I am considering autologous fat transfer to face as part of facelift surgery, as recommended by one facial plastic surgeon. However, another plastic surgeon believes once tissue is elevated by facelift procedure alone, I may not need the fat augmentation to my cheeks. My question is not what to do, but if doing fat grafting/injection at a later date is likely to "take" as well. (I've heard fat grafting has better success rates if done during surgery.) Thank you in advance for your comments.
Any Advantage to Fat Transfer During Facelift Vs Injecting at a Later Date?
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Doctor Answers 27
Fat transfer with facelift
I prefer to perform grafting at the same time as the facelift, in areas NOT undermined by the facelift.
What is to keep the graft there when it is placed between two skin flaps? What is to prevent the fat injection grafts from shifting or moving? The answer is nothing.
Grafting into areas NOT undermined are effective. Grafting into areas of the facelift that ARE undermined is less effective because the grafts can move.
Fat Grafting with Facelift
Facial plastic surgery has been undergoing a paradigm shift in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older subtractive techniques to newer restorative techniques. Natural looking plastic surgery is in demand.
Surgery which consists mainly of removing (subtracting) skin and fat, and pulling tissues tight will lead in many instances to a skeletonized and therefore more aged (or done) appearance.
This approach to plastic surgery often results in the "wind tunnel" look that screams, "I've had a facelift" Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion age the face.
The contemporary approach to surgical rejuvenation of the face consists more and more of restoring facial volume and contour in an attempt to emulate youthful facial features.
Specialists in plastic surgery will first maximize repositioning and recontouring of facial aesthetic areas and remove only as much tissue as necessary.
Structural fat grafting, using a patient's own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. Structural fat grafting does not require incisions or sutures and is applicable to more and more patients.
It involves carefully and painstakingly grafting (by micro-injection) a patient's own fat into areas which benefit from volume restoration. In selected patients, this is a powerful but minimally invasive means of permanently restoring cheek volume and projection.
The goal of aesthetic plastic surgery today is to provide a natural, not "done" result. When performed expertly, friends and family of an aesthetic surgery patient will often comment that a patient looks great, but can't put their finger on what the change is.
Facelifting and fat grafting/transfer
Fat grafting/transfer is an excellent procedure to have along with a facelift. As we age we lose volume in our faces and a facelift can only do so much to restore that loss through repositioning the fat in the cheeks and jowl area. In the typical facelift patient, many areas remain after lifting that need volume resoration such as the malar areas, nasolabial folds and marionette lines, jawline and others. I perform fat grafting after the facelft is completed but at the same operation. It is an easy convenient way and much easier on the patient than undergoing a separate procedure. I am not aware of any studies that show that there is an advantage to fat grafting at the time of the surgical procedure or later at a separate time. A detailed discussion with your surgeon should lead you to what is best for you.
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Fat transfer can be done with or without a facelift.
The results will be the same. It is usually done at the same time so that you have only one recovery time and it is cheaper.
Fat grafting with facelift is all about volume
I don't buy the argument that the take of the fat grafts is better after the facelift as opposed to during the procedure. Fat grafting and the other things that are done under the skin during a facelift are an important part of reshaping the face.
People tend to think of facelifts as just pulling on skin, but it is a 3-dimensional concept. That is one of the keys to having it look natural. If you save it for a later date, then the appearance after the facelift and before the grafts is not what you would want, and then there is another recovery time with some swelling and so forth.
Facial lipoinjections and facelifts
Fat grafting to the face is a great idea at the time of the face lift
The reason for the fat grafting at the time of the face lift is to replace natural loss fat from the face. The process involve grafting the fat to the deep layers that not undermine with the face lift. The main advantage of the grafting the fat at time of face lift is that you get a 3 dimentional lift and less lateral pull. Fat grafting results depend on the surgeon' experience.
Fat Transfer During Facelift Vs Injecting at a Later Date?
Fat grafting can be inconsistant under the best of conditions. The keys to successful fat grafting are: acquiring the fat with low suction pressure, properly preparing the fat for grafting, and micro-droplet injections. The reason of the latter is that small grafts are more likely to get a good blood supply before they dissolve than large grafts. So adequate blood supply is paramount for the fat grafts to survive.
This leads us back to the question of fat grafting during or after the facelift. Fat grafting must be done in areas that are not being elevated during the facelift. There is inadequate blood supply in any area where skin has been elevated for fat grafts to survive. Areas that can be grafted would be around the mouth, lips, and even under the eyes and in the pre-jown sulcus (the depresson in front of the jowl). Any other areas, such as the cheeks or jaw, fat grafting should be done during a second procedure.
Fat Graft to the Face and Face Lift Surgery
I prefer to perform fat grafting to the face at the same time as the facelift.
Performing facial fat grafting at the same time as a facelift saves the patient an additional surgery, recovery time, and money.
There is no survival advantage for the fat if it is grafted or injected into the face at the time of surgery or at a later date. However, it is important for the fat that is injected at the time of surgery to be injected in areas that have not been aggressively undermined or dissected. This will ensure maximum vascularity to the grafted fat and maximum fat graft survival.
Jaime Perez, M.D.
Face Lift Specialist in Tampa, Florida
Plastic Surgery Center of Tampa, Florida
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.