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Facial Fat Transfer

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Facial Fat Transfer

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer before and after photos by Sherber and Rad in Washington, DC

Facial Fat Transfer

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dr ariel rad

@drarielrad

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I loved helping my lovely patient feel more confident in her appearance as she felt self conscious about her nose for much of her life. Specifically she was concerned for a “hooked” appearing nose, dorsal hump, severely drooped tip shape especially when smiling, and compromised nasal breathing👃. Her nose distracted attention away from her beautiful eyes so the goal was a naturally balanced result.👁️
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Our single staged plan was closed preservation rhinoplasty to straighten her bridge, lift her tip, and open her airways for better breathing. I did a composite dorsal hump reduction, cartilage grafts to the top of the bridge (radix) and internal airway (internal valves) and then “preservation” tip plasty which involves exposing the tip cartilage structures (called “lower lateral cartilages”), reshaping them with sutures into a more lifted, defined shape. •••
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Recovery was about 1 week for swelling to calm down, and she was back at work in 7-10 days. With her nose in better harmony, it now fades to the background, letting eyes come to the forefront in a naturally beautiful way. 💯
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#faceops #faceoptimization #closedrhinoplasty #rhinoplasty #beforeandafter #sherberandrad

2️⃣ years post FaceOps: In the years before her surgeries with me, my lovely patient was concerned about early signs of aging including hollowing of her under eyes, drooping cheeks, and downturned eyes and mouth corners that she felt made her look older than her young years. Initially she underwent injectable filler treatments elsewhere, but quickly developed “filler fatigue” with progressive and unnatural inflation of her features after successive treatments. She felt as though she was becoming unrecognizable and decided that she wanted to restore and optimize her beauty.💯
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Although a facelift factored into my surgical plan, the overarching question was why her face was dropping faster than her age would predict? Diagnosing root cause is always my priority in order to arrive at the optimal surgical approach, 🎯 and in examining her facial architecture it was clear to me that she lacked optimal bone structure from her lower eye sockets to outer cheekbones, areas which are critical for aesthetic proportions and tissue support. This is what led to premature hollowing and tissue droop. Therefore, enhancing her facial bone architecture was essential both for the aesthetic improvements she desired and also for longevity of her facelift.
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First she had fillers dissolved, and then I planned a two staged surgical approach, first with a forehead reduction, fat grafting and buccal fat reduction for better facial proportions, and also implants made of high-density porous polyethylene (HDPPE), a biocompatible, lightweight bone-like material, to augment her lower eye socket and cheek bones. These implants gave a strong foundation to support repositioned facial fat from a deep plane face and neck lift in the 2nd stage. Additionally, reversing the downward tilt to her eyes with “bridge of bone” canthoplasty, along with an upper lip lift and fat grafting, completed the 2nd stage. Overall she looks even more naturally fabulous than ever and, with optimized midface bone support, her results will last decades, not just years! 💯
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#faceops #faceoptimization #deepplanefacelift #beforeandafter #sherberandrad

🔑 A key aspect of facial optimization is fat grafting, a procedure that can powerfully rejuvenate and optimize a face. I use fat grafting for 4 primary goals:
* Revolumizing hollows such as tear troughs, upper eye sockets, lips and temples.
* Smoothing and perfecting contours throughout the face such as forehead, glabella and radix (top of nasal bridge).
* Refreshing the skin complexion by plumping a deflated and atrophied subcutaneous layer, and also via a rejuvenating effect that I attribute to complex intercellular signaling and the presence of stem cells.
* Thickening and blending the soft tissue cover over orbital rim and midface implants.
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Having treated over 5,000 patients with fat grafting, my technique is precise and refined such that the majority of injected fat is expected to take well and become permanent volume to the target areas. 🎯 That is, when done technically well fat grafting can ok be expected to deliver permanent volume provided the target tissues are healthy. Keep in mind that loss of fat by the somewhat traumatic process of liposuction extraction, purification and injection will cause some fat cells to be disrupted and absorbed. This is normal, but viewed the other way, the portion of fat that takes, typically ~70-85% in my hands, after 6 months is permanent volume. Other factors that impair fat graft survival are smoking, extremely thin subcutaneous layer (fat grafting works better in more voluminous areas), radiated or vascularly compromised tissues, and poor technique.
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“Micro-fat” and “nano-fat” techniques refer to how much fat globules are broken down prior to injection. Micro-fat is ideal for volumization of thick areas such as the midface, temples and lips, whereas nano-fat is ideal for very thin areas such as under eye tear troughs and upper eye sockets. Overall, the skill of the surgeon and tissue quality (as well as lifestyle choices) determine the success of fat grafting and, in my hands, it is a wonderful adjunct to face lift and face optimization! 💯🙌
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#faceops #faceoptimization #fatgrafting #beforeandafter #sherberandrad

