Facial rejuvenation surgery or facelift is not just about pulling the loose skin in an attempt to smooth out the appearance of wrinkles, jowling, and sagging tissue. Leading Los Angeles plastic surgeon Dr. Tarick Smaili treats it as a three-dimensional concept in which the lost of volume or fat must always be taken into account.
Facial fat grafting is often performed simultaneously with facelift. The goal is to correct the gaunt appearance due to volume or fat loss, a common problem of patients who are on the thin side, explains Dr. Smaili.
Oftentimes, facelift is performed first then followed by facial fat grafting, although under one surgical setting to minimize the cost. However, proponents of one-stage procedure believe the grafts should be only injected into the areas not undermined by facelift to prevent shifting and other unpredictable effects.
For this reason, Dr. Smaili may recommend a two-stage procedure for patients who need a more extensive form of facelift in which more loose skin is reshaped and/or removed. The goal, he explains, is to achieve a more predictable result since the second surgery is attempted only after recovery from the initial procedure is complete.
Nevertheless, there is no current study suggesting the cosmetic advantage of fat grating at the time of facelift or at a later date.
While dermal fillers such as Restylane and Juvederm can also correct the skeletonized or gaunt appearance caused by aging, Dr. Smaili says that fat grafting makes it easier to achieve natural results because it feels and behaves just like the surrounding tissue. Nevertheless, it involves a rather more complex procedure in which gentle liposuction, purification method, and re-injection are performed.
Structural facial fat grafting is usually performed to restore the fat or volume in the cheek, jawline, and around the eye, although it can also soften the marionette lines (creases that run downwards from the corners of the mouth) and nasolabial folds (laugh lines).
However, Dr. Smaili says some surgeons prefer the use of dermal fillers to fat grafting when the primary aim is to smooth out deep creases like the nasolabial folds and marionette lines because these biodegradable, non-reactive materials are believed to have a more cohesive nature that makes them effective in softening facial wrinkles.
Since dermal fillers are readily available materials, they are generally less expensive than fat grafting, although not in the long run as they need to be repeated every four months to two years.
Fat grafting, meanwhile, provides a longer lasting result if the grafts are able to access or form new blood supply needed for their survival, explains Dr. Smaili.