I am 41 years old, and was thinking of refining my lower eyelids. I also have some loss of fullness in the lower area of my face, but I have nice cheeks (only they're not as full as they used to be). I wanted to know, will fat grafting or cheek implant (or a combination of both) help?
Fat Grafting or Cheek Implants?
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Cheeklift or Fat Transfer
This aging change is significant, but is often not fully appreciated as a feature which can age the face considerably. When I see a person who is in their sixties or older but doesn't 'look their age' (but hasn't had plastic surgery), quite often they will have cheeks which are full and prominent, a feature that the brain immediately associates with youth.
Cheek area rejuvenation by mean of a mid face lift can be performed as part of a facelift procedure, but is also sometimes performed alone to specifically address deflation and descent of the cheek fat pad. The procedure is performed through two hidden incisions. One is made inside the mouth, at the apex of the space between the gums and the lower cheek. The second incision is hidden behind the hairline of the temple area. Through the intra-oral incision, the cheek fat pad is freed from the cheekbone. A suspension suture is used to grasp the cheek fat pad, and the suture is then passed below the skin to the temple-area incision. Upward traction on the suture elevates the cheek fat pad, and with it the corner of the mouth is elevated slightly. The nasolabial folds soften and in some cases can be almost completely eliminated. The suspension suture is then anchored to the deep soft tissues below the scalp, producing a permanent elevation of the midface.
A technique which does not require incisions or sutures and which I find applicable to more and more patients is structural fat grafting, which involves carefully and painstakingly grafting (by micro-injection) a patient's own fat into areas which benefit from volume restoration. This is an excellent alternative for facelift patients who have flattening of the midface without significant aging changes in the nasolabial folds or oral commissures (corners of the mouth). In selected patients, I have found this to be a powerful but less invasive means of restoring cheek volume and projection.
Structural fat grafting can also be utilized in patients undergoing a midface lift, if additional enhancement of the lateral aspect of the cheekbones is desired. The midface lift and structural fat grafting, alone or in combination, allow me to restore or create youthful cheek and lower lid contours, without the need for cheek implants. Aside from the associated risks of migration, infection, and bone resorption, I feel that cheek implants tend to produce results that are not natural-appearing, and for that reason I do not use them in any facial rejuvenation procedures.
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Fat graft vs Implants
Cheek restoration Stemcell fat grafting
You describe a classical soft tissue atrophy of the cheek mount due to aging. If you did have prominent cheeks it means your bone stuctures are okay. In this situation I would stay away from an alloplastic(synthetic) hard cheek implant because it will give unnatural looking results and prone to complications. The best option is Adult stemcell enhanced fat grafting to replace the lost soft tissue and restore the volume. Because of the stem cell's regenertive effects the take is more than 90 percent and results last for a long time.
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It can depend on your thoughts and your anatomy
Some people are afraid of having implants and this an important thing to consider. I usually use implants to volumize the face when a person does not have a lot of fat to use, for example in women that are physically fit and have little body fat.
After implantation, you can then use the little fat that the person has to augment the implant. I usually do this in two phases with the implant first and then fat grafting at a later date. You also have to consider that fat and implants have different characteristics as well.
Implants require more incisions and usually are placed through the mouth. Fat transfer requires small holes instead of long incisions. Implants can also help in that fat transfering is needed less and cuts down on the need for more extensive fat harvesting.
Fat Grafting Versus Cheek Implants...Can You Say Wayne Newton?
There are many non-surgical treatments that can make you look younger, rested, and healthier.
I would not recommend cheek implants unless you like that Wayne Newton/ Dionne Warwicke full and unnatural appearance (works well for Las Vegas strip entertainers).
Fat transfer is an excellent choice, but is also a surgical procedure.
Sculptra injections by an experienced well trained injector gives very good results without anesthesia, the operating room, surgical scars, or the risk of surgical complications. It is not yet FDA approved for cosmetic use, but some physicians are using it off label. I believe that it will be the filler of the future.
Fractionated CO2 (Fraxel re:pair or Deep FX) will correct all of your concerns, plus give you refreshed skin tone, texture, and color, again without the surgeons scalpel. Again, as with any procedure on your one and only face, it is extremely important to choose your treating physician most carefully.
Good luck and be well.
With the combination of areas that concern you, from lower eyelid aging to cheek fullness to cheek position, it is difficult to know exactly what surgery would give you the best result.
The surgical plan could run the spectrum from injectables only, to lower eyelids, lower eyelids with fat repositioning, a cheeklift (minimal incision, with autologous tissue grafting to the cheek area), cheek implants of even a facelift, all depending on your anatomy and your wishes.
Benefits of fat grafting to the face - Los Angeles
Cheek implants will address the midface, while the fat grafting procedure can be customized to address the entire face in small increments to provide a nice overall improvement. Raffy Karamanoukian Los Angeles
Cheek Implants vs fat transfer
An exam will be required to see if you would be a good candidate for either fat transfer or an implant. Both are highly successful tor the right person. A full discussion re: pros and cons of each would take place at your exam with your plastic surgeon. In my practice most patients now choose to have fat transfer.
Fat grafting is over sold
When I offer a patient a facial aesthetic procedure I want the procedure that I offer to work in the vast majority of my patients with as little morbidity as possible. Fat grafting or injections do not fit this mold. A percentage of patients will get a good result but unfortunately a fairly high percentage will not when followed for over a year. This is due to the inability to quantify from patient to patient the exact amount of fat resorbtion that will occur from patient to patient. This leads to some patients looking over done for an extended period of time, some getting a decent result and some looking good for awhile but when they are examined a year of so latter, the results are less than satisfactory. There are other less common risks such as clumping which although not common can be difficult to repair.
For that reason when I evaluate the midface and lower lid in the aging face I'm looking to see what kind of patient am I treating, an ectomorph (high metabolism, this dermis, tends to develop mid-face fat atrophy over time), an mesomorph (average metabolism, average dermis, and average in terms of fat atrophy over time) or an endomorph (low metabolism, thicker dermis in general and tends to retain fat). I then look at the 3D bony anatomy of the patient. For the vast majority of patients that have hollowness underneath the eye a SOOF lift blepharoplasty works typically for all body types.
I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. As far as improving the nasolabial fold a SOOF lift by itself will help minimally. Most of my patients that have midface laxity have laxity elsewhere and have a deep plane minituck or facelift. I would recommend you avoid endotine lifts in the midface and/or "thread lifts" as in my experience neither is very helpful in the long run. To lift the midface solely a malar pad lift is done in my office with good results. It can be done under local. Occasionally a cheek implant is also helpful depending on the patient and pertinent anatomy. Seek a facial specialist and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.
For temporary, use fillers, for permanent, use implants
Each procedure has both its pros and its cons. With fat grafting, the fat will usually stay in position, but whether or not all the fat grafted will survive isn’t entirely reliable. It depends largely on the skill and techniques used by the surgeon performing the procedure. Additional surgeries are possible for additional corrections.
With implants, there may be the possibility of future procedures related to the implants, but the main issue with implants is that they tend to change your fundamental appearance just a bit. This can certainly be a good thing, but it’s important for patients to be aware of this fact before proceeding. Fat grafting and fillers tend to not affect your fundamental ‘look’ and instead give you a softer and sometimes rounder appearance.
For more temporary results, fillers can be used to enhance the cheek area, and are less invasive. However your costs after multiple treatments can often be comparable to the costs of implants or fat grafting, so talk to your Board Certified Plastic Surgeon. They can then help you decide the best course of action based on your particular situation and goals.