Considering Fat Transfer During a Facelift or Later Injections?

A traditional facelift in many cases yields lasting results only with the addition of an eyelid lift, rhinoplasty on the nose or facial implants. A more contemporary approach that we have seen develop recently, though, is greater focus on restoring facial volume during, or in addition to having, a facelift procedure with fat transfer or later fat injections.

What happens to our faces as we age?

Growing older is a natural process that leads to tense facial muscles, skin droopiness and what about those fat pads that so nicely held up our cheeks for years? Well, they too start to flatten and redistribute in precarious ways. Even our facial bones lose mass. Darn!

It’s well known that collagen and acids within our skin keep cells hydrated and elastic but that years of laughing, sun exposure, gravity and cell aging alter the histological characteristics of that collagen and increase oxidant levels in the skin.[1][2] 

Fat volumes shift and tend to accumulate in lower sections of their pockets, which is one cause of that triangular fold at the corners of the mouth we so commonly refer to as laugh lines. We expect some areas to puff out and grow more convex while other areas seem to deflate. In older patients with obviously deflated areas of supporting fat pockets, that loss in volume causes the skin to sag without its primary structure in the cheeks to keep it full and lifted.[3]

What is the better approach to plumping up the face with fat?

Whether you opt for fat transfer during operation or fat injections at a later time, the outcome will likely be the same. The differences might be extremely minimal and, in some professional opinions, there are only two things you ought to keep in mind:

1. Will requesting fat grafts during my procedure increase the overall cost excessively?

2. How important is it to me that I undergo as few procedures as possible, thereby reducing my overall recovery time and time I may need to take off work?

Some professionals say that adding this procedure into a facelift would cause the price of the surgery to skyrocket, while others view it moderately as a benefit because you can condense multiple procedures into a one-time, cost-effective treatment.[4]

What should I expect?

Facelift surgeons make an incision into your hairline and around the tragus downwards to the bottom earlobe and sometimes extend into the neckline. If you and your surgeon agreed to introduce fat grafting into the procedure, here are some common things to expect:

• Volume loss is most obvious in the upper cheek and lower orbital rim (undereye) area. Micro fat transfer techniques to plump up these areas will significantly rejuvenate the face.

• Clinicians will gently harvest excess fat from other parts of the body (such as the thighs or stomach region) with a flexible blunt-tip microcannula. The fat gets processed, concentrated then injected via a very small cannula with a feathering technique. 

• Expect that a certain percentage of the transferred fat to be reabsorbed by the body and a slim chance of fat cell necrosis (cell death) but, generally, 60-70% survives indefinitely.[5]

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