How Are Facial Depressions Corrected With Fat Grafting?
Facial depressions left by injury, infection or surgery rarely fill in on their own. Broad, soft hollows are usually treated with fat grafting (your own fat, injected); deep, tethered scars may need a dermofat graft, a single piece of dermis and fat placed beneath the dent. In 27 studies, 26–83% of grafted facial fat remained (47% on average).
What causes a dent or depression in the face?
A facial depression is a hollow where fat and connective tissue under the skin has been lost, or where scar tissue pulls the skin inwards. Unlike the even volume loss of ageing (see facial fat injection), it is usually confined to one area and follows a specific event:
- Injury: a blow, cut or fracture can damage the fat under the skin, or the healing scar can tether the skin to deeper tissue.
- Infection: a deep abscess, inflamed acne or prolonged inflammation can destroy tissue and leave a sunken scar.
- Previous surgery: contour deformity is common after surgery on the parotid salivary gland in front of the ear [1].
- Skin irregularities: pitted (atrophic) scars and uneven, scar-tethered areas.
The cause may be soft tissue, bone or both, and this shapes treatment.
Will a facial depression go away on its own?
Where tissue has truly been lost, the dent usually does not fill in by itself, but not every early hollow is lasting: swelling and new scar tissue change the picture and can soften over time. So:
- Grafting waits until infection and inflammation have fully cleared. In a dermofat graft study, the fat broke down quickly in some cases where they had not [4].
- A wait of several months is usually advised for scar tissue to settle; timing is decided at consultation.
- If bone is missing, fat alone may not be enough, so bony support is assessed first.
Fat grafting vs dermofat graft: what is the difference?
Fat grafting (facial fat transfer)
Fat is harvested with fine cannulas from an area such as the abdomen or hips, purified, then injected beneath the depression in tiny droplets at different depths. It suits broad, soft-edged hollows that need a smooth transition. The steps are on the facial fat injection page.
Dermofat graft (dermal fat graft)
The top layer of skin is removed and the deeper skin layer (dermis) is taken with its attached fat as a single piece. After the scar is released, the block is placed in the space beneath the dent. As one solid piece, it is considered for deep, sharply defined hollows and tethered scars.
In a study of 13 patients with post-traumatic scar contracture (8) or depressed scars (5) treated with groin dermofat grafts, volume correction and contour were maintained well in most cases without major complications; scar scores improved significantly and average satisfaction was 17.07 out of 20 [4].
Which treatment suits which kind of depression?
No single method suits every dent; the choice depends on width, depth, tethering and the cause.
| Type of depression | Option to consider | Keep in mind |
|---|---|---|
| Broad, soft-edged volume loss (e.g. cheek, temple) | Fat grafting | Part of the fat is reabsorbed; another session may be needed [2][3]. |
| Deep, sharply defined hollow; scar pulling the skin in | Scar release and dermofat graft | Stitched scar where the graft is taken (e.g. groin) [4]. |
| Deep hollow with uneven contour around it | Dermofat graft and fat grafting in two stages | Used for a depression after parotid surgery in Assoc. Prof. Dr. Yalçın Bayram's 2012 case report [1]. |
| Small, mild dent; non-surgical preference | Hyaluronic acid filler | Temporary; needs repeating. |
| Mainly surface irregularity of a pitted scar | Scar revision or skin-surface treatment, with fat if needed | Fat alone may not correct surface scar tissue. |
| Missing bone after a fracture | Bone repair or facial implant; fat for fine contouring | Soft-tissue methods alone may not replace bone. |
Weighing fat against filler? See fat grafting vs fillers and fillers. For bony contour, see facial implants and custom jaw implants for jaw asymmetry.
How much of the grafted fat survives?
Some transferred fat is reabsorbed in the first months; the rest establishes itself. How much remains varies by person and area:
- A meta-analysis of 27 studies (1,011 patients) found measured facial fat retention of 26% to 83%, pooled average 47%, at 3 to 24 months. The authors called the exact percentage unpredictable, noted that the measurement method affected results, and saw a trend towards better retention with repeat grafting [2].
- A meta-analysis of 31 studies (1,572 patients) estimated 12-month retention at about 43% for acquired atrophic deformities versus 64% for mixed deformities, and concluded fat transfer may be less effective for acquired deformities [3].
So a dent from injury or infection may need more than one session. Fat that settles changes with your weight like other body fat.
Recovery timeline and planning from abroad
Facial fat grafting is surgery, usually under sedation or general anaesthesia; a dermofat graft adds a stitched incision at the donor site. Swelling and bruising usually peak in the first 3 to 5 days, and most patients return to social life within 1 to 2 weeks. Over 1 to 3 months the initial fullness fades as part of the fat is reabsorbed, and the face largely reaches its final shape around 6 months, when any further session is considered.
If you travel to Istanbul, most of this settling happens at home. Planning starts with a photo-based virtual consultation and is confirmed face to face in Istanbul; return travel follows the treating surgeon's postoperative assessment. Before flying, confirm your follow-up schedule and how to contact the clinic. See international patients.
What did Assoc. Prof. Dr. Yalçın Bayram's 2012 case report describe?
