Sharon Osbourne, 74, on her family’s podcast this week, finger tracing a line from the corner of her nose to her chin. An indentation, she called it (People has the clip). Her account: the surgeon took a phone call and handed the work to a colleague. She did not name the surgeon or the operation. Neither will I, and I have not examined her.
But I fix dents. Here is where they come from and what I do about them.
What a Dent Is
A hollow is one of three things: too much taken out, something pulling the skin in from underneath, or volume that left on its own. Each has a different fix.
Too much taken out, in my own operating room, is the thing I watch for constantly:
“Let’s take a look. We have to be careful, because we don’t want to overdo it and then you get irregularities. There’s no fat here, really. It’s really just muscle. That’s all the fat that you have on the other side. We want that amount of fat; that makes it nice and smooth. If I take any more out, then it’s going to look irregular.”
“I would try to get as much as we can without creating any irregularity.”
Something pulling from underneath:
“The thing with the dimples is that you can fill it in, but there’s a band that’s pulling on the skin and creating that dimple. So what we have to do is cut the band. And it pops out. And then we can put a little fat there. Otherwise, it comes right back.”
Fix One: Fat, Placed at the Same Time
Removing a small lump near the eye of a patient who had surgery elsewhere:
“I’ll have to see when I take it out that it doesn’t create a dent. If it does, I’ll put a little bit of fat at the same time to camouflage it.”
That is the habit. Anticipate the hollow and fill it before the patient ever sees it.
“I think fat grafting has been rising for many years. It’s an essential component of almost all facial procedures. I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight.”
Fix Two: Release, Then Fat
“The back, I would try to pop out a little bit with the cannula, so I would release the bands, and then I might put just a little bit of fat so those fibers don’t stick again.”
Cut what is pulling, fill what is missing, in that order. Fat into a tethered dent comes right back out.
| What is pulling the skin in | What I do |
|---|---|
| Too much fat removed | Fat graft to the hollow, or donor fat (alloClae) when the patient has none to give |
| A scar band tethering skin to muscle | Release the band, then a small fat graft so it does not re-stick |
| Volume lost with weight or age | Fat graft; filler as a short-term bridge |
| Tissue repositioned unevenly in a lift | Revision, after the swelling has fully settled |
“We’ve been using alloClae very often. I’m one of the early adopters, and actually one of the first 20 surgeons who was invited to start using alloClae, more than a year ago. The most common places we’re using it are in the breast, in liposuction contour irregularities, and in the buttock, especially for projection or to fill in the hip dips.”
Why Not Just Filler
“Filler cannot really give us a natural feel. When properly done it can give us a natural look, but it’s often overdone. It can also not give us a long lasting result, and this is where fat has its benefits. Now, the main factor that disappoints people with fat injections is that the amount of retention is really unpredictable.”
Filler is a bridge. Fat is the repair. Both have a catch; the long version is in my fat vs filler read.
Fix Three: Revision, and Who Will Do It
“Some patients do come in unhappy with their results and are looking for a revision surgery. This is not possible in the early stages, and patients are usually told to wait until healing has been achieved, which can vary depending on the procedure from three months to a year. For their own particular reasons, many surgeons do not perform revision surgeries on other doctors’ patients. At Southwest Plastic Surgery, I believe that we are here to help patients, and we do perform revision surgeries on other surgeons’ patients, as long as we believe that the results can be improved and that the patient’s expectations are appropriate.”
Osbourne says she is done with procedures. Fair. For the patient who is not, the dent is usually fixable. How I take on patients who had surgery elsewhere is its own post.
Why Choose Dr. Agullo
Double board-certified, by the American Board of Plastic Surgery and the American Board of Surgery. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years. Fat grafting is part of every facelift he performs.
Ready to Talk?
Show me the dent. I will tell you which of the three it is. (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.