October 22, 2026 | Facial Rejuvenation, Fat Transfer, Plastic Surgery Recovery
Sharon Osbourne traced a line from her nose to her chin on her family’s podcast this week and called it an indentation from a procedure. She named no surgeon and no operation. I have not examined her. This post is about the dent, not the celebrity, because dents walk into my office every week.
Cause One: Too Much Taken Out
“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.”
That is me, mid-liposuction consult, stopping. The fat you leave is what makes a result smooth.
“I would try to get as much as we can without creating any irregularity.”
Cause Two: A Band 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.”
Scar tissue tethers skin to muscle. Fill it without releasing it and the fat squeezes out.
Cause Three: Volume That Left
Weight loss, age, or a procedure that removed a lump or a gland. On a patient who had a small nodule near the eye after 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.”
| Cause | Fix |
|---|---|
| Too much removed | Fat graft to the hollow; donor fat (alloClae) when there is none to harvest |
| Scar band tethering the skin | Release the band with a cannula, then a small fat graft |
| Volume lost to weight, age or an excision | Fat graft, placed at the same time when I can predict it |
| Uneven repositioning in a lift | Revision after full healing, three months to a year |
The Fix: Fat, Placed Right
“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.”
“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.”
When the patient has no fat to give:
“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 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 bridges. Fat repairs. Neither is free of a catch.
Revision, and the Wait
“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.”
How that works in practice is in my aftercare for patients who had surgery elsewhere post. The commentary version is on drworldwide.com; the non-surgical side is on the Southwest Plastic Surgery post.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. He incorporates fat grafting into every facelift he performs and was among the first twenty surgeons invited to use alloClae donor fat.
Ready to Talk?
Show me the hollow. I will tell you whether it needs a release, a graft, or time.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
