What happened
This week Jessi Draper, one of the cast of The Secret Lives of Mormon Wives, told a podcast and then People that her most recent operation had been her biggest regret. She went in for upper and lower eyelid surgery. Her surgeon suggested adding fat grafting around the eyes. She agreed, and told him to do whatever he thought was needed to keep her face balanced. She says she woke up with fat from her thighs placed around her eyes, in her jaw and in her lips, that the lips had never been discussed, that she looked swollen for months on camera, and that she has spent nine months trying to reverse it, including fat-dissolving injections. Her advice to viewers was: do not get fat grafting. She also said she has body dysmorphia and is done with surgery.
I do not know her face, her surgeon or her chart, and I will not comment on any of them. I am writing because her sentence “do whatever you think I need” is the most common sentence I hear in consultations, and because her story contains, in order, the three ways fat transfer goes wrong and the one way it is put right.
The common misconception
The misconception is that fat grafting is the safe, natural option: your own tissue, no foreign product, nothing to react to, and if you do not like it, it can be dissolved like a filler. Three of those four things are true. The fourth is the problem. A filler is a product that a specific enzyme removes in an afternoon. A fat graft that has taken is living tissue with its own blood supply. There is no enzyme for it. Removing it means either waiting, or surgery, or an injection that was designed for a different part of the body. That is why I wrote earlier this month that fat is a graft, not a filler, and why the decision deserves more care than a filler appointment, not less.
The clinical reality
The first error is the plan, not the fat. Fat goes into the regions we agreed on in the consultation, and nowhere else. How much goes into each of those regions I decide on the table, because tissue behaves differently once it is in front of me and a cheek often takes more than a photograph suggested. That is surgical judgment, and it is the part a patient should leave to the surgeon. The regions themselves are not. If I decide an area we never discussed needs fat, that is a new operation, and a new operation needs a new conversation, not a decision made while the patient is asleep. “Do whatever you think I need” gives me permission to judge volume. It does not give me permission to add regions. A patient who wakes up with fat in her lips after agreeing to fat around her eyes did not get an extended procedure. She got a procedure she did not consent to, and the swelling that follows is the least of what has gone wrong.
The second error is judging a graft at two weeks, or at two months. The pooled data are consistent: across 27 studies and 1,011 patients, about 47 percent of grafted volume survives, with individual studies ranging from 26 to 83 percent, and most of the loss happens in the first three months. So a face that looks overfilled at week two is carrying graft, swelling and fat that will not survive, in proportions nobody can read from the outside. This is not a reason to ignore the patient’s distress; it is a reason not to operate on it yet. I judge a fat transfer at six months, and I say so before the first session.
The third error is trying to dissolve a graft with a chin injection. The injection used to reduce a double chin destroys fat cells where it is placed. It is approved for the fat under the chin, and the systematic review of its side effects notes that safety in other areas remains unstudied and that larger volumes bring more severe reactions. Grafted fat in a lip or under thin lower-eyelid skin is not a submental fat pad: it is small, uneven, close to nerves and to the skin surface. The result is often patchy softening in some spots, firmness in others, and a contour that is now harder to correct surgically than the original overfill was. I do not put fat-dissolving injections into a graft.
What actually works is patience, then a small operation. Once the graft has declared itself, at six months, the excess that remains can be removed with microliposuction: a fine cannula through a tiny access point, taking out the surplus in the same plane it was placed. A 2026 series of 38 patients with overfilled foreheads after fat grafting, revised this way with imaging to map the fat, reported objective flattening and high satisfaction, with temporary eyelid swelling in every patient and short-lived nerve irritation in about 5 percent, all of which resolved. Lips are the most delicate site for this, and the same principle holds: a fine cannula, in small steps, once the graft has settled. Cutting fat out of a lip is more than the problem deserves, and the published revision data are for the forehead, not the lip, so expectations there have to be modest. Either way, the order is fixed. Wait, measure, then subtract. Never subtract from a graft that is still settling.
Some faces should not have been grafted at all, and the reason is not anatomical. Draper linked her decisions to body dysmorphia and to years of being examined in high definition. Last week the UK’s NICE published a draft guideline saying that anyone seeking a cosmetic procedure should be asked structured questions to identify body dysmorphic disorder, and that when it is suspected the procedure should not go ahead. The evidence behind it puts clinically significant body dysmorphia at nearly one in five people attending plastic surgery clinics, against about one in fifty in the general population. Where I see it, I do not operate, and I say why. A graft cannot fix a distortion that is in the mirror rather than in the face, and it cannot be dissolved afterward.
The practical takeaway for patients
Before surgery, agree on the regions, and ask one question: will you add any region we have not discussed? If the answer is “I will do what looks right”, ask again. If it is “I will judge the volume in these regions, and add nothing else without asking you”, you have a surgeon who understands consent.
If you are unhappy early, say so, and then wait. Send photographs at six weeks, three months and six months; the surgeon should want to see the sequence, not react to the first one. Do not accept a fat-dissolving injection into a graft, whoever offers it.
If the fullness is still there at six months, ask what the subtractive plan is and where the access points would be.
If you recognize yourself in the description of body dysmorphia, or someone who loves you does, the right next step is a conversation, not a consultation. The when should I stop page on this site was written for exactly that moment.
Honest limits
The revision series I cite is one center’s forehead work, not lips or eyelids, and the survival figures are pooled from very different techniques. There is no controlled study of removing grafts with fat-dissolving injections, which is precisely why I do not do it, not proof that it never works. And a public figure’s account is her account: it tells me what she experienced and what she was told, not what her surgeon planned or why. My rules are mine. Other good surgeons draw the consent line differently. I would rather be asked.
If fat has been placed in your face and you are not sure whether what you see is swelling, surplus or the result, send unedited photographs and the date of the operation to +90 544 772 0772. The surgical team reviews them the same day and tells you whether it is time to wait or time to plan.
Dr. Mustafa Aydınol is a plastic, reconstructive and aesthetic surgeon in Istanbul and a member of ISAPS.
Sources
- People, 22 September 2026: Jessi Draper on her most recent plastic surgery and nine months of trying to fix it. Link
- 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, 27 studies, 1,011 patients, pooled retention 47 percent. Aesthetic Plast Surg, 2021. DOI
- Zhu M, Xie Y, Zhu Y, Chai G, Li Q. A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring, 22 patients, most loss within three months. J Plast Reconstr Aesthet Surg, 2016. DOI
- Huang Z, Zhang X, Jiang C, et al. Forehead overfilling after autologous fat grafting: literature review and retrospective evaluation of MRI-guided microliposuction for revision, 38 patients. Aesthetic Plast Surg, 2026. DOI
- Pham CT, Lee A, Sung CT, et al. Adverse events of injectable deoxycholic acid: a systematic review of 28 studies. Dermatol Surg, 2020. DOI
- National Institute for Health and Care Excellence. Draft guideline on obsessive-compulsive disorder and body dysmorphic disorder: screening questions before cosmetic procedures, draft guideline and consultation documents, published 17 September 2026, consultation open to 21 October 2026. Link
