The recent Aesthetic Surgery Journal January 2021 had an article, “Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of current Treatment Paradigms.”
Let me start by saying if you have read my website at all, you know I love fat grafting. It is liquid gold. You need to replace volume loss, and replacing what you lost (fat) with fat is the BEST. It is super natural. It has stem cells. I love it.
I have for awhile done fat grafting almost anytime I do lower eyelid or facelift surgery, as you can’t fix the ills of facial aging by just tightening things. For a natural, balanced, seamless look, you need to add volume to replace volume loss, not try to fix volume loss by tightening. So I think anyone who is doing facelifts without adding fat back is not doing our current gold standard operation.
But is it safe?
Does doing fat grafting at the same time as a facelift cause complications? Does the fat survive when doing it with a facelift?
Study: Review of all clinical reports on fat grafting combined with facelift surgery. (Facelift being deep plane, sub SMAS facelift, SMAS facelift, minimal access lifts, component facelift, midface lift, SMAS plication facelift, SMAS ectomy.
- They found the most common locations of fat graft injection were:
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- Nasolabial Folds
- Tear trough
- Temple region
- Midface/cheek
- Marionette groove (the downturn around the mouth)
- Lips
- Earlobes
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- The addition of fat grafting added significant improvements to facial volume and aesthetic assessments
- It was safe
In their review, they found significant improvements in those who had fat grafting. “Those who had fat transfer to the area around the mouth had a 2 times more significant improvement in perioral wrinkles than those who did not.” “Significantly increased patient satisfaction in overall facial appearance, aging appearance appraisal, and satisfaction with cheekbones in patients with adjuvant lipofilling.” “The patients treated with fat injections looked 2 years younger than those with facelift alone.”
So does the fat survive?
For this, there are studies which do volumetric analysis of the face. They found the fat is retained when doing a surgery at the same time as fat grafting. Some studies did show less fat retention when done with a facelift. There did seem to be “rebound” with the lowest volume being measured at 6-9 months, with increasing amounts later.
Is it safe?
There were no complications listed, such as cellulitis (infection), bleed, or fat necrosis (the fat dies and can harden). No needs for revision was seen.
My thoughts?
I think you have to fix loss of facial volume by adding volume back. I am a huge fan of subtle, natural results, where you just look like a younger version of you, not a distorted version of you. Up until you are in your mid50s, most of the facial changes are due to volume loss. You must address it.
Assessing how much fat survives is tough. How was the fat harvested? processed? How much was injected? Where? Is the patient an ex or current smoker? We know all people have a different “quality of their soil” when we plant the new fat into its new site.
Much of where we inject fat during a facelift is in areas we aren’t undermining for the facelift. One issue with traditional facelifts was they did not do well in addressing the aging of the cheekbone and area around the mouth. Fat grafting does a beautiful, superior job of this.
Nice to know it is safe, that studies routinely show better patient satisfaction and outcomes with it, and that the fat does survive.
Preaching to the choir.