What is the reality concerning pain and discomfort following SMAS facelift with fat transfer?

Every patient heals differently, each surgeon has their own techniques for surgery. For my patients, the feedback I get is that the pain is minimal and easily controlled by pain medication usually only needed for the first 2 or 3 days. However, swelling and tightness is what is somewhat uncomfortable but not painful and the swelling can take a couple of weeks for most of it to resolve. It can take a few months for all of the swelling to resolve.

In my practice, it is rare to have a patient experience intense pain after facelift surgery.  Having said that, most patients do complain about pain, especially around their ears, the first night of surgery.  After that time period, the pain is typically mild.  Most patients describe mild discomfort during the majority of their postop period and it is unusual to have someone complain about severe pain.  After the first 1-2 days postop, we will typically use a non-narcotic form of pain medication during the day and reserve the narcotic pain medication for bedtime, if needed. Hope that helps to answer your question.

I will say that my facelift patients usually do not have a lot of pain post-op, maybe a 3-4/10 on a pain scale if that much.  It's mostly incisional discomfort. The recovery is fairly quick with most being able to go back to light duty within 7-10 days. Bruising in many instances goes away within about a week or so.  Swelling is the thing that lasts the longest.

 In our practice, most patients take a few medium strength pain relievers for the first few days after the procedure like Vicodin.. We also do not use painful pressure wraps or bandages, just drains that are left in for the first day.

 Hi, I have performed SMAS facelifts for over 30 years.  The reality is that the more invasive the facelift technique, the longer the recovery time which can be 6 to 12 months for a full face and neck lift, deep plane, mid face or subperiosteal facelift.  The more extensive tissue dissection associated with these facelifts simply takes much longer to recover and heal from versus the minimally, invasive (short incision) SMAS facelift.  Then throw in fat transfer that in my experience offers far less of a reliable and predictable volume to shape the face than an off the shelf dermal filler or silastic implant and you have added additional recovery and healing issues as the fat is unevenly dissolved by the body.  I have performed many facial shaping procedures using dermal fillers, facial silastic implants, liposuction and facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.