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For optimum contouring should I have fat grafting during facelift or later?

Cost and downtime are NOT the biggest consideration for me; results are. Since I was told that fat cannot be grafted in areas where skin is undermined is it preferable to wait until all the areas of my face that need volume can be grafted without the need to avoid some areas? Or was the information I recieved about limitied access due to skin undermining incorrect?

Doctor Answers (23)

Facelift First Fat Grafting Later For Best Result

+5

Thank you for your question. Your surgeon is correct in that fat grafting should not be done beneath skin that is undermined during a facelift. In addition you want your surgeon to concentrate on achieving the best facelift result and not be concerned about avoiding areas that need to be fat grafted.

Another good reason to delay fat grafting as a second procedure 3-6 months following a facelift, is that any recurrent laxity of the facial tissues, especially in the mid face region, at 3-6 months after your facelift, can be improved with fat grafting done at a later date.


Boston Plastic Surgeon
4.5 out of 5 stars 30 reviews

Fat grafting and facelift have no place together. (Same thing with laser resurfacing.)

+3

Since facelift operations involve detaching the skin from the underlying tissues, the level of dissection is a critical component of preserving blood supply to the skin while avoiding damage to deeper structures such as the facial nerves that supply innervation and animation of the facial muscles. Even when surgeons tighten the deeper layers, what we are "lifting" and rejuvenating is the SMAS (superficial musculoaponeurotic system), which is the layer of "gristle" on top of the facial muscles, and continuous with the temporalis fascia and platysma fascia. The facial nerve branches are deep to the muscles, which themselves are deep to the SMAS.

Fat grafting, when done to restore facial volume lost in the aging or weight loss process, is done by placing small living fat globules within the living layers of facial fat that provide oxygen and nutrients to the transferred fat as it heals and develops its own blood supply. This takes small grafts in well-vascularized recipient tissues.

If a facelift is done skillfully and thoroughly, there is fairly extensive undermining and detachment of the skin and a small layer of adherent fat from the deeper fat, SMAS layer and muscles--the very plane into which fat grafts are placed. You can't put grafts into a cavity (even a virtual one) until it has adhered and healed enough to provide circulation to the grafts. If you try to place them in the areas you just "lifted," they have no immobilization and no encompassing tissue for viability.

Which means that IF grafting is being done at the same time as facelifting, either the dissection is "less" than optimal to preserve the graft recipient areas, or the grafting ends up being largely a "sham" operation (or the grafts are being placed deeper where there is risk for damage to the facial nerve branches--not really smart or advisable). There are certain types of facelift that could simultaneously support fat grafting, but deep-plane facelifts have their own issues.

The same thing applies to laser resurfacing. Lifted facial skin has already had its circulation compromised. Lasering the surface can fatally damage skin that has had its healing capabilities diminished by lifting it away from part of its blood supply. Sure, this (facelift plus laser) CAN be done, but only if the facelift dissection is limited (suboptimal) and the laser resurfacing is extremely limited (suboptimal). Or if you're willing to risk dead skin and potentially-horrible scarring. So if you'll pardon the usage, half-baked facelift plus half-baked resurfacing, plus half-baked fat grafting is NOT a "trifecta:" it is hobbling all three horses and proclaiming the last three to finish in a horse race to be "better" than completely and skillfully-performed SMAS facelift, followed by full healing, and then (once the swelling has healed and the surgeon can adequately assess the amount and location of volume deficiency to be corrected by grafting) the proper grafting procedure can be completely and skillfully executed. Laser resurfacing would be optimal when all swelling has resolved and facial lines and residual wrinkles are fully visible and completely-treated by the laser--NOT some half-baked, limited-energy (but usually full-priced) promise for improvement.

Grace, you asked about optimum--and the above is the answer your gut was telling you was correct. I truly believe that in this specific case and example, you are much better off having separate procedures. Doing everything at once is more about maximizing profit for the surgeon and saving you time (and possibly some money) at the expense of the best possible result. I'm not accusing surgeons who do both or all three together of being unethical or inappropriate, just being willing to accept less than "optimal." Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Fat grafting during facelift or after?

+3

Depends... fat has to be deposited into tissue that is able to accept it and keep it alive, and not let it slide around during the healing phase. A surgically dissected area is not the best home for a fat graft. Fat grafts are usually placed into other areas such as deeper, or away from the surgical area. By the way, fat grafts are rarely part of routine facelifts.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Fat grafting and a facelift

+2

The information your surgeon told you may or may not be true. It may be true if he/she plans to do an extensive skin undermining and also wants to do fat grafting more laterally on your face. Sounds like this may be the case. It may not be true if the plan is to fat graft centrally and elevate less skin, then go deep plane.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
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Fat Injection Grafting and Facelifts

+2

Fat grafting can be done at the time of a facelift and where it may be needed can affect the way the facelift is done. It can not be placed in areas of skin undermining and this is most relevant in the midface near the cheek area. Depending upon the amount and location of loose skin, the cheek area may not be undermined so that the buccal spaced can be injected. Central facial areas such as the nasolabial folds and lips can always be injected.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 27 reviews

Fat grafting and facelifts?

+2

Fat grafting can be performed at the same time as your facelift or later -- the decision is between you and your surgeon. You are correct when you say that fat can't be placed in areas that have been undermined or dissected; it has to be placed in areas where it can receive a blood supply and not move around. However, some surgeons will routinely perform fat grafting at the same time as the facelift, while others will prefer to wait till later. I would suggest that you discuss what option would be best for you with a board certified plastic surgeon. Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 8 reviews

Facelift

+1

Can you post a picture of your face? That way we can recommend procedures for you. In general, fat grafting can be done at the same time, but it depends on where the fat is going to be placed. This is where your picture would help as I could tell you where you need the fat.

Best,

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

For optimum contouring should I have fat grafting during facelift or later? #facelift #fat grafting

+1

Thank you for your question. Typically, I perform fat grafting at the time of my facelifts. It will take approximately 1 hour to obtain the fat and then inject it into the regions of interest. The injections are typically deep and will not be affected since the injected spots are not undermined. It is a trend in plastic surgery to re-volumize the face which adds youth to your end results. The amount grafted can range from patient to patient and surgeon to surgeon. Often, I may transfer up to 50 or 100 cc's of fat at the beginning of the operation while the tissue has been un-affected. I hope this helps.

Joel B. Beck, MD, FACS
Bay Area Plastic Surgeon
5.0 out of 5 stars 29 reviews

Fat grafting and face lifting

+1

Fat grafting can be performed at the time of facelift but only in areas that not being elevated and undermined during the facelift procedure. For many examples of face lifting results, please see our facelift photo gallery link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

​Fat graft and facelift

+1

Fat graft and facelift

Fat graft can be done at the time of the facelift quite successfully. the fat is placed into the tissue planes that are not affected by the surgical maneuvers. Also, the techniques of harvesting the fat and placement of the graft are quite important. Not everyone undergoing a facelift needs a fat graft. Only an experienced and talented surgeon can accurately analyze an aging face and determine the best technique. Conversely, some patients can get significant rejuvenating result from fat graft alone.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.