Under eye filler and cheek filler, can a SOOF (Sub-Orbicularis Oculi Fat) lift still be done? Or does filler need dissolved?

Question

Just wondering if a SOOF lift can be done with filler remaining in the under eyes and cheeks, I like the effect of the filler so I would like to keep it while the SOOF lift is done. Also, how much does the SOOF lift move the cheeks upwards? Can the SOOF be moved vertically instead of laterally?

Mehmet Ozdemir, MD · Answer

It is completely understandable that you want to keep a look you already love, but performing a SOOF (Suborbicularis Oculi Fat) lift with existing filler in the area is generally not recommended by most surgeons. Because the SOOF lies in a very deep tissue plane, residual filler can distort your natural anatomy during surgery, making it incredibly difficult for the surgeon to see exactly how much real tissue they are lifting and potentially leading to an overcorrected or uneven result once the filler eventually dissolves. To answer your other questions, a SOOF lift is actually designed to move tissue primarily in a vertical direction rather than laterally, making it excellent for correcting a dropped, flattened midface by restoring volume directly upward onto the cheekbone; however, the actual movement is measured in subtle millimeters rather than inches, focusing on a refreshed, natural transition rather than an extreme pull. For the safest and most predictable outcome, the standard approach is to dissolve the old filler with hyaluronidase a few weeks before your procedure, allowing your surgeon to safely reposition your natural fat pad vertically and achieve a beautiful, permanent foundation that you can always safely enhance with light filler later on if needed.

Carl Truesdale, MD · Answer

A SOOF lift (sub-orbicularis oculi fat lift) repositions the deep fat pad of the midface to support the lower lid and cheek. When there's pre-existing filler in the under-eye and cheek area, most surgeons will want it dissolved first, and there are good reasons.
Why filler should usually be dissolved before a SOOF lift:
Surgical planning accuracy: The surgeon needs to assess your true underlying anatomy. Filler distorts the tissue planes and volume, so operating around it means planning against a false baseline. The result is less predictable.
Tissue plane disruption: HA filler, especially placed over time or in multiple layers, integrates into the tissue and can blur the surgical planes the surgeon dissects through. That makes the operation technically harder and raises the risk of contour irregularity.
Post-op result distortion: If filler is left in place, as it gradually degrades over the next 12 to 24 months your surgical result will shift and settle unevenly. What looked good at 3 months may look different at 18 months purely because of filler resorption.
Migration and lumping: Filler in the under-eye is prone to migration. Operating around migrated filler, or having it shift after surgery, creates problems that are hard to revise.
The usual sequence:
1. Dissolve the existing filler with hyaluronidase.2. Wait 2 to 4 weeks for swelling to settle and tissue to return to baseline.3. Re-evaluate your true anatomy.4. Plan and perform the SOOF lift (often with a concurrent lower blepharoplasty).
Exceptions: If the filler is very old, very small in volume, and the surgeon can clearly feel they're working in a clean plane, some will proceed without dissolving. But that's the surgeon's call after an in-person exam, not something to assume.
What to do: discuss this directly with the surgeon who'd perform the SOOF lift. Ask specifically whether they want your existing filler dissolved first, and if so, how long before surgery. A surgeon experienced in midface lifting will have a clear protocol. If they're vague about it, get a second opinion.

Pasha Mostofi, MD, DMD · Answer

Yes, a SOOF lift can often still be performed even if you have filler in the under-eye and cheek area, but whether the filler should be dissolved first really depends on the type, amount, and placement of the filler. In many cases, filler can make it harder for the surgeon to accurately assess your natural anatomy and tissue position, especially around the under-eyes where even small amounts can blur the true contour. If the filler is subtle and looks natural, some surgeons may leave it alone. However, if there is a lot of filler, puffiness, or migration, dissolving it beforehand usually leads to a cleaner and more predictable result. Personally, I’m not a huge fan of relying heavily on facial fillers long term because they can sometimes mask the real structural issue rather than correct it. In select patients, I prefer facial fat grafting because it can look softer and more natural.
A SOOF lift is designed to elevate the deep cheek tissues and improve the transition between the lower eyelid and cheek. The movement is generally more upward than sideways when performed thoughtfully. In fact, a vertical lift is usually the goal because it restores a more youthful position to the midface without creating an overly “pulled” appearance. The amount of lift varies from person to person, but it is typically subtle and natural-looking rather than dramatic. The best candidates are patients with early midface descent, hollowing, or heaviness beneath the eyes who want restoration instead of simply adding more volume with filler. An in-person evaluation is important because the decision to keep or dissolve filler really depends on how your tissues look underneath it.

Under eye filler and cheek filler, can a SOOF (Sub-Orbicularis Oculi Fat) lift still be done? Or does filler need dissolved?

Answers (3)

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