F37, mid-face lift or fat grafting for sagging face due to fat loss? (Photos)

Question

Dear doctors, I've lost a lot of face fat in the last two years, esp. in my cheeks which started to sag. One side seems to have lost more than the other so my face looks more asymmetric now (more fat on one cheek + upper eyelids looks different). What procedures could help in my case? I was thinking about endoscopic brow lift for upper eyelids + lower blepharoplasty with fat transfer for under eyes but I'm not sure what to do about my cheeks? Fat grafting or endoscopic cheek lift?

Ronald J. Edelson, MD · Answer

I think you are too young for a facelift. You could  try fillers if you like but they tend to be expensive over time

Donald Groves, MD · Answer

Hello and thank you for your question. 
From what I can tell based on the pictures you have provided, there is some early/minimal jowling and facial asymmetry present as you had mentioned. This occurs with age as the soft tissues of the face start to descend and as we lose volume from fat atrophy and bone loss, resulting in the characteristic changes of facial aging. You do not appear to have excess neck skin or visible platysmal banding in your neck. Based on all that, you could make an argument for or against getting a facelift at this time- you could certainly hold off a little if you'd like. A facelift would be the best way to address the asymmetric soft tissue descent and hollowing- there are different techniques to manipulate the SMAS layer (an important soft tissue layer under the facial skin) to really control the symmetry achieved in a facelift. At the same time, facial fat grafting can also be done to address the volume loss and help further correct the asymmetries. In your case, if you are currently interested in a facelift, I'd recommend facial fat grafting combined with a "mini-facelift" (a.k.a. short scar facelift- does not carry the incision back behind the ear into the mastoid/occipital hairline). If you do not yet wish to pursue any type of facelift, you could still get some benefit from facial fat grafting alone, and defer the facelift to a later time.
Regarding your eyes- I do not see any obvious brow ptosis, just maybe some upper eyelid skin redundancy, more on your right compared to your left upper lid. I see some prominence of your tear troughs and some mild bulging of your lower eyelids on both sides. Based on this, there would not be any benefit for the endoscopic brow lift you mentioned. I would instead recommend a lower lid blepharoplasty, and possibly also an upper lid blepharoplasty if there is enough upper eyelid skin redundancy.
With all that said, it is difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos you have provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Pawel Szychta, MD, PhD, DSc · Answer

To address cheek sagging and facial asymmetry, a few options could help restore volume and lift:
1. **Fat Grafting**: This involves transferring your own fat from another area of your body to your cheeks. It can restore lost volume, improve symmetry, and provide a natural look. It's especially effective for volume loss but doesn't significantly lift sagging skin.
2. **Endoscopic Cheek Lift**: This procedure lifts sagging cheek tissues without adding volume. It may be combined with fat grafting if you need both lifting and volume restoration for optimal results.
3. **Fillers**: Hyaluronic acid fillers can be used as a less invasive alternative for volume restoration. They provide temporary results and can be helpful for evaluating how adding volume might affect symmetry.
Considering your plans for a brow lift and lower blepharoplasty, it might be worth discussing combining procedures to achieve a balanced outcome. A consultation with a facial plastic surgeon would provide a tailored approach based on your specific needs.

Marcin Jadczak, MD · Answer

In your case, it is worth considering lipotransfer - it will fill the gaps in fat tissue and give a lasting effect. Lifting the middle part of the face or tightening the orbicularis oculi muscle can also be considered. As for endoscopic eyebrow lifting - the photo of the eyes is not very clear and it is difficult to assess whether the problem is in the eyebrows or in the excess skin on the upper eyelids. To be discussed during live consultations.

Michael S. Kluska, DO · Answer

Facial asymmetry is extremely common, and as we age after the age of 33 facial bone and fat, atrophy occurs which further skeletonize is a patient’s asymmetry. With that being said, you would be a great candidate for lower eyelid, blepharoplasty combined with full facial fat grafting plus or minus upper lid and or brow lift surgery.

F37, mid-face lift or fat grafting for sagging face due to fat loss? (Photos)

Answers (8)

Answer: there are several possibilities

Answer: there are several possibilities

Answer: Facial Asymmetry

Answer: Facial Asymmetry

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Everything you need to know about Facelift

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F37, mid-face lift or fat grafting for sagging face due to fat loss? (Photos)

Answers (8)

Answer: there are several possibilities

Answer: there are several possibilities

Answer: Facial Asymmetry

Answer: Facial Asymmetry

Browse related questions

Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.