Does Analogous Fat Transfer Lead to Sagging Facial Skin?

While not all of the injected fat survives during a fat transfer procedure, the facial skin doesn't become overstretched and lead to more sagging. If the procedure is performed well, the skin should appear less saggy do the replaced volume. 

It's hard to comment on how how much fat survives during a transfer procedure. Gentle handling of the fat grafts during the procedure helps to ensure maximal survival. Also, careful 3-dimensional placement within the facial soft tissues helps to maximize the available surface area for blood vessel in-growth.

An important thing that I tell my patients is that the process of fat graft "take" occurs over many months. Around 6 months after the procedure you'll see a low point (where the swelling has dissipated but the fat graft hasn't yet fully taken hold). From this point on up to about 18 months after the procedure you'll find a gradual improvement as the fat cells blood supply matures. 

 

Your concern is that the initial swelling form the fat injection will stretch the skin and as some fat resorbs that it will cause sagginess.  This is not true since the amount and duration of swelling from the fat (even with planned overcorrection) is not enough to stretch the skin.

Since fat grafting adds volume, it does not create saggy skin. Rather the opposite is true, it adds volume and 'inflates' the saggy skin. We often remark that the aging face is like a deflated beach ball, but the youthful face is full and round like an inflated beach ball.
Essentially, the fat transfer procedure harvests fat from one part of the body where an excess exists and then places it in another part of the body where the additional bulk is used for cosmetic and aesthetic purposes. Fat transfer -- which is also known as fat grafting, fat autografts, autologous fat transplantation, fat injecting or microlipoinjections is utilized in facial plastic surgery to restore lost volume to the face. The youthful face is round, full and heart shaped. The aged face becomes more gaunt, deflated, square shaped and bottom heavy.
Fat grafting achieves a more youthful volume and fullness to the face. Fat grafting may be performed alone or in conjunction with other more traditional rejuvenative procedures such as facelift.