As a specialist in facial aging, I wrote a book called “The Fine Art of Looking Younger” where I emphasized the process of facial aging: one is sagging and thinning of the deeper tissues called the SMAS (superficial muscular aponeurotic system), the other process is loss of volume through bone, muscle and fat.
Although a fat transfer is a good strategy to improve facial volume, it has a certain rate of absorption. Sagging and loss of volume will eventually occur so a second procedure to add volume is needed to achieve desired results.
I recommend facelift as the first part of facial rejuvenation where the tissues are placed in the proper position. However, after several months, elasticity and regression may happen at the mandibular notch and cause marionette lines. To help enhance volume, I often use fillers called Radiesse or Restylane and strategically use it to meet the patient’s expectations. I also combine fillers with a material called platelet-rich plasma (PRP) which is drawn from the patient’s own blood. This helps with healing and dramatically improves volume. I hope that was helpful, and thank you for your question.