Facelift or Fat Transfer for Lower Cheek Fat Loss?

I am 37 years old, and my problem area is my lower cheeks. Is it time for me to have a facelift or would fat grafting be enough?

Doctor Answers 13


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You are not ready for a facelift. Don't be talked into it. Fat grafting is very tricking and has a level of uncertainty to it although other surgeons may feel otherwise. A bad result will be very difficult to correct. One test would be to look in the mirror and see what you look like when you make a small smile. Usually you will see a rounding and filling out of the midface region and there is a relative small procedure that can be performed to mimic that look. FInally, it may be important, although perhaps disheartening to know, that sometime there is not a good surgical solution to simple problems. You might need to look a little "worse" before you can do something to make you look "better." I would suspect that you have some familial or genetic features and might try temporizing with cosmotology procedures like light peels. You seem to have a very attractive and structurally advantageous facial anatomy (i.e strong chin point, high cheek bones and angular jaw).

Beverly Hills Plastic Surgeon

Facial hollowing: an early sign of facial aging?

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Oxana, from the photo submitted you have a lot of advantages: excellent facial skeleton, preservation of fat in the midface (upper cheek), lack of mandibular jowls, full lips and unblemished skin. Many women in their mid 30's experience some facial fat lipoatrophy, as we struggle to keep our bodies toned. You could consider surgery, however from what you've shown, your early sign of facial aging is relatively minor and as such can be treated by dermal fillers such as Juvederm Ultra Plus or Perlane. Assuming that you are in Russia, you may even have access to Voluma (a longer lasting Hyaluronic acid filler). By balancing the hollows in the lower cheeks, you can simulate a younger, fuller face and compliment your lips.

Structural fat grafting is a powerful technique, however it does require an operation with subsequent recovery. Almost every woman will agree to fat grafting, however in my experience, the technique is most successful in individuals whose weight is "normal"; their fat grafts persist 3-5 years. By contrast, very thin patients and/or vegetarians tend to experience less longevity.

Facial surgery is more appropriate for individuals whose facial features have more pronounced stigmata: mandibular jowls, looser skin, diastased neck bands, global hollowing. You're not there yet. good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Be careful what you wish for.

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Dear Oxana

The facelift remains one of the most powerful cosmetic surgeries that we perform on patients and there is no question in my mind that it would help your issue. However, this seems like a lot of work for such a small issue. You have to weight the expense and the reality of scars at the edges of the face. As good a job as can be done hidding these scars, they are still present. To my thinking, a facelift is the best option when there are lower face skin or volume issues plus a neck cord. Now the balance is tipped in favor of the facelift over virtually any other procedure.

Fat grafting is a viable option for improving your cheek hollows. However, fat grafting is still a surgery that requires about 12 days of down time and then uncertainty regarding how much of the fat will survive and the possible need to have additional fat grafting procedures in the future. A very good alternative is to fill the cheeks with Perlane. This does not require a surgery or post surgical down time. The longevity is 1.5 to 2 years depending on how much volume you got initially. Yes there is cost but the fact that this is a 20 minute office treatment with not surgery more than balances the longevity. Also think about the fact that your face changes in time. Fat placed there now may not be in the right place 5 years from now. Also if there is an issue with the Perlane, it can be erased with an enzyme called hyaluronidase. Try doing that with a botched facelift, lumpy fat grafts or even Radiesse.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Facelift v.s fat grafting for a young individuao

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You're too young to have a facelift. You have great facial structure, but there are hollowed area that can benefit from fat grafting with PRP to improve them. Please visit a board certified facial surgeon with experience in facial fat grafting. 

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

Fat Grafting, Fillers, Facelift

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The treatment of facial aging should be individualized based on the patient’s aesthetic goals, anatomic findings and social situation.  No two patients are exactly alike and because of this appropriate treatment depends on the patients specific anatomic needs.

In your case, a mini facelift probably wouldn’t address your concerns.  This procedure would address skin laxity, jowls, poor definition of the jawline, and nasal labial folds.  None of these issues appear to be a component of your current problem.

Fat grafting is a viable alternative but requires a surgical procedure.  In addition, there’s the potential for complications at both the recipient and donor sites.

The use of injectable fillers represents a third therapeutic option which may have value for treating loss of lower cheek volume.  Although this treatment is not permanent and may require multiple applications, it’s usually successful at treating this type of problem.  The procedure is associated with high satisfaction rates and minimal complications.

Under these circumstances consultation with a board certified plastic surgeon is appropriate.  This surgeon should be able to help formulate a plan that’s appropriate for your condition.

Facelift or Fat transfer

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Your face looks pretty good to me from the single photo.  The hollowness in your lower cheeks can be filled with either fat or resorbable fillers.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Facelift or fat transfer

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Based on your photograph and age, I would not recommend a facelift.  A facelift will address the jowls, jawline, and neck.  You seem to be in good shape with regards to these.  You do seem to have some depression below your cheeks in an area that may make some patients look gaunt or thin.  Fat grafting to this region works wonderfully and you would likely be a good candidate.  Seek an experienced surgeon for a fat grafting consultation. 

Etai Funk, MD
Houston Facial Plastic Surgeon
4.9 out of 5 stars 69 reviews

Fat transfer would be helpful

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Based on the picture you have submitted and your age, a facelift probably wouldn't address your concerns. A facelift primarily addresses your jawline and neck. While it can help with tightening the cheek, in your case, fat transfer would probably be a better option to give you a rejuvenated midface. With either procedure, results are directly related to the experience of your surgeon!

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.3 out of 5 stars 14 reviews

Options for fat loss in the lower cheeks

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In your case, a facelift would not be appropriate because you don't have jowls or laxity in the neck.  Fat grafts or Restylane could provide volume where you are deficient.

Options for lower cheek fat loss

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Since you are only 37 years old a facelift is probably not in order at this point unless there is excess skin laxity. Your best options are fillers consisting of Restylane, Juvaderm or Sculptra. These are all temporary fillers. Fat injections into the buccal space where the hollowness is present would probably be the best option. Make sure the fat injections are placed in the buccal fat space and not in the dermis. Fat grafting should be enough, but it may take two or three procedures to get enough volume. Cheek augmentation would not be a good option since your cheekbones are high and it would be of no benefit.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 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.