Fillers or fat grafting after deep plane facelift?

Question

I had deep plane facelift 6months ago and noted my face started sagging soon after the procedure. My surgeon says I have ”lazy smas” and refuses to revise. I do not wish another invasive procedure either so was thinking about just fillers or fat grafting. The sagging is significant on mid face area and under the eyes. But my tissues are scarred and fibrotic after the procedure. Would the fat even stay in scarred tissue? Are fillers more risky in such tissue?

Cory Bovenzi, MD · Answer

After facelift surgery while you have scarring in the planes of surgery, both fat and fillers can be used. There is theoretically a very small chance that the blood supply to the injected fat would have a harder time growing through old scar but it all depends on the areas of dissection during your original surgery and where the fat is injected- but this likely would not cause any noticeable effect on fat resorption, etc. Fillers are not riskier in tissue after facelift surgery.
Overall, I would not change your decision on fat vs fillers based on the fact that you had facelift surgery in the past.

Jonathan Kulbersh, MD · Answer

Thank you for your question. A facial fat transfer can volumize various areas of the face to address the sagging which you describe. Fat grafting can restore volume to sunken areas beneath the eyes and cheeks to create a more youthful appearance while improving the quality of the skin. Results from a facial fat transfer can be long-lasting and even permanent for some patients.
Facial fillers are another non-invasive way to lift sagging skin and add sufficient volume to the face with results that may last for approximately 6-12 months. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and medical history and help you decide on the best approach.

Michael A. Persky, MD · Answer

Hello Joan,
I have treated many patients like yourself after their facelifts.  The good news is that the fibrotic or scarred areas respond better to the treatment than "virgin" facial tissues.  I would treat you with biostimulatory filler (Sculptra) combined with either Ulthera or Profound RF.  I would not recommend fat transfer.  Feel free to contact me for either a virtual or in person consultation.  The most important aspect of your treatment is making sure that your choose your treating expert physician very carefully.  Good luck and be well.
Michael Persky, MD
Encino, CA

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi JoanX. Sorry you're experiencing trouble after your deep plane facelift. I haven't heard of the term "lazy SMAS" to comment on what that means. If done correctly, there should be minimal sagging after the procedure. Fat grafting can be a great option. Sometimes, I will do this the same time as the deep plane facelift. The fat transfer can be successful for volume rejuvenation for 5-10 years. It's safe because it's your material - it's just moving spots. Fillers can work, but you often need significant volumes and upkeep. This can be costly as well. Most deep plane facelift results declare themselves after 12 months. I would continue to watch your face evolve before making a decision. But, fat transfer may be an excellent option. Best of luck!

Leonard Grossman, MD · Answer

Facial rejuvenation by means of fat grafting is an excellent alternative to a facelift procedure in general. Fat grafting does survive in scar tissue even though not as well as in healthy and untouched tissues. Fat grafting into scarred tissue improves the general quality of the tissues and scar itself and can easily be repeated if necessary. As long as the procedure is done by a plastic surgeon with a great deal of experience in fat grafting, the results should be extremely natural and long lasting if not permanent. I hope this helps and good luck from New York City Plastic Surgery

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