Facial fat transfer has become an integral part of facelift surgery, and for some patients it could even serve as a stand-alone procedure. Today’s plastic surgeons have recognized that surgical dissection to lift the sagging tissue is not enough to achieve optimal rejuvenating effects.
Facial fat transfer is not just about collecting donor fats from the abdomen, thigh, or hips and then injecting them into certain facial regions. First and foremost, one of the primary goals is to reshape the face in a way that it looks young.
But what is the inherent shape of a youthful face?
Young people have full cheeks [and tight jaw line] because of the abundance of “baby fat,” leading to a somewhat heart-shaped face. But in late thirties most will experience loss of fat especially in the lower eyelid and cheeks, while jowling—sagging skin and possible some fat in the lower third of the face—may start to show.
Simply put, aging turns the once heart-shaped face into a triangular appearance since the lower facial region looks “full” or “fleshy.”
Fat transfer aims to restore facial volume loss and when carefully executed the results can last for many years. Its long-lasting nature makes it appealing to patients who want to avoid regular “touch-ups” required by traditional fillers such as Restylane and Juvederm.
Aside from correcting volume loss, facial fat transfer can also soften the appearance of laugh lines or nasolabial folds and other deep creases.
A good number of facelift patients are advised to undergo simultaneous facial fat transfer to avoid “reminders” of surgery that could present themselves after several years.
The appearance of hollow lower eyelid can further aggravate the cheek “crescent” or sag, two common reminders of facelift that may appear years after surgery. Aside from a surgical dissection technique that goes deeper into the cheek/mid face muscle, fat transfer can also prevent these “future” problems and allow the face to age well.
Despite giving impressive rejuvenating effects, not all facelift surgeons offer facial fat transfer because it requires a steeper learning curve compared to readily available traditional fillers. Also, the survival rate of grafts might be different among doctors since there is no standardized process.
However, surgeons from Inland Empire Plastic Surgery Institute all agree that purifying the donor fats (i.e., removing biomaterials such as blood) and microdroplet injection techniques can lead to high survival rate and long-lasting results.
Facelift scars are well concealed behind the hairline, around the ear’s contour, and within the natural folds of skin. Nevertheless, proper wound closure in which there is little or no tension on the skin is important to prevent scar migration, which is one of the most common concerns of patients.
Beverly Hills plastic surgeon Dr. Karan Dhir says scars tend to fade quicker and better in older patients whose skin is more lax than younger individuals who typically wait 18-24 months for their scars to settle and “mature.”
Most of the healing takes place within two months, although Dr. Dhir advises patients to wait up to a year before they “judge” their scars, especially if they are considering a scar revision surgery.
In the first few days, the wound goes to an inflammatory stage in which it appears swollen and red and is susceptible to infection, although the risk can be minimized by good hygiene, wound care, and possibly use of antibiotics.
The second stage, meanwhile, happens three to four weeks postop in which fibroblasts or cells responsible for forming new skin and other tissue are produced in abundance. At the same time, the injured skin releases collagen to close the wound together and release tiny blood vessels needed for healing.
The fibroblast stage is believed to be a crucial time since scar tissue caused by “faulty” collagen may develop, leading to keloids or hypertrophic scars that appear thick, raised, and discolored.
At this stage, it is not uncommon for doctors to require their patients to use silicone sheets or tapes for as long as tolerated. Proponents suggest that these treatments provide constant pressure that prevents scar tissue or “haphazard” collagen from forming within the dermis.
And because the silicone sheets create a moist environment, they also encourage the scar to heal and fade quicker.
Aside from the use of scar treatments, Dr. Dhir says good nutrition and health plays a crucial role in “favorable” scarring, i.e., fine lines that blend well with the skin and/or behind the scalp. The general rule of thumb, he adds, is to increase protein intake weeks prior to facelift and during recovery as well.
Avoiding smoking at least three weeks before and after facelift also prevents “unnecessary” or “aggressive” scars. Dr. Dhir warns that all tobacco and smoking cessation products contain nicotine, which is known to constrict blood vessels and lead to compromised healing.