❤️‍🩹Loving these early results for my lovely patient after deep plane face and neck lift, deep sculpting, endo brow + fox eye lift 🦊, upper and lower blepharoplasty, and fat grafting. There are 💯s of subtle synergies to appreciate here:
• Her beautiful eyes are restored by the brow and eyelid lifts along with a subtle upward tilt to her eye shape (fox eye 🦊).
• Preop she had excess left eyelid fold on the left side where her brow was higher. This required a precise asymmetrical lift of her right eyebrow and removal of left eyelid skin.
• Her face and jaw look lifted, soft and feminine but not overly tightened owing to a lift of the deep muscle/fascia layer.
• A subtle “Mona Lisa” smile and elimination of the perioral mounds (around mouth bulges) reversed the downward drooping character of her mouth corners.
• Fat grafting gave her subtly enhanced lip volume and balance, as well as a youthful complexion and more curved contours from her forehead to temples to underyes.
• Note the preop flat forehead and temple hollows are now soft feminine convexities.
• Her nose and #11 lines look more aesthetic due to the forehead lift and fat grafting at the radix (top of nasal bridge) and glabella (between eyebrows).
• Lips are naturally plump from fat grafting.
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Creating such subtlety requires thousands of nuanced steps that can’t be rushed during surgery, and take time to evolve and blossom into their full glory which comes at 6 months. She will have so much more beautiful improvements as her results transform in the ensuing months.🔥
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#facets #faceoptimization #facialrejuvenation #blepharoplasty #deepplanefacelift #foxeyes #endoscopicbrowlift #fatgrafting
#deepplanenecklift #beforeandafter #aesthetics #sherberandrad

👁️ 👁️ Eyes are the window to the soul, and much of my work focuses on reversing the appearance of age, fatigue and dullness that often falsely undermine the vitality that patients feel inside. My patient had heaviness of his upper eyelids and wrinkled lower eyelid skin with under eye bags that created deep tear troughs, dark shadows and a crepey texture. I treated him with upper and lower blepharoplasty, to remove excess skin and shift tissue volumes in a more favorable way to eliminate bags and fill hollows beneath them.
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The subciliary lower eyelid lift approach involves an incision precisely under the eyelashes, careful separation of skin from the underlying orbicularis muscle, then transition under the muscle to the orbital septum, a fibrous sheath that contains the bulging fat pads which I carefully release and shift into the tear troughs, like moving a hill into a valley. Many surgeons remove the fat and layer fat grafts which can work well, but using the fat pads, which have a rich blood supply to maintain their volume, to better advantage can improve longevity of results. Fat transposition is more meticulous so as not to entrap or tension the delicate inferior oblique muscle which I always visualize and protect during surgery. And subciliary approach has the advantage of smoothing wrinkled skin though is also very meticulous and has a risk of ectropion. To reduce the chance of ectropion, I routinely support the lower eyelid through orbicilaris muscle suspension before I trim the excess skin and close without tension. 🎯
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Overall his eyes now convey youth and vitality and I’m grateful to have his trust to do such delicate work. 💯
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#faceops #faceoptimization #facialrejuvenation #blepharoplasty #eyelidlift #beforeandafter #aesthetics #sherberandrad

