I am 63 and have heard that fat grafting only 'takes' about 35% of the time in older people. I don't want to pay thousands of dollars for something that is not permanent. Will having a facelift help fill out my cheeks or do I need more?
What are most beneficial (and cost effective) procedures to have done to improve my wrinkled Irish skin? (photo)
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Multiple modalities needed here for good result
You have a few things going on here that will need to be addressed. You have some significant sun damage with wrinkling and also diffuse tissue laxity in the face. You will need a face and neck lift, which I would combine with a fat transfer at the same time. Usually about 50% of the fat transferred with survive, and you will need this to help restore some of the volume to your face. When done at the same time as the facelift it will significantly improve the rejuvenation. You will also need some laser resurfacing especially around the mouth. The facelift will not improve these lines at all. There are a variety of lasers which can help, but unfortunately it is very hard to completely eradicate these lines. The laser treatments can be done just around the mouth, or to the whole face depending on the condition of the skin.
Procedures to improve wrinkled skin
From your picture, it does appear that you would benefit from a facelift. This procedure would mainly help with the jowls on your lower face and to help tighten the skin on your neck. The wrinkling on your skin would need to be addressed with a different procedure. Options to help with the wrinkling would be chemical peels or laser resurfacing procedures. Your picture does not show significant volume loss in your face, so you may not necessarily need fat grafting or fillers to add volume to your face. It would be important to see you in person or have pictures of your face from different angles to determine if you might be a candidate for adding volume to your face or not.
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Facelift and hollow cheeks
Every face requires an individualized approach for a facelift. Some facelifts will require a fat graft, while others a very specific lifting techniques to fill out a hollow cheek. Few patients can achieve a dramatic result with fat graft alone. In your particular case you would require a SMAS type of a lift with skin resurfacing to achieve your desired result. Properly performed fat graft results in permanent result. Seek out an experienced and talented facelift surgeon that can deliver the promised result.
What are most beneficial (and cost effective) procedures to have done to improve my wrinkled Irish skin?
A face and neck lift will produce the greatest improvement. Fat grafting can be done as an adjunct. Find a plastic surgeon with ELITE credentials who performs hundreds of facelifts, necklifts, facelift revisions, and facial procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA
Facelift and resurfacing
Based on your picture you would benefit from a few procedures to address your age related changes on multiple levels. First off, you have skin laxity and soft tissue decent with looseness in your face and neck. A facelift would give you the most long lasting and dramatic improvement in your cheeks, jawline and neck. You would also benefit from some volume in your cheeks and throughout your face and I think fat grafting is a great option as a supplemental procedure to a facelift, but would be disappointing and not worthwhile on its own. Your Irish skin tone is very susceptible to sun damage and age related changes and to address some of the deep set lines and skin texture changes, a deep resurfacing procedure would be beneficial. A deep phenol based chemical peel would be a great option for you. Deep resurfacing cannot usually be performed at the same time as surgery. Other resurfacing options include CO2 laser resurfacing or dermabrasion.
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