A facelift surgery eliminates or softens the visible signs of aging in the face and neck with the use of hidden incisions placed behind the hairline and/or within the ear’s contour. However, a more important goal is to create results that respect the patient’s anatomy, motives and expectations, and gender.
Male facelift procedures face unique challenges because of issues involving the anatomy and the patient’s goals.
Men have thicker, more vascularized skin than women, which predisposes them to increased risk of bleeding and persistent bruising. For this reason, renowned Los Angeles plastic surgeons will avoid any unnecessary surgical trauma and may possibly consider “modified” or minimally invasive techniques.
Another anatomical difference is that men tend to have a less severe cause of jowling than women. And because they require less contouring in the area, the incisions typically just stop behind their ear.
On the other hand, patients who have jowling and neck sagging will need their incisions to be extended into the lower scalp or nape area. Nevertheless, the resulting scars remain well concealed within the hairline and “inside” the natural folds of skin.
Another challenge of male facelift surgery is the susceptibility of men from hair loss, making it trickier to hide the scars. But one compromise is to modify the incision pattern in which the scars are only around the ear’s contour, avoiding the temporal area (used in standard facelift technique) because there is no hairline to conceal the surgery’s “stigmata.”
However, a facelift technique that is limited to the ear’s contour will not provide the same rejuvenating effects as those delivered by the standard approach in which the scars start from the temple area, behind the hairline.
But despite the limited rejuvenating effects of minimally invasive facelifts, they are suitable for a good number of male patients because they tend to have a more conservative goal—i.e., to soften the deep wrinkles without actually eliminating them.
Some doctors will deliberately allow some wrinkles to preserve the masculine and “more mature” appearance. This is a way better option than rely on excessive skin pulling, which is tied to a wide range of cosmetic problems such as visible scars, overly tight look, and probably the worst, effeminate countenance.
In some cases, the only way to correct the overly tight appearance is to wait for the skin to relax again, which can take a couple of years.
Meanwhile, it is not uncommon for male facelift patients to ask for brow lift performed at the same time as their surgery. In this procedure, it is important to raise the brow conservatively to preserve the “heavy” masculine look.
Facelift surgery is not just about “indiscriminate” skin tightening and pulling. A more important goal is to rejuvenate the face without resulting in stigmata such as overly tight appearance, pulled-up mouth, emotionless face, visible scars, pixie ear deformity in which the ears appear too long, and flat cheeks.
Facelift Orange County expert Dr. Tarick Smaili explains the top 10 traits you should look for in a facial rejuvenation surgeon.
- The “right” certification is the best indicator of a doctor’s training. A good rule of thumb is to select someone certified by the American Board of Plastic Surgery, which demands strict qualifications from its members.
Being a member of reputable plastic surgery affiliates such as the American Society of Plastic Surgeons and the American Academy of Facial and Reconstructive Surgery also shows credibility. Take note that all members of these associations are board certified surgeons.
- Experience is a must. Choose a surgeon who performs facelift surgery and its adjunct procedures on a regular basis, allowing him to accumulate knowledge and deeper understanding of the anatomies and their limits.
Because facelift is a highly complex procedure, avoid non-specialists and doctors who have not yet performed the procedure without the supervision of senior fellows (i.e., under fellowship program).
- Hospital privileges and facility accreditations. These “venues” adhere to strict patient care standards, sanitation guidelines, and building codes. They also have qualified and trained staff, including licensed anesthesiologists and nurses.
Outpatient surgical centers only allow surgeons who are board certified to use their facilities, while hospitals have review committees that scrutinize the qualifications of doctors.
- Impressive before-and-after photos. Some experts describe facelift as 25 percent science and 75 percent art because its primary goal is to rejuvenate the face in a way that it looks natural.
