Are Fat Injections Necessary Before Facelift?

Hi Doctors, I'm a bit confused--some doctors favor fat injections while others say stay clear. I have been offered fat injections to upper lids, cheeks, nasolabial folds and marrionette lines along with a facelift.

I am now wondering if I really should have the injections as so many people are unhappy and the doctors are not in agreement. Thank you for any answer you can give about this.

Doctor Answers 6

Are fat injections necessary before facelift?

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"I have been offered fat injections to upper lids, cheeks, nasolabial folds and marrionette lines along with a facelift."

1. The danger of blindness and injury to the eye globe being VERY high and the benefits being so few due to the thinness of the skin, No ethical surgeon would EVER inject fat into the upper lids. if this indeed is what happened, I would find another surgeon.

2. As we age 2 processes take place, we lose facial bone mass AND we lose fat from our faces giving rise to the deflated face look. IF your face is deflated in certain areas, you would lose nothing (except for post operative swelling and potential incomplete "take" of fat grafts) by having fat grafting of those areas.

BUT - if there are areas that bother you, then I would do it only to restore the youthful upside tapered face, not to just squirt fat in there.

3. I would NOT do it before a facelift if you are planning on having a Facelift since it can easily be done at the time of a Facelift.

4. If you were asking would fat injections do away with the need / benefit of a Facelift ? NO they would not. Fat grafting does not lift and reposition fallen tissues, it only fills the tissue where is sits now.

I hope this was helpful.

Peter A Aldea, MD, FACS

Memphis Plastic Surgeon

Understanding Fat Grafting - Look at Photos!

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Obviously it appears as though there are as many opinions on fat grafting as there are plastic surgeons, and this must be profoundly confusing to prospective patients. I would encourage patients to view before and after photos on a plastic surgeon's website as evidence of expertise with fat grafting.
A number of physicians responding in this thread have made dogmatic statements about various procedures that may very well represent their own personal experience and preferences, but that do not necessarily provide interested laypersons with a balanced and accurate view of the options currently available for restoring facial soft tissue volume.

I think that the primary reason that fat grafting is rated low in RealSelf is that there is such a wide range of techniques, instrumentation and experience among the surgeons that perform this surgical procedure.  Because of the tremendous variability in all of these factors, there is tremendous variability in fat grafting results.  To perform fat grafting successfully and reproducibly a surgeon must employ careful preoperative planning, appropriate instrumentation and meticulous surgical technique.  It is not something you can 'rush through' or spend just a few minutes on during a larger surgical procedure.  The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.

One must also have an aesthetic vision for ideal and youthful-appearing facial fullness.   Just like traditional facelift surgery can be overdone or performed incorrectly to produce an unnaturally tight, pulled, 'windswept' look, fat grafting can be overdone to produce an excessively full and even bizarre postoperative appearance.  Too much fat grafted into any area (or any fat placed where it doesn't belong) looks unnatural.  It's analogous to breast augmentation results: if the surgeons selects an appropriate implant volume and positions the implants correctly, the patient gets a beautiful, natural-appearing breast enhancement.  If the surgeons stuffs a pair of 500cc implants behind the breasts of an average-sized patient, then that patient ends up with a cartoonish 'boob job'.  I think many of the unfavorable results in fat grafting are from the overzealous placement of excessive amounts of fat, which may have been the inevitable response to the recent paradigm shift in aesthetic facial surgery: away from the 'wind tunnel look', and towards the restoration of soft tissue volume.

Here is one patient’s experience with fat grafting posted to RealSelf:

Fat is great when used JUDICIOUSLY and CONSERVATIVELY, but too much of a good thing becomes a nightmare and deeply regrettable. Make sure your surgeon listens, draws up precise operative plans beforehand and makes plenty of time for you and your concerns. Do NOT take it lightly.

I couldn’t agree more with this patient’s response to her experience with fat grafting.  Just like breast implants, or liposuction, or browlifts, too much of a good thing is not at all a good thing.  And cosmetic surgery (and this includes the preparation for surgery) of any kind without attention to detail and a focus on natural-appearing results will leave patients feeling disappointed at best and feeling disfigured at worst.  Now regarding whether or not fat grafting is a surgically sound concept…

For transferred fat to truly qualify as a 'graft' the following must happen: living tissue must be transferred to a new location, and that tissue must gain a blood supply at the new location which provides oxygen and nutrients which allow it to persist indefinitely as living tissue.  We know that with appropriate instrumentation and technique this is achievable, so one of the opinions expressed in this thread that "most of the cells from fat injection are dead " is simply untrue (and structural fat grafting, to be clear, does not involve 'injection' of fat).  MRI studies have shown that with appropriate technique grafted fat persists long-term as living, vascularized tissue in the recipient site.

