A question about lower face lift and fat transfer to upper and lower cheeks. Can I ask, what procedure would be done first?

Doctor Answers 12

​ Combination or staged Fat grafting and Facelift

Dear sedvid:

Facelifting is a combination of procedures to rejuvenate the face from the jawline to the cheekbone. It includes:

  • Elevation and redraping of the facial skin laxity
  • Repositioning, suspending and tightening of the soft-tissues including fat, glands and muscles of the face under the skin

Fat grafting is one of many filler options to add volume to the facial features which have diminished or thinned with aging such as the cheeks and lips.

While the facelifting technique tends to tighten the facial features, the opposite occurs with fat grafting which fills or adds volume to the face. Despite these seeming opposite actions, a combination of facelift and fat grafting is performed often and quite enhancing to the final result.

Fat grafting as an option to adding lost volume in the face may also be performed at any time before and / or after the facelift as well.

It is my preference to perform the facelift and reposition the tissues into the new, rejuvenated position and then fat graft those areas of volume atrophy at the end of the procedure.

I hope this has been helpful. All the best!

Baltimore Plastic Surgeon
4.8 out of 5 stars 82 reviews

Fat Transfer and Facelift

This is a good question.  I like to utilize fat transfer at the same time a s doing a facelift.  The results are superb when performing the 2 together.  Face lifting techniques involve lifting and pulling the tissues and removing skin.  This does not replace the volume at the same time and that is where the fat transfer procedure comes into play.  This procedure gives a youthful look to the face and adds the necessary volume needed for a youthful look.  Combining the 2 procedures gives a great result.  You can have them done separately because each addresses different problems of the face.  I highly recommend adding fat at some point in the rejuvenation process.  Thank you for your question.  Good luck.

Walton Montegut, MD
Newport Beach Physician
5.0 out of 5 stars 31 reviews

Facelift and fat transfers

These two procedures, in combination, are excellent for facial rejuvenation and are typically done in the same surgical setting, with the facelift first and then the fat injections.  I routinely perform fat injections in conjunction with a facelift and achieve excellent results.   Be sure to discuss these procedures with a board certified plastic surgeon to optimize your outcome.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 63 reviews

Facelift and facial fat transfer at the same time

Facelift and fat transfer to the face are a wonderful coupling of two procedures that both lift and restore natural-looking volume to rejuvenate a patient's overall look.  Both procedures can be done simultaneously, facelift first followed by fat transfer.  Doing both procedures allows the patient to have only one recovery time.  Degree of recovery time will vary form patient to patient.

Vu Ho, MD
Plano Facial Plastic Surgeon
4.8 out of 5 stars 48 reviews

Up to Doctor

This order doesn't really affect the outcome of your result - it's completely up to the discretion of the physician.

Louis P. Bucky, MD
Philadelphia Plastic Surgeon
4.4 out of 5 stars 41 reviews

Which Procedure First?

These procedures can be done in the same surgery, which will allow you to combine the recovery time. If you are asking which procedure would be performed first in the surgical suite, the lower facelift would be completed first, and then the fat transfer.
I agree with the other surgeons who have responded, in that there may be cases in which these procedures need to be staged for the health of the patient, or to provide a better outcome. Each individual is unique, so you should be sure to have a board certified facial plastic surgeon evaluate you and provide you with an individualized treatment plan based on your health and anatomy.

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 49 reviews

Facelift and Fat Grafts

These procedures can be performed at the same setting.  Their are pros and cons to fat grafts.  Consult with a Board Certified Plastic Surgeon who is highly experienced to confirm you are a candidate for these surgeries.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

A question about lower face lift and fat transfer to upper and lower cheeks. Can I ask, what procedure would be done first?

  Hi, I have performed many facelifts and facial shaping procedures over the past 30 years.  IMHO, fat transfer is far less reliable at providing the proper aesthetic volume and shape than a dermal filler or a facial implant.  I perform facial shaping and contouring with every facelift following the beauty principles outlined in my book on face and body beauty.  These beauty principles reveal that women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front.   Cheek augmentation using a dermal filler (I prefer Restylane Lyft) or with cheek implants for a permanent enhancement will create full, round cheeks anteriorly that will feminize the entire face.  Male faces, on the other hand look ruggedly handsome when there is angularity in the cheeks, chin and mandibular angles. In addition to chin augmentation, cheek augmentation with either a dermal filler or cheek implants (for a permanent enhancement) will add angularity to the cheeks. Mandibular angle augmentation with a dermal filler (jaw implants IMHO have too many unwanted side effects) will add volume, angularity and flare to the jaw line.

  If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation. I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers to the cheeks will lift tissues is an urban myth. Filler to the cheeks or cheek implants will not lift up the jowls. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured. The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

•very small incisions
•minimal tissue dissection = less bruising and swelling = rapid recovery
•can be performed in 90 minutes or less, with or without anesthesia
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
•most patients fly back home to parts all over the world in as little as 3 days post-op

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Facelift and fat transfer to the face

 In our practice, we do not recommend fat transfer to the face due to the fact that  it is unpredictable, has significant variations in results, and sometimes has to be repeated multiple times to get a result. When patient's have flat cheeks, we  insert small Silastic cheek implants which give a consistent result. They're also very easy to remove if ever necessary. The goal of the lower face and neck lift is to tighten loose facial and neck skin, lift the jowls, tighten loose facial and neck muscles, and remove any fatty deposits in the neck. For many examples of both procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Lower face lift and fat transfer to upper and lower cheeks. Can I ask, what procedure would be done first?

While the procedures can be done in either order, they are usually performed at the same time in the appropriate patient.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.