LAM FACIAL PLASTICS

Dr. Lam, thank you in advance for taking the time to answer my question. I read a lot of your posts and have seen a lot of your wonderful fat transfer results (they make me wish I had chosen you as a surgeon a year ago); I hope you can give me your skilful opinion.

A year ago I had fat injected in the malar area. The fat injected into the right side of the face feels firm. It feels like a (quite) hard area - which appears to be located on the bone - the area is about 1.2 inch long.
I'm confused since - having read some information I found online - one surgeon mentioned fat injected onto the bone generally feels firm, however, some surgeons mention injected fat should feel soft (after a couple of months). I know by fact my surgeon didn't use a lot of parcels injecting the fat (since no general anesthesia was used), and about 5 cc was injected into the right malar area. My first question is whether in your opinion fat injected onto the bone indeed feels firm (after the recovery period of several months), or whether it is to be expected the fat graft feels firm since the too much fat was injected (using too little passes to inject the fat).

My concern is overprojection: the right cheek is overprojected and since the overlying skin is quite thin, the outlines of the graft are visible.
I'm wondering how such a firm graft can be removed - taking into consideration the graft is about 1.2 inch long, which makes me wonder whether excision would be too invasive. I read your explanation about lumps and bulges and the best way to treat them, but I'm not sure how to catogorize the firm area I'm experiencing post-surgery.

Thank you Dr. Lam!

first i have not seen a firm lump deep in the malar region or the idea that putting it near bone would make it hard. my fat is very soft after the first 2 months. the only thing i have seen is a patient who came to me and had a firm cigar roll under the eye due to incorrect placement. i used 5-FU to manage the area not because it was firm but because it was sticking out. if you have firmness and an area sticking out, then you should possibly have that area injected with 5-FU that can bring the area down. however, to reduce a huge area of over injection, 5-FU is not as reliable. it is more reliable for small discrete areas of firmness. i don't know what the firmness is exactly. my best guess is some kind of tissue response to large boluses of fat placed but i could be wrong. i don't put fat in that way so i don't know. i also put a ton less fat than most physicians. if the area is simply overcorrected, then that is a harder thing to correct. i tend to prefer microliposuction but i don't have much success with it. to cut it out requires a scar, which is many times an unsavory prospect. i would have to see you to figure out some thoughts.
best,
sml