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What is the sequence of procedures when facelift, lower bleph and fat transfer are scheduled in one surgical event?

Is there a USUAL or Customary sequence to these procedures that applies MOST of the time. In your practice have you developed a "standard" approach to the sequence of these procedures?

Doctor Answers (17)

Facelift and Fat grafting

+2
I agree that in most cases of combination lower blepharoplasty and facelift that the facelift should be performed first.  I find it easier to deal with the lower eyelid once the facelift is complete due to the shifts in skin and muscle tone with the facelift.  Unlike the other surgeons, I prefer to harvest the fat and inject it after the facial surgery is complete.  My routine is to harvest fat through a small cannula and spin it in the centrifuge for a brief period, remove the oils and serum, and then immediately inject it into the chosen sites. 


Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Sequence for Facelift, Lower Blepharoplasty, and Fat Graft

+2
When doing multiple procedures together, it is best to do any one of them that affects the others first and continue doing so until the last procedure is done.With the procedures you have ask about, I would do the facelift first.Frequently this requires liposuction of the neck.This is a good way to get the fat that you need for injecting into the face later.It also gives you a basis of what the face will look like.Additionally it affects the area around the eye.Next I would do the lower blepharoplasty.Once these are done you know what areas still require attention.At that point you can correct these last areas with the fat grafting.Of course, all this could vary depending upon your particular face and what you are attempting to do.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Sequence of events in multiple procedures...

+2
Similar to the other surgeons, I typically harvest fat first, perform the facelift second, do the upper eyelids third, the lower eyelids fourth, and the fat transfer last. I think that this sequence allows me to evaluate the incremental improvements that result from each step of the procedure and make small adjustments as the contour changes.

Todd C. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

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Sequence of facelift, upper and lower blepharoplasty, and fat grafting.

+2
I agree with the sequence and reasoning of Dr. Hughes: (fat harvest, facelift, upper bleph, lower bleph, then fat grafting). A properly-performed facelift will create vectors of force in a mostly upward and somewhat backward direction. THe upward component of this skin pull causes additional folds or creases in the lower eyelid skin. While some excess skin provides a bit of security to avoid increased scleral show or lowering of the lid margin, it also diminishes the quality of the lower eyelid outcome--a critical part of the entire result!

Since the eyelids are the most susceptible to minor changes causing significantly visible concerns, the best results in the eyelids are achieved after the facial skin has been lifted, deeper tissues tightened, and excess skin removed and the incisions closed. This allows the most precise work on the eyelids to be done, and does not change the facelift results.

Conversely, if the eyelids are done first, the facelift can change the appearance of the lids, altering the outcome and diminishing the quality of the result.

That is not to say that my colleagues who perform things in a different sequence are "wrong," it simply means that they have learned how to compensate for these changes (since I'm certain they don't simply accept suboptimal results!)

While I too like to use the fat as soon after harvest as possible to preserve viability, I don't want to graft a face that I am going to change--I want to graft a face that has already been rejuvenated and needs that little bit of volume correction to yield an even more superlative result. So I harvest before I do the lift, and graft after everything is done with the lift. (You don't paint the house until it's been built.)

Interesting question, but recall Dr. Common's comments about art. Skilled cosmetic surgery involves lots of hard science and technical skill, but the truly outstanding results are achieved by those who have an artistic eye and think 3-dimensionally well! For 7 examples of my facelift patients, click on the web reference link below. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 116 reviews

What is the sequence of procedures when facelift, lower bleph and fat transfer are scheduled in one surgical event?

+2
    I perform fat harvest, facelift, upper bleph, lower bleph, and then fat grafting.  I use fat grafting at the end so that volume deficiencies can be precisely addressed when skin tension issues have been resolved.  I perform the lower bleph after the facelift so that lid laxity is assessed after tension is placed along the facelift flap.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 192 reviews

The sequence of multiple facial aesthetic procedures is at the discretion of the surgeon.

+1
I don't think that there is any preferred order for the operations that you are considering. I do my facelift before I do the eyelid surgery but this is purely a matter of personal preference.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

Order of Procedures in Facial Rejuvenation

+1
This is a great question, and the answer may vary between surgeons, and may be related to specific techniques used, patient surgical positioning, and personal preference.  Most plastic surgeons will address the eyelids before the rest of the face.  There are a couple reasons for this.  First, the lower eyelid skin will be looser at the beginning of the operation; after the facelift, this may be tighter and more difficult to work with.  Second, it is important after the facelift to get a soft compression dressing in place.  If the eyelid surgery is not yet complete, this would delay dressing application.  As for fat grafting, this timing varies more between surgeons.  Some advocate placement of fat grafts before executing the lift, while other finish the lift and then look at the areas that may need extra volume. Best of luck moving forward!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

Sequence of procedures in facial rejuvenation

+1
Multiple surgical facial procedures can be performed during a single surgical event. The sequence of the procedures intra-operatively depends on the surgeon’s preference. A “usual” or standardized order does not warranty that successful outcome across all the surgeons. Different sequences could achieve the same surgical result among surgeons. Patients seeking facial rejuvenation/enhancement though multiple surgical procedures should undergo consultation with a Board certified plastic surgeon specialized on the face

John Mesa, MD
New Jersey Plastic Surgeon
5.0 out of 5 stars 8 reviews

Best Sequence for Multiple Facial Procedures

+1
There is the best sequence but this will vary from surgeon to surgeon.
In order to allow for best execution, personally I will harvest the fat first (from hips, thighs or lower abdomen). The facial procedures follow: blepharoplasty, fat grafting, face and neck lift.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 24 reviews

Facelift combined with other procedures

+1
Facelift surgery can be safely combined with other procedures. Longer procedures may require deeper sedation however. Consult with an experienced board certified facial plastic surgeon. Good Luck!

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

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