Scrutinize the “after” photos of your surgeon and make sure there is no visible scar; facial volume is in the right place; no overly tight appearance or “stretched” mouth, unnatural ear contour, and redundant skin; and the patient should look younger (compared to the “before” pictures) rather than operated on.
- Good reputation. You may ask your primary care physician for recommendations, although asking a friend or family member who had facelift and like its results can be also helpful. Nevertheless, it remains crucial to check a plastic surgeon’s background, particularly his board certifications and affiliations.
You can visit the American Board of Plastic Surgery website to check if your facelift surgeon is “properly” certified.
- Impressive core values. Aside from skills, you should also choose a surgeon based on his core values—e.g., honesty, ethical standards, and trustworthiness.
A good facelift surgeon will discourage or refuse patients he deemed to be poor candidates due to poor healing and other similar condition, unrealistic goals and expectations, emotional and psychological instability, and “weak” facial structures or anatomies.
- Patient safety. A good facelift surgeon will prioritize patient safety above all else, and will not think twice of refusing to perform a surgery on someone who is a poor candidate due to underlying illnesses or unrealistic expectations.
Aside from strict patient selection, a good surgeon knows the importance of month-long preparation, surgical planning, “gentler” techniques to minimize trauma and bleeding, and follow-up care.
- Diligence. During consultation, your surgeon must be able to allay all your concerns and answer your questions in the most honest, accurate manner.
He should also take the time to describe in details your surgery and the possible risks and ways to avoid them.
- Follow-up care. Your surgeon’s responsibility does not end after your actual surgery; he must also monitor your recovery and ensure that you are healing without any problem.
Also, follow-up care must include revisions should you need them. Keep in mind that many surgeons these days perform “touch-up” for free (if they perform the primary surgery), although their patients have to pay for the anesthesia and surgical facility fee.
- Reasonable cost. While you should be wary of surgeons whose asking price is way below the “average” (because most likely there will be some compromises in patient safety), you should not assume that someone who asks for a “ridiculous” price has the best training.
Remember that facelift cost varies considerably depending on the location, techniques and use of adjunct procedures, surgeon’s experience, and other similar factors. As of this writing, the average price is between $8,000 and $20,000.
The real challenge after a facelift surgery is not the pain since it usually lasts just a day or two (and is easily managed by mild painkillers), but the interruption of social activities. The general rule of thumb is to take at least a two-week off to wait for most of the swelling and bruising to subside to a significant degree.
While some patients had successfully returned work on the seventh to tenth day after surgery, at this stage there might be some noticeable symptoms, although scarves, large sunglasses, and camouflage make-up could be of help. For this reason, many choose to wait at least two weeks if they are trying to be discreet.
Patients with desk job can return work about a week postop if they don’t mind unsolicited questions and inquiries from their co-workers. However, they may want to wait a little longer if they are assigned to physically demanding tasks.
Dr. Tarick Smaili, one of the leading Brea plastic surgery experts, says patients who are less active during facelift recovery are less likely to experience persistent bruising and swelling. The idea, he adds, is to keep the heart rate and blood pressure within the “relax level” in the first three weeks.
But Dr. Smaili warns that prolonged immobility and bed rest should be avoided as well because it can lead to persistent swelling and delayed healing, so he recommends short walks several times a day to promote good blood circulation that can prevent the aforementioned complications.
Because “uncontrolled” stress could delay one’s recovery, some patients choose to work part time for a while, then resume their usual routine after they get their preoperative energy level back, which can take four to six months. Meanwhile, anecdotal reports show that people who are physically active prior to their surgery recover faster than individuals whose lifestyle is less active.
Aside from waiting for most of the swelling and dark bruises to dissipate, patients who are trying to be discreet may consider getting a drastic hairstyle beforehand. Doing so might also be ideal because it can take a minimum of six weeks before they can dye or cut their hair.
Overall healing—i.e., skin redraping to the new contour and looking more relaxed than overly tight—can take up to six months. For this reason, in the first few weeks it is not uncommon to look “overdone,” explains the leading Brea plastic surgery expert.