Should I dissolve fillers and opt for fat grafting during facelift?

Question

If an individual had both significant laxity and volume loss, but had already used dermal filler to address the latter, would it be better to dissolve the filler and do the lift with fat grafting or integrate the filler volume and fat graft later if necessary after natural dissolving of the filler? I am concerned about the unpredictable nature of fat transfer, but also the chance of filler distorting my baseline and causing excessive oedema after a lift.

Jake Thayer, MD · Answer

I think dissolving the filler prior to surgery is a great idea. The filler can distort natural tissue planes and removing it will help your facelift surgeon better identify these planes and reposition the deep structures (SMAS) more appropriately. I personally feel fat transfer can be more predictable, natural and elegant than fillers in the long term. Thanks!

Mehmet Surmeli, MD, FEBOPRAS · Answer

Hi,

Choosing between dissolving fillers and opting for fat grafting during a facelift depends on your aesthetic goals and the condition of your facial tissues.

If existing fillers interfere with surgical procedure, expected outcomes, or create inconsistencies, dissolving them prior to surgery could be beneficial. But if the fillers are well-adapted into tissues or aesthetic units and if the fillers do not interfere with the surgical procedures, there is no need to touch them at all.

Fat grafting, on the other hand, uses your own fat cells to restore volume, offering a very natural and long-lasting result. Incorporating fat grafting during a facelift can enhance facial contours and improve overall harmony. 
But in our practice, to decrease the operation time, to decrease facial swelling and to increase the precision of the fat injections we usually prefer to perform fat injections 6-12 months after the facelift procedure.

So, it's important to discuss these options before the operation to develop a personalized plan.

My comments and recommendations are solely based on your text and are subject to change. I always recommend a face-to-face consultation with a specialist to plan the treatment.

Best wishes, Dr. Surmeli.

Tanveer Janjua, MD · Answer

It is best to get a facelift after the fillers dissolve over time on their own. However, if you are in a time crunch you can dissolve the fillers. Keep in mind only Hyaluronic Acid fillers can be dissolved. Fat grafting can be done at the same time as the facelift. 
Regards
Dr. J

Chet Mays, MD · Answer

Thank you for your inquiry!  Filler is a temporary fix whereas a small amount of fat transfer lasts longer.  It is your fat and will respond accordingly.  If you are active and can easily burn through fat, this fat will act the same.   We would love to sit down with you and discuss your concerns.  Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

John Michael Thomassen, MD · Answer

Usually fat grafting can be done if fillers are already in place.  There is no need to dissolve them, specially if they look fine and are not causing any deformity.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!Filler tends to make the job of your surgeon much harder , it distorts the anatomy both within the tissue layers and on the outside thus affecting the surgeons plans. So dissolving it pre-op cab help your surgeon come up with solutions that can address the different issues that you have without having them being masked by the filler.Fat is relatively reliable in the face since it is very vascular. and you can always add more later if needed. I hope this helps, best of luck!

Ronald J. Edelson, MD · Answer

If the filler isn’t causing any problems just leave it alone. As far a fat transfer is concerned I am not a fan. Just do a standard facelift

Erman Ak, MD · Answer

If you're planning a lift and you already have filler in the area, dissolving the filler beforehand is generally the better approach. It allows the surgeon to work with your natural tissue without the interference of filler, reducing the risk of complications like excessive swelling and distortion. After the lift, fat grafting can be done to restore or enhance volume in a more predictable way, once the tissue has healed and settled.
If you're hesitant about fat grafting's unpredictability, dissolving the filler and using it as a secondary procedure down the line (after natural filler dissolution) is a safer, more controlled approach.
MD Erman AK

Jacob Tower, MD · Answer

Hello, hope you are well. That's a great question, but the bottom line is that there is no "right" way. There are more things to consider, including where exactly the filler is, when it was done, the amount that was injected, etc. In general, it's best to keep things simple unless you have a good reason to do otherwise. In this case, the simplest thing to do is leave the filler as is, undergo the facelift, and utilize fat transfer down the road if needed. Having filler is not realistically going to cause excessive edema after a facelift. Furthermore, fat transfer is an easy office procedure--you don't need to be under general anesthesia for it.

Best,
Dr. Tower

Best,
Dr. Tower

Christopher Park, MD · Answer

We are blessed this day and age to have a wonderful array of volume replacement options. We have a patients own fat which can be transferred and the fat that survives will persist just as it would in its current location. It can enlarge with weight gain or reduce with weight loss. Fat of course is a soft filler and more for volumizing and less for form correction of specific lines or wrinkles. We have fillers made of different materials and we have different consistencies of fillers made of the same material such as hyaluronic acid that can be selected for the need. Firmest fillers for adding volume near the bone, medium firm fillers for filling in folds and soft tissue loss and thinner fillers for fine lines and delicate areas such as lips. I say all of that to answer your question. I would not recommend that you dissolve your filler. Surgery addresses many of the issues of aging of the face but not everything can be corrected surgically. Fat grafting is a wonderful adjunct to do during the facelift and replaces some needed filler. But additional filler and neurotoxin can be artfully used to add even more improvement to your facial rejuvenation process going forward. So I would not recommend that you dissolve filler that’s already hellping the overall change

Should I dissolve fillers and opt for fat grafting during facelift?

Answers (12)