Is Fat Grafting Alone Enough To Treat Sagging Skin and Marionette Lines? (photo)

Is fat grafting alone enough to take care of the marionette lines and the sagging skin or is mid face lift the better choice for this face?

Doctor Answers 13

Will fat grafting fix me?

In your particular case I think fat grafting alone will not improve your facial contour enough. I would reccomend you look into a facelift that is combined with well placed fat injections to fill your NL folds and marionette lines. I do this all the time as part of the minimal access cranial suspension (MACS) facelift that I commonly perform. This facelift uses minimal incisions and carefully placed sutures to reposition the midface and works great with fat used to blunt the deep facial folds you have. Best of luck! Dr Kerr

Austin Plastic Surgeon
4.9 out of 5 stars 216 reviews

Facelift to correct excess skin, then fillers.

Facelift to correct excess skin, then fillers is a better solution. Fat grafting which I have done for 35 years will not correct sagging skin and ofter causes lumpiness, etc. I would need to see and feel your face to determine if a sheek lift is also indicated.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Fat Transfer Complementary but does not replace a facelift

Fat transfer is complementary to a facelift procedure but does not replace it. In my opinion you will require both (mini facelift like a MACS or LiteLift) and fat transfer to the pre-jowl area (between the chin and jowl) and cheeks and the lift procedure to rejuvenate loose skin.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Fat grafting will definitely improve...

the appearance of your nasolabial folds, but it will not completely eliminate it. Neither will a mini-facelift, but the combination would be more optimal.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 38 reviews

Fat grafting and mini face lift a good choice

Based on your photos it appears that you are a good candidate for fat grafting and a mini face lift.  A midface lift (cheek lift) would be low on the list.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Minimal procedures often yield minimal results.


This is a very reasonable question.  The answer is that you need real surgery.  A mid face lift (probably together with fat transfer) should give you a natural youthful look.  Good luck!

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Fat transfer to the face

The picture posted shows significant loss of volume in the face . Fat transfer can improve your deep naso labial fold and marionette lines. You may not need a face lift after proper placement of the fat in the face.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Fat Grafting or Face Lift

Fat Grafting and the Face Lift treat different problems but can be used together or alone to achieve goals of facial rejuvenation.  In your case, I think a mini-lift and mid-facelift with endotines would provide the best, longest lasting result and correction of the nasolabial folds and some improvement in the marionette lines.  However, there are some other benefits of fat grafting for you.  I would use fat in the nasolabial folds, cheeks and on top of the cheek bones.  This would help with your volume loss, but if used alone, would not help with the sagging skin.

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 87 reviews

Fat Grafting or Lifting?

From your photos, it appears that you have lost volume due to age or weight loss. Without a full exam, it appears that you could have a significant benefit from fat grafting alone. There is the possibility that you could still need a lifting procedure after, but it is worth looking into a fat grafting procedure alone. Fat also has been shown to improve skin appearance and texture as a side benefit to the procedure. It can usually be done under local anesthesia alone and is well tolerated by patients. 

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

Addressing sagging skin and lines with full facial fat grafting instead of a facelift

Full facial fat grafting would give you a very rejuvinated appearance.  The key to success in this type of intervention is to balance the entire face, not just focus on what jumps out at you.  from your picture it is clear that your malar fat has thinned and descended, giving your midface and cheeks a flat appearance and thus accentuating your nasolabial folds.  By fat grafting to create an uplifted appearing cheek(malar fat) your nasolabial folds will appear blunted. Fill at the nasal base will further diminish the aesthetic consequences of your nasolabial folds.  minor fill in the folds and filling of the jaw line complete the picture.  A face lift with fat graffting is preferable when addressing these issues but I have many patients that opt for aft grafting instead and are very happy.  I hope this helps!



All the best,


Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Physician
4.9 out of 5 stars 73 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.