No Subcataneous Fat Between Facial Skin and SMAS, Have any of You Seen this Before?

I recently had a facelift. When my Plastic Surgeon lifted the skin, he found no subcataneous fat layer between the skin and the muscle. NONE! In his 30 years of practise he had never encountered this.I wondered if any of the plastic surgeons that contribute to this site have ever seen this in their surgeries? And if so, why would this occur? I never smoked, drink only an occassional glass of wine. I am 5'6" weight 120, mid 50's post menopausal,no health problems but had cosmetic laser treatments

Doctor Answers 15

Absent subcutaneous facial fat.

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I agree with all the other surgeons that your surgeon was implying that you had an extremely thin layer of subcutaneous fat.  This could easily be the case given your body habitus and age.  Although several other surgeons have recommended facial fat grafting, your situation can be quite challenging because relatively slight degrees of clumping or maldistribution during the grafting procedure will result in visible surface irregularities.  This is analagous to fat grafting in the lower eyelid, a naturally occuring area with very little to no subcutaneous fat between the skin and the underlying muscle.

Mario J. Imola, MD, DDS, FRCSC.


Denver Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

Your problem is one that I have been interested in for years, but the answer is not fat grafting.

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Patients who are athletic, maintain their youthful weight, and have low estrogen tend to develop a "gaunt" face.

While many before  me have recommended fat grafting, I have found that the patients who really need fat grafting tend to have a poor take of the fat and limited durability.  This is after trying most of the available current techniques.

My answer for patients such as you who need a better anwer is to use dermal-fat grafts.  These are taken at the time of surgery from another area such as the abdomen.  They are not injected, but rather placed where needed. They are very reliable and I have patients with gaunt faces who have maintained the result for many years

Dr. Mayl

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

No Subcutaneous Fat Found in Facelift

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    Finding very little fat in thin patients is not extremely unusual.  This will allow for little forgiveness for any SMAS irregularities.  Kenneth Hughes, MD Los Angeles, CA

No Subcataneous Fat Between Facial Skin and SMAS

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For a thin face with minimal fat you should consider facial fat grafting as a way to augment the results of your recent face lift

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

No fat under skin?

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As others have also eluded there us always fat (subcutaneous tissue) under the skin. It would be abnormal if there was not any subq fat. I would get clarification from your surgeon. There is more likely a very thin layer rather than no layer. Also any defects may be amenable to fat grafting or fillers if there are localized defects. But certainly you should visit a plastic surgeon to hone specifically on your needs.

Subcutaneous fat

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Thank you for your question. Yes it is possible to see no gross fat under the skin especially in very thin patients.

Thin facial fat

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What you are describing sounds like a very thin layer of fat rather than no fat that can occur with aging.  Your height, weight, age all points to this.  A nice treatment for this is structural fat grafting in which we use very small canulas to transfer the fat from your flank/abdomen to the face.  This can be done in office/or as an outpatient procedure with minimal downtime.

Michael A. Fallucco, MD, FACS
Jacksonville Plastic Surgeon

Fat under the skin

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it is possible that the fat layer under your skin is extremely thin. This can be due to a combination of genetics, low body fat, aging. If it affected our result, this can be remedied with fat grafting of ejectable fillers. If it has not, then it is not a cause for concern. All the best.

Mark Samaha, MD
Montreal Facial Plastic Surgeon
4.9 out of 5 stars 97 reviews

Lack of facial fat responds to fat grafting

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We think there must have been something lost in your surgeons explanation, as everyone will have a layer of fat under the facial skin and over the SMAS, even a thin one. We often will add structural fat grafting where needed for facial shaping during facelift, especially the area around the mouth and facial folds. Cheeks fill out well too when needed.
Best of luck,
Peter Johnson, MD

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Fat in the Face

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As you age, the fat layer in your face diminishes.  This is part of what causes wrinkles and the need for a face lift.  It is also why fat grafting and dermal fillers have become so popular to replace the missing volume.  Other products that are also useful are Juvederm, Sculptra, Radiesse and Restylane to replace missing volume in the face.


Good Luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.