$🫶🏻I love this natural refresh for my patient who wanted to look softer and more youthful but wasn’t quite ready for a full facelift. She was concerned that her eyes looked dull and tired, that she lost significant facial volume. She was also disappointed by the results from a prior open rhinoplasty done elsewhere, which left her with a saddle nose and polly beak deformities. 👃 ••• Her goal was to soften her facial features with subtle volume, brighten her eyes and restore a natural appearance to her nose. I treated her with revision rhinoplasty, facial fat grafting, endoscopic brow lift and upper blepharoplasty. Since her brows were already arched, my strategy was a more of a lateral elongation and slight lift with addition of volume throughout forehead, temples, under eyes, upper eye sockets, midface and lips. The volume you see here is permanent and there’s a beautiful glow to her skin owing to a rejuvenating effect of fat that we often attribute to stem cells (though stem cells were not fractionated and specifically injected). 🎯 For her nose I did a closed revision and corrected the “inverted V” deformity with cartilage grafts which I harvested from behind her ears. Ear cartilage is a soft, supple tissue that is perfect for revision rhinoplasty when the septum is not available due to prior septoplasty as it was not for her. I corrected the supra tip “polly beak” by reduction and then tip grafting which takes advantage of building on a stable foundation rather than reconstructing the whole cartilage framework which can destabilize the underlying structure. ••• Overall her eyes are brighter, warm and inviting and now take the focus of attention away from her nose. She told me afterwards that initially she was nervous to have a big change, but now she’s so inspired by her natural results that she wants the full facelift. Good news is that it’s perfectly fine to have another procedure and aim to restore her face to look decades younger! 💯 • • • #faceops #faceoptimization #facialrejuvenation #blepharoplasty #endoscopicbrowlift #rhinoplasty #closedrhinoplasty #nosejob #beforeandafter #aesthetics #sherberandrad$

🎯 My patient is looking incredible 10 months after deep plane lower face and neck lift with deep neck sculpting (gland reduction), buccal fat removal and chin augmentation. Before we met, he had 2 prior submental liposuction procedures done elsewhere, with no meaningful improvement despite his $8K investment.💰
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When we consulted he had a very bottom heavy face and it was clear to me why the liposuction didn’t work — he is a slender guy with very little subcutaneous fat, the only layer that liposuction thins. The real problem was bulging deep tissues: saliva glands, subplatysmal fat and strap muscles which liposuction does not change. These tissue structures were larger than his mandibular (jaw bone) frame and so bulged especially when his chin was pointed down. 💯% correction required “deep neck sculpting”, a meticulous technique to reduce the deep tissues so that they fit inside the jawbone. Believe it or not *no* skin was removed and I worked through hidden incisions behind his ears and under his chin. Also his bulging lower cheeks were perfect for buccal fat reduction to sculpt his lower face. His chin was already well projected and so I used a pre-jowl implant to smooth the contour from chin to mid-mandible.
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Gland reduction is technically complex due to large blood vessels running through and behind the glands and the hypoglossal nerves which control tongue movement are nearby. In experienced hands it is a safe procedure and crucial to achieve optimal results. Results effectively last forever because these tissue don’t grow back. Now his confidence is higher than ever and has permeated other ares of his life.💪 What do you think about his results? Comment below!👇
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#faceops #faceoptimization #facialrejuvenation #deepplanefacelift #deepplanenecklift
#deepnecksculpting #beforeandafter #aesthetics #sherberandrad

🫶🏻I really enjoyed getting to know and providing care for this lovely young lady from Florida. She was concerned for a crooked deviation of her nose which compromised her breathing, 👃 as well as hollowing under her eyes which made her look tired and distracted attention away from her beautiful eyes.👁️
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When we met in consultation, she had a dorsal hump on her bridge and a crooked nasal curvature to her left. When I tested her airflow I determined that she had a septal deviation and collapse of her internal air passage on one side. Our single staged plan entailed closed rhinoplasty for hump reduction, narrowing and gentle tip lift, and opening her airways for better breathing. For her under eye hollows, I first determined that she had “positive vector” orbital rims, meaning that her socket bone structure is well projected, so her tear trough hollows could be addressed by gentle fat grafting throughout the soft tissues. Patients with positive vector eyesocket structure can get excellent results with fat grafting because the volume required to fill hollows is much less than that for negative vector anatomy, and as you can tell her eyes look so much more refreshed.
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Think of the air passages through our noses as parallel oval-shaped tubes — the top of the tube, closest to the bridge, is called the “internal nasal valve” and when it’s pinched airflow is severely reduced and manifests as difficulty breathing. The treatment for this is a technique called “spreader grafts”. “Graft” refers to a piece of tissue from another area, in this case a thin piece of cartilage from the septum, and “spreader” refers to placing it in the internal nasal valve to “spread” it open. By splinting open the pinched top of the tube, airflow is restored.
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Her beautiful eyes are the focus, now that her nose blends with the background of her face, and her eyes look rested and refreshed. 💯🙌
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#faceops #faceoptimization #fatgrafting #closedrhinoplasty #rhinoplasty #beforeandafter #sherberandrad

