Facelift with or without fat grafting? (photo)

Considering that volume loss (loss of fat tissue) is a part of aging, we use fat grafting as the integral part of facial rejuvenation for over 25 years. Approximately 80-90% of our face lift patients have fat grafting in the same time. Results are subtle but noticeable and significantly enchanted facial rejuvenation. In our experience approximately 30% of the fat injected in periorbital area will survive dispute significant individual variations. Secondary fat grafting (6 and more months after first application) is done in some patients to build desired volume. Hope this will help your decision. Good luck.

There are two purposes of fat transfer in face lifting: adding volume & tissue regeneration. Fat transfer that is structural is used to add volume to cheeks and specifically is used to address some of the subtle hollows that happen with age. Areas of shadowing at the lid cheek junction or the jowl sulcus. Nanofat is fat at has been lysed until it is really a cellular signaling soup for regeneration of the tissues. It can help by adding luminosity and improves textural issues. I often pair it with a laser resurfacing when possible (though you do have more darkly pigmented skin and have to approach laser resurfacing very carefully). In reviewing your photos I would recommend that consider a deep plane face and necklift with someone who is skilled in understanding the anatomy and maneuvers for correction. It will help reposition your tissues and provide you with the contours you desire. The fat transfer provides an enhancement of the result, but it will not need to be a high volume of fat. Patients like yourself require 8 - 12 ccs of fat injected very strategically for the whole face. But it does have a big impact & it takes a lot of skill from the surgeon to do it properly.

Great question and thank you for attaching photos to review.
Unfortunately I don't think you will ever find a unanimous approach when it comes to the nuances of facelifts. I agree with your assessment about having good volume of the face and I think you will also get some more volume in the cheeks with the facelift (based on technique) so the decision on fat grafting is a hard one. Personally, I think you may get some additional benefit with small amount of fat grafting along the pre-jowl sulcus (jawline), nasolabial folds, and undereye/upper cheek. However, based on the pricing this may not be something you are as interested in. I think regardless, you will likely get a good improvement with the facelift with or without fat grafting, the fat grafting is often just an extra benefit (cherry on top).
Hope this helps and best of luck,Kyle Kimura, MD