Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,

I have experienced a fair amount of acne scars on my cheeks which are quite noticeable and resultant loss of fat which appears to accentuate the scars. The scars are (not ice pick) longer and have left a reasonable depression of the surface of the skin.

I have been to see a few dermatologists who recommend the Erbium fraxal laser and after 4 sessions don't believe there are any real benefits. The most recent Dermatologist said I need to have the fat replaced or built up in my cheeks to fill the areas that have been lost, leading to a possible dermal filler or fat transfer. From what I have seen there are bad side affects of permanent fillers and people are happy to sell short term fillers which last for a year. Additionally the fat transfer appears to have very mixed results.

I personally think a fat transfer is a better option, however I don't really know what the success probability is like.

Could you please let me know your thoughts on fat transfers to fill in acne scars in large cheek areas?

Thanks,
Dave

that is a great question. yes, i know that the word on the street is fat does not last and does not work consistently. as you may surmise from this website, i have seen anything but with my technique. my fat transfer truly lasts and works tremendously well. however, does it do enough for acne scars? not entirely. let me explain that i believe that acne scar depressions need to be lifted up and filled and not further sanded down to become even. as you said it best, this is a question of fat loss and volume loss. i prefer to raise the depressions that are abnormal to match the normal skin rather than sand down the normal skin to match the depressions.

what can fat grafting do? fat is to elevate large areas of volume loss that occur through acne scarring and aging, principally the latter. if you have any signs of aging then fat grafting hits two problems at once. the third unspoken benefit is that fat grafting also can create a stem cell effect to help the skin texture tone and the scar can improve over time. can i promise you that? no, but i have seen it quite oftentimes. if someone is getting fat grafting for aging face and they have acne scars, i put it in all of the scars anyway.

now, if fat grafting is mainly for large volume deficiencies what is better for targeted volume loss? i use silicone to modify rolling depressions rather than fat for two reasons. i do not believe fat is safely used to be placed into discrete holes but rather more widely across the face because weight fluctuations and aging can make asymmetrically placed fat grow asymmetrically. also fat does not have the power to lift etched down scars as well as silicone. if you are wondering the safety of silicone use and how i use fat versus silicone as well as why i do not use other permanent fillers but these two, watch my 3 part video tutorial here: part 1, part 2, part 3 (they are in my video log section). you may also want to watch my recent lecture in st. louis on long-term fat results and stem-cell changes (it is the last lecture in the video lecture section).

in summary, you will almost definitely need silicone to manage the problem. the question is do you need fat transfer as well? that is where a consultation comes into play. if you need large volumes then fat is recommended. if your volume loss that has accentuated your acne scarring is due to aging, then fat grafting is in order. just remember whatever i do for you i can't fix the acne scarring perfectly. i can only improve it.
best,
sml