What happen to the cheek fat pads with aging? Do they drop/sag? is it just volume loss? Both?

Question

If it is both, would both a midface lift and submalar/fillers/fat be necessary to obtain best results?

Ronald J. Edelson, MD · Answer

Without pictures and your age it is hard to know whether you are a candidate for a facelift. It is clear that you have done research on surgery and fillers. I must tell you that the midface lift and fat injections are absolutely worthless procedures in my opinion. If you need a facelift get a standard, properly done facelift and leave out the midface and fillers. They are facelift add ones which will simply raise the cost but do nothing for the final result..9

Alejandro J. Quiroz, MD · Answer

Thank you for your question.   The answer this question, is difficult because the changes that occurs are changes in the skin tone and also the  structure of the tissues that support the fat and also the absorption of the fat that occurs in the aging process

Edwin F. Williams, III, MD · Answer

The cheek fat pads descend with age, however they also experience volume loss. Another contributing factor is recession of the underlying bony anatomy. Fat grafting is a procedure I commonly perform in facelift patients. The appropriately performed facelift can make a strong impact on the malar fat pads, however we sometimes need to replace volume as well. If you require volume restoration, I typically recommend autologous fat grafting as this tends to give you the longest lasting results.

Christopher T. Maloney Jr., MD · Answer

Thank you for your question. As we age the cheeks lose volume and begin to sag. The gold standard remains a face lift to reposition the underling structures to lift the midface, tighten the neck, improve the jowls and give you face a more youthful appearance. If you have lost volume, fat grafting can be performed at the same time as the face lift. You should find a board certified plastic surgeon in your area who specializes in facial rejuvenation. Best of luck.

Nashielli Torres Espinosa Chiu, MD · Answer

Thanks for your question!  The fact is that the face is made up of three structures, muscle, fat and skin.  As we age, we lose the fat/volume in our face.  That, along with drooping muscles and skin elasticity changes, all contribute to seeing ourselves differently as we age.  
Without photos, I can't address your particular case but in my practice I include the facial fat transfer procedure with the face lift to help address all three issues to give the freshest and most natural results.

Evan Ransom, MD, FACS · Answer

Thank you for the great question. The reality is both, but for most patients, sagging is the predominant factor. In my opinion, a facelift procedure that allows for repositioning of the fat pads in the cheek and jowl region is essential. If this is accomplished, addition of fat or filler from other areas of the body is not needed for most patients. The exception to this is often two areas: 1) the temple hollow; and 2) the tear trough. For these areas, I use microfat which is placed at the time of the face and neck lift procedure. Best of luck moving forward!

Michael Boggess, MD · Answer

Hello.  Thank you for your question.  Aging of the face is a complex process that involves progressive loss of facial fat and bone volume and progressive laxity of skin and and supporting connective tissue that leads to sagging in the most dependent areas, including the neck, jawline, marionette lines and nasolabial folds.  Each individual is unique in the progression of these aging changes with some demonstrating more laxity than volume loss, while vice versa for others.  Therefore, management for facial rejuvenation must be individualized for each patient.  Depending on the degree of aging changes, this may involve a facelift to address the laxity in the lower face and neck, midface volume restoration using grafted fat, fillers or implants, or a combination of both.  I would encourage you to seek a consultation with a board-certified Facial Plastic Surgeon or Plastic Surgeon who has extensive experience and expertise in facial rejuvenation, and allow them to assess your individual anatomy, concerns and goals, in order to determine the best treatment plan for you.  I wish you the best in achieving your aesthetic goals.

Dimitrios Motakis, MD, PhD, FRCSC · Answer

The cheek complex appears to drop gradually with age. It’s upper part slides forward and downward to give rise to the nasolabial folds, the the lower part of the cheek slides in a similar fashion to give rise to the marionette lines and the jowls. In reality the changes that result in these shifts happen at every level of the facial tissues, including changes in the bony skeleton. However, two of the main components of this descend are: 1. Stretching of the skin and it’s attachments and 2. Fat volume loss.  Each person is individual and not two people age exactly the same. In some cases the volume loss is more pronounced and in other cases the volume loss is minimal, but the sagging is more prominent. Therefore, when it comes to facelifts the procedure is customized to the patients needs. If there is no volume loss the cheek is repositioned by performing a deep-plane facelift alone. In cases where there is volume loss with aging, micro-fat grafting is performed in conjunction with the facelift for optimal rejuvenation. Consulting with a certified surgeon who is experienced in both procedures is best, in order to achieve a long lasting natural result.

Kenneth Hughes, MD · Answer

Aging, along with gravit, causes both sagging and volume loss of the cheeks.  Could address your question better if photos were provided.  In general, fat grafting has a few advantages.  A greater volume can be transferred than would be feasible with fillers.  The nasolabial area can be filled along with the marionette lines, the cheeks, areas around the malar bags, and the tear troughs among others.  The procedure can be performed under local but with more areas than just one or two, I think the procedure is far more comfortable with sedation or general anesthesia.  Consult with a board certified PS via Skype or in person to obtain advice.

Ajaya Kashyap, MD · Answer

Thank you for your question.  The fat pads undergo multiple changes with age including sagging and volume loss, Many procedures can be helpful depending on the exact issue. For significant sagging and loss of volume I usually do both, a facelift and autologous fat injection.
Please find an experienced Board certified Plastic Surgeon who can examine you and help you with all your concerns. All the best!

What happen to the cheek fat pads with aging? Do they drop/sag? is it just volume loss? Both?

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