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.

Andrew Kornstein, MD, FACS · Answer

If you feel that you have lost facial fat, prematurely(you look young), and I agree with you, then replacing what was lost seems to make the most sense. 
Fat grafting to your face, done properly as a single surgical procedure, will replace the missing fat tissue restoring volume and contour as well as antigravity support. 
In addition, if the fat cells are transplanted(not simply injected) then they can act as the body's most powerful stem cell and restore circulation to your facial tissues thereby slowing the aging process.
Based on what I can see from your photos all you would require is fat grafting and not a browlift or blepharoplasty. 
You skin appears somewhat inelastic and may benefit from non sugical shrinkage/tightenng enhacing the fat graft contour.
Hope this helps

Mats Hagstrom, MD (license on probation) · Answer

The men’s facelift became very popular in the late 1990s. It is since dropped in popularity. A lot of this is because of the quality fillers now available as well as advances in understanding of fat grafting.
There are different ways to restore, mid face volume. Implants were used for many years and can give it very good results. The mid facelift can also give very good results but the recovery is a bit intense with persistent swelling for a few months.
Facial fat transfer can be unpredictable, imprecise and unforgiving if patients don’t like the outcome. It’s generally better to be on the conservative side and have a touch up session grafting a bit more fat, if needed, rather than to overdo it.
Fillers are probably the best option of all. Fillers are precise, predictable, and extremely forgiving if people don’t like the outcome.
I sometimes recommend patients check out the website of Dr. David Mabrie, MD in San Francisco. His work with mid face fillers is some of the best I’ve ever seen. It gives you an idea of what fillers can accomplish in the hands of a really talented provider.
Well, choosing the right procedure is important. It’s probably more important to choose the right provider, and the right provider may have different ideas of how to best achieve the end outcome.I suggest having multiple inperson consultations with plastic surgeons or facial plastic surgeons, who have a lot of facial aesthetic experience. 
Ask providers to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own for whatever procedure they recommend. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually done. The time to be critical of plastic surgeons is during the vetting process while having consultations.
Continue having consultations until you feel very confident you found the right provider for your needs.
Best,
Mats Hagstrom, MD

Umut Zereyak, MD, FEBOPRAS - Account Suspended · Answer

You are a very good candidate for endoscopic midface lift, brow lift and temple lift.It works especially well in young and middle agesHelps with hair incision due to small and endoscopic upper, lower eyelids, eyebrow, temple and mid-face liftAll the faces go up and it's like anti gravity

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

Answers (8)

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