Published in the Journal of Craniofacial Surgery in 2012 with Assoc. Prof. Dr. Yalçın Bayram as first author, from the plastic surgery department of Mareşal Çakmak Military Hospital, Erzurum [1], the report describes a two-stage surgical approach combining a dermofat graft with lipofilling (fat injection) in a patient with both a facial depression and established Frey syndrome (cheek sweating while eating) after removal of the superficial parotid gland; the authors considered the technique a practical, satisfying and effective solution for Frey syndrome appearing late after this operation.
It reports a single patient, so it does not show that the method works the same for everyone or outperforms other options.
Risks
Both are surgical procedures and carry risks:
- Reabsorption and under-correction: the dent may not fully correct; another session may be needed. Fat can break down faster where inflammation persists [4].
- Irregularity: firm lumps, small oil cysts, waviness, asymmetry or over-correction.
- Swelling, bruising and infection at both sites.
- Donor-site scar with a dermofat graft.
- Rare but serious: very rarely, injected facial fat can enter a blood vessel and cause vision loss or stroke, so it is injected in small amounts, in a controlled way.
The two meta-analyses reported complication rates of 2.8% and 3.4% [2][3]; these do not replace a personal risk assessment. Results vary from person to person, and the right method is decided at consultation.
Who is it not right for?
- People whose infection or inflammation has not fully cleared [4]
- People still healing, whose scar tissue has not settled
- People whose depression has no clear cause or is still progressing
- People whose dent is mainly due to missing bone, until the bone is assessed
- Very slim people with too little fat to harvest; filler may be discussed
- People with uncontrolled diabetes, heart or lung disease, or who cannot stop smoking
- Anyone expecting a flawless correction in one session
Assoc. Prof. Dr. Yalçın Bayram's approach
In the view of Assoc. Prof. Dr. Yalçın Bayram, a specialist in plastic, reconstructive and aesthetic surgery, facial depressions come not only from ageing but also from injury, infection and skin irregularities, and fat grafting or a dermofat graft are options in these cases. In his 2012 first-author case report, a post-surgical facial depression was addressed with a dermofat graft and fat injection in two stages [1]. He performs facial fat injection, using a micro-injection technique with tiny droplets at different depths.
Consultations and checks take place at his Nişantaşı practice in Şişli, Istanbul, where the cause, depth, tethering and bony support of the depression are assessed together to decide the suitable method. See about us or arrange a consultation via contact.
Frequently Asked Questions
Can a dent in the face be fixed?
Often, yes, depending on the cause. Broad, soft hollows are usually treated with fat grafting, deep or tethered scars with scar release and a dermofat graft, and small mild dents with temporary filler. Missing bone may need bone repair or an implant. Suitability is decided at consultation.
How long does fat grafting to the face last?
Part of the fat is reabsorbed in the first months; fat that settles usually stays for a long time and changes with your weight. In a review of 27 studies, 26% to 83% of grafted facial fat remained, 47% on average. Retention can be lower after acquired tissue loss, so a second session may be needed.
What is a dermofat graft, and how is it different from fat transfer?
Fat transfer injects purified fat in tiny droplets. A dermofat graft is a single piece of dermis with its attached fat, placed beneath the dent after the scar is released. It is generally considered for deep, tethered hollows; fat transfer suits broad, soft ones.
How soon after an injury or infection can a facial depression be treated?
There is no single timeline. Infection and inflammation must have fully cleared; in some cases where they persisted, graft fat broke down quickly. A wait of several months is usually advised for scar tissue to settle. Timing is decided at consultation.
When can I fly home after facial fat grafting in Istanbul?
Return travel is planned after the treating surgeon's postoperative assessment. Most patients resume social life within 1 to 2 weeks; the final shape settles around 6 months, mostly after you are home.
References
- Bayram Y, Sever C, Karagoz H, Kulahci Y, Genc G. Two-stage surgical approach with dermofat graft and lipofilling for the treatment of established Frey syndrome and facial depression deformity. J Craniofac Surg. 2012;23(4):e311-e314. PMID: 22801164 · DOI: 10.1097/SCS.0b013e318254320e
- Lv Q, Li X, Qi Y, Gu Y, Liu Z, Ma GE. Volume Retention After Facial Fat Grafting and Relevant Factors: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2021;45(2):506-520. PMID: 31940073 · DOI: 10.1007/s00266-020-01612-6
- Ma X, Huang J, Long X, Wang X. Quantifying outcomes of autologous fat transplantation in different facial deformities: A systemic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2023;87:117-130. PMID: 37837945 · DOI: 10.1016/j.bjps.2023.09.007
- Choi MH, He WJ, Son KM, Choi WY, Cheon JS. The efficacy of dermofat grafts from the groin for correction of acquired facial deformities. Arch Craniofac Surg. 2020;21(2):92-98. PMID: 32380808 · DOI: 10.7181/acfs.2020.00038
Last reviewed: November 2026
Medical review: This article has been medically reviewed by Assoc. Prof. Dr. Yalçın Bayram, specialist in plastic, reconstructive and aesthetic surgery (Şişli, Istanbul). For his background and academic publications, see about us. This article is for general information; the right approach for you is decided at consultation.