It is also well-established that adult human fatty tissue contains stem cells that have the capacity to repair damaged or injured tissues, and stem cells can be concentrated during the fat harvesting process.  This effect has applications in both cosmetic and reconstructive surgery.  Fat grafting is now being used, for example, as a means to stimulate the repair of chronic, non-healing wounds.  Several centers have reported on fat grafting immediately below non-healing chronic wounds resulting from radiation therapy for cancer, with rapid improvement and eventual healing of wounds for which no other wound treatment was successful.  The development of stem cell therapies involving the harvesting and processing of viable human fatty tissue is one of the hottest topics in both clinical and experimental medicine today.

When performed correctly fat grafting actually has the capacity to heal, revitalize and rejuvenate the local tissues at the recipient site.  I have treated a number of patients with facial fat atrophy following overly aggressive 'non-invasive' rejuvenation treatments including Thermage, Fraxel and IPL.  Most of these patients report not only an aesthetically  pleasing and permanent improvement in facial soft tissue volume, but also an improvement in the quality and vitality of their facial skin.

I perform extensive facial fat grafting during most of my facial rejuvenation procedures, and it is the very first thing I do - before making any incisions to lift the brows, eyelids, face or neck.  Fat grafting allows me to obtain results that are simply not possible with conventional, subtractive surgical techniques alone.  Patients frequently return for grafting of additional areas after their initial experience with strucutral fat grafting.  To characterize it as the pointless and potentially harmful placement of non-viable tissue is an opinion only, and it is an opinion with which quite a number of plastic surgeons who successfully rejuvenate faces (and breasts and bodies) with fat grafting would vehemently disagree, myself included.

Solid fat/fascia and fat dermis grafts are another means by which facial soft tissue volume may be significantly and permanently enhanced.  As with fat grafting, survival of the grafted tissue is variable and some of the graft material is reabsorbed.  As with fat grafting, potential complications such as infection and cyst formation are possible.  And as with fat grafting, appropriate preoperative planning and surgical technique are required in order to obtain ideal and lasting results.  In my opinion structural fat grafting is more versatile, as fat can be easily and rapidly added to any tissue plane (level); and it has the added benefit of the ‘stem cell effect’ which is difficult to quantify but unquestionably present in many cases.

Both structural fat grafting and fascia-fat (or dermis-fat) grafting can be competently performed (or not) by Board-certified plastic surgeons.  Neither should be trademarked or considered proprietary.

As with any surgical procedure take time researching your plastic surgeon. Schedule several consultation, view many photos from many patients, each from multiple perspectives (start by looking at photos on this website) and speak to former patients of any plastic surgeon you are considering.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

The short answer is no

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The concept and practice of fat injections has been around for some time. In recent years, it has received a newer ground swell of interest. The efficacy and safety of the procedure is somewhat debatable, but certain facts will remain true:

1) Fat injections will not replace a Facelift for an individual who needs a Facelift.

2) Fat injections are very technique dependent. Some surgeons get great results, many do not.

3) Fat injections carry with them the native properties of the fat cells (adipocytes). When you gain weight, the injected fat cells can be expected to increase in size.

4) Fat injections can be less predictable than fillers in results. In addition, fat injections carry the morbidity of a donor site harvest, which is not necessary with fillers.

Fat injections are designed to restore volume. If this is a physical finding which can be improved upon aesthetically, fat injections may help you. However, fillers remain as very effective alternative in correcting volume deficiency

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Fat injections can be useful together with facelift.

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As we age, we lose volume in our upper face.  So fat injections or fat transfer can improve the results of a facelift.

The problem is that fat injections are quite difficult to do well.   So ask to see lots of before and after pictures.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Fat Injections for Facial Rejuvenation

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There isn't one correct answer. The anatomy and desires of every patient are unique.

Some plastic surgeons inject fat exclusively into the face and avoid traditional facial plastic surgery. Some plastic surgeons always add fat injections, in addition to, traditional facial plastic surgery. Some plastic surgeons avoid fat injections all together, although this group is likely in the minority. Each of these groups of plastic surgeons will have great results and suboptimal results.

Fat injections are typically given in the nasolabial folds, marionette line, cheek areas, and prejowl areas. Upper eyelid fat injections are less common, and more often avoided by plastic surgeons.

Plastic surgery is a balance and compromise of patient anatomy, desires and expectations, plastic surgeon training and expertise, and safety. Only after a comprehensive evaluation can a plastic surgeon determine the best option for you. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Fat transfer needed befroe facelift?

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They are not "necessary" but are a common adjunct to enhancing the final result.  Even without a facelift they are used as a filler would be used; to enhance volume, not correct age related descent of tissues.

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.