired physical aesthetic result.  I would recommend that you seek out a very experienced rhinoplasty surgeon so that you can achieve your aesthetic goals.

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Question: I have a large birthmark on my cheek and finally, at age 34, want it removed.  Will I have a scar?

Answer: It really depends on what of birthmark you have.  If it is a vascular birthmark, then we can typically treat these with lights and lasers and get a very nice reduction in the appearance of this birthmark without the need for any surgery and resulting scarring.  If it is a pigmented birthmark, it depends on what type of a pigmented birthmark it is but, frequently, we will be able to use an ablative laser to make this birthmark visually disappear or, at the very least, greatly improve the aesthetic appearance of it again without the need for surgical intervention or resultant scarring.  If this is a very pigmented, deep birthmark-type of a pigmented lesion, then surgical intervention may be necessary, and this would result in some sort of a scar remaining but the desire would be to create a scar that is much less conspicuous than the birthmark was.  The scar also would be placed in what are called relaxed skin tension lines, and scars placed in these locations can be very inconspicuous.  Ultimately, I would recommend a consultation with a board-certified facial plastic surgeon so that an appropriate evaluation can be performed and a customized treatment plan can be discussed.

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Question: Will the doctor decide if I need a full facelift or a mini facelift?  I would choose the easiest one to undergo, naturally, but only if it will show results.

Answer: Well, I certainly will direct patients toward the specific procedure that I feel is going to give them the best value but, certainly for patients who are not good candidates for a mini facelift, I will certainly tell them this and discuss the significant limitations or compromises that would come with performing that type of a procedure.  With that said, most patients are excellent candidates for a more significant procedure such as an extended SMAS deep plane facelift or what I call comprehensive facial rejuvenation, which would involve not only a facelift but also typically a browlift, upper and lower blepharoplasty, and Erbium laser resurfacing.  Ultimately, I highly customize my facial rejuvenation procedures for each individual’s anatomic variations as well as their personal expectations and desires.

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Question: I am very overweight and have failed at every diet imaginable.  I want to have a facelift but have been told I have to lose weight first.  Is there any procedure I can safely undergo even though I am heavy?

Answer: I would personally have to evaluate you and your individual anatomic features but I see no reason that someone who is overweight cannot undergo a facelift procedure.  I will admit that heavy faces are much more difficult to contour and provide significant rejuvenation but, due to the fact that I perform extended SMAS deep plane facelifts with platysma plication surgery, my patients typically get very rejuvenating results even when they have heavier faces.  I would, therefore, recommend that you consider a consultation so that we can discuss your expectations and a customized treatment plan can be developed.

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