Facial rejuvenation is a common request from patients considering cosmetic surgery.  Which procedure – fat transfer or facelift – is most appropriate to address signs of facial aging?  The answer to this question depends on a patient’s aesthetic concerns, clinical presentation, and general medical health.  Patients presenting with more advanced signs of facial aging generally require a facelift.  Fat transfer (also called fat grafting or fat injections) may performed in combination with a facelift in many cases to add further volume and to create a more youthful facial appearance. 

Facial aging often leads to excess skin as elasticity decreases over time.  The effects of gravity, sun exposure, genetics, among other factors contribute to redundant soft tissues of the lower face and deepening of facial lines.  Patients often dislike the appearance of prominent jowls, blunting of the neck angle (between the chin and neck), and loss of volume of the cheeks.  Facial wrinkles become deeper over time, particularly the nasolabial (smile) and marionette (extending from the corner of the mouth) lines.  When considering fat transfer or facelift, it is important to consider how these procedures address signs of facial aging.

Facelift is the gold standard to address signs of facial aging.

It removes redundant skin and resuspends the underlying facial muscles to increase volume in the cheek region.  It reduces the appearance of prominent jowls through this lifting effect.  The neck angle may also be improved by facelift surgery.  Excess fat may be removed from the chin region to increase definition.  As excess skin is removed and soft tissues are lifted, this also reduces the appearance of facial wrinkles.

Fat transfer alone may be performed in certain cases with less pronounced signs of facial aging.

Fat transfer first involves harvesting fat from other body sites, most commonly the abdomen or thighs.  The fat is then carefully prepared for re-injection into the face in small quantities to increase volume.  It may be performed in the midface to increase volume of the cheeks.  This may result in subtle improvement of the nasolabial (smile) lines through a secondary lift effect.  Fat may also be injected directly to plump up facial wrinkles, including smile and marionette lines.  Injections may be performed around the eyes (periorbital region) to decrease prominence of the tear trough deformity and for further contouring around the cheekbones.

For patients with more advanced signs of facial aging, fat grafting alone is generally not recommended. 

When considering fat transfer or facelift surgery, it is important to understand that fat grafting alone does not address skin redundancy.  Although fat grafting may reduce the appearance of the jowls, it does so by adding further volume to the jawline.  Jowl formation is related to the effects of gravity on the facial soft tissues, which accumulate in the lower face.  A facelift improves the appearance of the lower face by addressing the underlying cause, while fat grafting masks it.

Fat transfer may be performed in patients who are not candidates for facelift based on other medical conditions or smoking status.

Fat grafting is less extensive than a facelift.  Facelift may lead to skin necrosis if performed in an active smoker given compromised blood supply of the facial skin flaps.  Fat grafting is less invasive and does not challenge the blood supply of the facial soft tissues to the same degree as a facelift.  It is still recommended to achieve smoking cessation for one month pre- and post-operatively to lower risk of healing complications.  Smoking may reduce fat graft take, meaning that less fat may survive following injection into the face.  The risk of major complications (skin necrosis, in particular) is lower following fat transfer vs. facelift.  For patients with other medical conditions for whom facelift is not recommended, fat transfer may be an alternative option.  It is a shorter procedure and requires less time under general anesthetic and shorter recovery time.  Scarring is minimal.  It is important for patients to be aware of the shortcomings of fat grafting alone based on their specific aesthetic concerns, however it may be an alternative to more invasive surgery.

Fat transfer may be combined with facelift.

Patients presenting for a facelift may also benefit from facial fat grafting to combine the effects of both procedures.  The facelift may reduce skin redundancy and lift the facial muscles, while the fat transfer enhances volume.  During a facelift, the muscles are most commonly stitched to a higher position in the midface, which combats the effects of gravity.  Fat grafting may be combined to restore volume and to achieve a more youthful facial appearance.

Please contact us if considering facial rejuvenation in the Toronto area.  Dr. Power will give recommendations as to the most appropriate facial procedure – fat transfer or facelift or a combination procedure – based on your specific concerns.