FaceOps IG Live! Key takeaways 🔑:
• safety first: to maintain the highest levels of safety, highest level of expertise in surgery and anesthesia and nursing care
• the best results are customized: your face I uniquely 1 in 4,000,000,000 on the planet so our surgeries also need to be customized to each face
• my surgeries are customized and fine tuned to your anatomy & goals — this requires deep discussion - I spend time with you!
• aesthetic optimization is all about millimeter changes throughout the face that synergize and harmonize
• diagnose the problem: deficient bone structure can never be compensated by soft tissue procedures alone
• synergy occurs when the aesthetic result of one procedure makes other areas of the face look more attractive — for example, orbital rim implants enhance both the eyes and the midface
• I use synergistic “proportion effects” to enhance eyes and lips: for example, a rhinoplasty that narrows the nose on front view, or canthoplasty that lengthens the palpebral fissure (ie the eye opening) can make the eyes look slightly farther apart, often a positive aesthetic effect. Similarly a forehead reduction hairline lowering and deep plane face and neck lift can make the eyes look larger.
• the best surgeons in the world are the most meticulous, visionary and technically competent
• how long do procedures last? It depends on quality of tissues, quality of the facelift and the maintenance that you do with neuromodulators, laser (Clear+Brilliant is the most effective; stay away from CO2), skincare with high quality sunscreen (check out “truck driver facial aging”)
• stay away from Renuvion and Morpheus8 which are inexpensive devices that have no feedback control mechanism and can’t modulate the amount of energy delivered to tissues — this can result I get atrophy and microscopic scarring that causes a leathery texture without appreciable skin tightening
• Thermage FLX is the gold standard non-surgical skin tightening device that reliably delivers the right amount of thermal energy to tissues by virtue of its feedback control mechanism.
• no non-surgical treatment can never deliver results like well executed surgery
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🔥Female facial optimization to rebalance the nose and midface can be powerfully transformative yet look incredibly natural. My patient felt self conscious about her nose and under eye hollows, and even compelled to hide one side of her face. Every photo and look in the mirror was a reminder to her that she didn’t look like her best self. 😞
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When we met in consultation, it was very clear to me that a large dorsal hump distracted from her pretty eyes👁️ 👁️ and further her under eye hollows gave her a tired appearance much beyond her early twenty-something age. “Negative vector” eyesockets creates under eye bags and deep tear trough hollows but these are consequences of deficient bone structure, so their correction requires bone augmentation — this is 60% of the solution. Only treating soft tissues with fat grafting, lower blepharoplasty and midface lift is the other 40% of the solution. In fact bone and soft tissue enhancement work synergistically: better bone structure means better soft support which leads to best results and favorable aging. Optimization all around! 🎯
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Our single staged plan entailed closed rhinoplasty for hump reduction, narrowing and gentle tip lift, and endoscopic temporal lift which gave access for orbital rim augmentation with porous polyethylene implants. Scarless lower blepharoplasty fat transposition and fat grafting smoothed her lid-cheek junction, temples and forehead. Her eyes become the focus, now that her nose blends with the background of her face, and eyes are framed to look energetic, vibrant and refreshed just like her personality. 💯🔥
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#faceops #faceoptimization #looksmaxxing #fatgrafting #blepharoplasty #porouspolyethylene #beforeandafter #sherberandrad

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