What reasons would fat be added just to the upper face? Can this still look natural?

I love using a patient's own fat to replace volume loss in the face! Where the fat is placed depends 100% on where you have lost volume (or have a non-age related contour issue like deep tear troughs).
So yes, fat can be added just to the cheeks.
I always want to see photos of my patients from 15 to 20 years ago so we can "turn the clock back" and replace what has been lost for a natural look.

Thank you for your thoughtful question. Since no photos are available, it’s not possible to make a direct assessment, but your description offers helpful context.In many cases like yours, volume restoration in the upper face is essential not for adding fullness, but for restoring balance. With age or sudden weight loss, we often see a deflation of the midface—particularly the cheeks, under-eye transition (tear trough), and temple areas—which can lead to a drawn or hollow appearance. This affects how the skin drapes and how light reflects across the face.Adding a small amount of fat to the upper face is not about creating roundness—it’s about reestablishing youthful contour, softening skeletal shadows, and blending transitions between facial planes. When done conservatively and with a deep understanding of facial anatomy, fat grafting can be subtle and refined. The goal is not to change the shape of your face, but to reconnect it with its previous proportions, especially if you once had a fuller, harmonious look.Fat is often placed in the upper face because this is where age-related volume loss is most visible and where support has the most impact on overall expression. The key lies in precise placement and restraint. When fat is layered thoughtfully into structurally supportive areas—like the deep medial cheek, infraorbital rim, or temple—it can restore softness without distorting identity.A consultation focused on your past photos and facial dynamics in motion can help your surgeon create a plan that restores—not replaces—what has changed.Warm regards,Op. Dr. Güray YeşiladalıBoard-Certified Plastic Surgeon

To start, a deep plane facelift can often create as much bad as good because of the pronounced amount of swelling that can be caused. In addition, when many surgeons describe their facelifts as “deep plane”, it is hard to know with certainty whether that is even being performed, and sometimes the techniques being used can create as much facial disharmony as anything else. A well done deep plane facelift, when combined with fat grafting, should address the midface and upper face tissue adequately, so that there isn’t hollowing near the eyes and a gaunt look. It brings into question what procedure was done. That said, if someone does have soft tissue volume loss, fat grafting is often an excellent way to address these changes. If you use a cosmetically trained (preferably cosmetic fellowship-trained) plastic surgeon who has advanced expertise in fat transfer and has been using it for a considerable amount of time in their practice, they should have the skillset to address these concerns in a lasting, natural, and artistic way.