Facelift Q FT, better to tighten the "shriveled raisin" then plump into a grape vs to plump "the raisin"first then tighten skin?

? Optimal order (based on results-independent of cost and 2 recovery periods) to do fat volumization of face prior/after facelift- concerned if large amounts fat transferred for volume loss eg cheek hollows would look odd when shifted upward on the face if followed by any type of facelift? Vs volumize first, bc after lift the skin and fat compartments tighten down so fat grafting is harder to do and doesn't took as natural? And all over skin rejuvenation w FT(small amt) prior to facelift/after?

Doctor Answers 28

Tighten or Plump First?

As a general rule, most surgeon perform tightening (facelift) and plumping (fat transfer) in a combined surgical procedure. There are many benefits (single operation, single anesthetic, single recovery) to this approach providing very good results with few downsides (increased length of operation). If you would prefer to do it in stages then the recommendation would be to do the facelift first, allow it to heal for several months, and the do the fat transfer. The reason for this is that fat transfer works better in a tighter skin environment, and it tends to soften and complete the results of the facelift.

Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Facelift or volumize, which one first?

If your surgeon has informed you that you will benefit from both, I usually start with the facelift.  If you have a good result you may not need to do fat injections.  Most facelifts, if performed appropriately, look great without fat.

Another approach by some is to add fat at the same time.  This is usually part of their routine and it helps them to correct areas they don't feel they can correct using a facelift alone.

You may find some who forgo the facelift and do the volumizing as a standalone.  I don't feel this is a naturally appearing course.

If you do decide to undergo fat injections after a facelift, you will generally require less fat to achieve your objective.

Whatever you decide make this discussion while consulting with a Specialist in your area.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Fat injection and facelift

Yours is an easy question to answer from my stand point.  I think fat injections to the face are an absolute waste of time and money.  I know many plastic surgeons try to push this on patients and I would avoid this approach.  A well done facelift does not need fat added and most of the time it resorbs anyway.  

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Customize, Customize, Customize

Your question presumes all faces are equal, all aging is equal, and all goals are equal.
I'll have a Big Mack, please!

Every patient has difference genetics, physiology, anatomic ramifications of aging, and a unique individual beauty which can be revealed with proper vision and surgical approach. 

One size fits all only works in fast food ... and maybe not even then!

Scott R. Miller, MD
La Jolla Plastic Surgeon
4.8 out of 5 stars 6 reviews

Face lift - tightening or plumping first?

Thank you for asking about your face lift.

  • Usually, fat transfers to the face are done at the same time as a face lift.
  • That said, not every one wants them or needs fat grafts done.
  • Discuss with your own plastic surgeon that look you want so s/he and you can decide the best approach for you.
  • Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Facelift and restore volume during same procedure

Thank you for a very insightful question!  My approach is to perform a facelift concurrently with fat transfer for the best results.  There is no need to separate these for medical reasons, and there is a definite synergy between these two procedures when done concomitantly.  For skin resurfacing, it is best to do at another time.  In my hands, I find that most patients would like to have their facelift/fat transfer first and then 6 months later have skin resurfacing with CO2 laser.  Best wishes for a beautiful result!

Alyson Wells, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 24 reviews

At the same time

Like many others, I prefer to combine Fat grafting at the time of facelift. It does not change the ability to maintain a natural look in my opinion. In addition to both of those, skin resurfacing is the other adjunct that will help with overall rejuvenation. Good Luck.

Paul W. Papillion, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 58 reviews

What to do first- Lift or Fill the Face


There are over 20 distinct fat compartments in the face. Both volume loss and volume drop (ptosis) of these compartments contribute to the aged appearance of the face. While one may dominate, most people have varying degrees of both. When both occur simultaneously, it can be difficult to tell the degree to which each is contributing to the aged look. It is my opinion that the lifting of the compartments should be done first to bring them back into a more youthful anatomical position. This allows a true assessment of volume loss and can be followed by tailored filling with fat either during the same surgery and/or after full healing has occurred. 

My rationale for not filling first has to do with the variable nature of fat grafting. How much of the fat graft actually survives is variable and hard to predict. Filling prior to a lift requires more fat (due to loose, ptotic fat compartments) and may result in suspension of pre-filled area in a less than ideal position after the lift. In addition, based on the amount of fat survival, a second fill may still be needed after the lift.

In my practice, the lift is performed first followed by targeted filling of the temples, mid face and jawline (if needed) during the same procedure.  After healing, volumes in the tightened and lifted compartments are assessed and minor additions can be made with fat or other non-surgical filler/collagen stimulator.

Daniel Beck, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 23 reviews

Optimal Facial Rejuvenation

Re-volumization, deep tissue repositioning, and skin tightening can be all part of a single, comprehensive facelift procedure. It does not need to be broken up into two procedures. Go visit a few ABPS certified/ASAPS member plastic surgeons or AAFPRS member facial plastic surgeons. 
Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Facelift and Fat Grafting?

Thanks for your question.  In my practice, nearly everyone undergoing a facelift procedure has simultaneous fat grafting due to either or both benefits of volume restoration and skin rejuvenation from the contained stem cells.  I see no reason to separate the procedures.  I hope that this helps you.  You'll probably also find the video above of interest and help.  Best wishes.

Jon A. Perlman, M.D. FACS
Beverly Hills Bd. Certified (ABPS) Plastic Surgeon

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 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.