Hello,
I am Dr. Yang Sung-hyuk, Director of Hugo
Plastic Surgery.
One of the questions I frequently receive
during facelift consultations is:
“Can fat grafting be performed at the same
time as a facelift?”
The answer is yes. Facelift surgery and
fat grafting can be performed simultaneously. However, combining the two
procedures is not necessarily the best option for every patient.
Facial aging is not caused simply by loose
skin.
In addition to sagging of the skin and soft
tissues, several factors contribute to facial aging, including fat loss and
redistribution, as well as changes in the retaining ligaments and fascial
structures.
Therefore, when planning a facelift, it is
important not only to determine which areas have become lax, but also to assess
which areas have lost volume.
In particular, nasolabial folds and
lateral cheek hollowing are concerns for many patients. Because these
changes can have different underlying causes, the appropriate surgical approach
should be determined based on each individual's facial anatomy and condition.
Why Do Nasolabial Folds Develop?
The area commonly referred to as the nasolabial
fold is the crease that extends from the side of the nose toward the area
around the mouth.
The deepening of nasolabial folds with age
cannot be attributed to a single cause. Rather, it is the result of several
factors acting together, including:
✔️ Downward displacement of the midface soft tissues
✔️ Changes in the position and volume of buccal and cheek fat
✔️ Sagging of the skin and soft tissues
✔️ Changes in the retaining ligaments and fibrous structures
✔️ Repetitive movement of the facial muscles
✔️ Age-related changes in the facial skeleton and soft tissues
As the midface ages, the soft tissues of
the cheek can shift downward, while changes in the supporting structures can
make the nasolabial folds more pronounced.
Therefore, the idea that “the skin has become
loose, so simply pulling the skin tight will eliminate the nasolabial folds”
may be an overly simplistic approach to complex anatomy of the face.
Why Do the Lateral Cheeks Appear Hollow?
Many patients also say,
“My lateral cheeks look hollow, so I would
like to have fat grafting.”
However, hollowing of the lateral cheeks
cannot always be attributed simply to a lack of fat. Broadly speaking, there
are several possible causes.
1. Actual Loss of Volume
As we age, facial fat may decrease in
volume or change its position, causing the cheeks to appear more hollow than
before.
In such cases, restoring an appropriate
amount of volume to the deficient areas may be considered.
2. Hollowing Caused by Tissue Descent
Even when there has not been significant
fat loss, the upper cheek tissues may descend and accumulate lower on the face.
This can create a visible transition
between the cheekbone and the cheek, making the lateral cheek appear sunken.
In such cases, simply adding fat may make
the entire face appear unnecessarily fuller.
Therefore, when treating hollowing of the
lateral cheeks, it is important to first determine whether there is an
actual lack of fat or whether the hollow appearance is primarily caused by
changes in the position of the soft tissues.
Can Facelift Surgery and Fat Grafting Be
Performed Together?
A facelift is a procedure designed to
improve facial laxity, including sagging of the skin and SMAS, as well as the
contours of the jawline and neck.
Fat grafting, on the other hand, is
performed to restore volume to areas that have become deficient and to improve
facial volume and three-dimensional contour.
However, combining facelift surgery with
fat grafting requires careful consideration.
A facelift alone can reposition sagging
cheek tissues upward, which may make certain areas appear fuller.
If a significant amount of fat is then
added on top of this, the face may appear excessively full, or the result may
become more corrected than intended.
For transplanted fat to survive, the
grafted fat cells need to receive an adequate blood supply from the surrounding
tissues.
Because facelift surgery involves tissue
dissection and can temporarily alter local blood flow, fat graft survival may
be affected.
Can Facelift Surgery and Fat Grafting Be Performed Together?
A facelift is a procedure designed to improve facial laxity, including sagging of the skin and SMAS, as well as the contours of the jawline and neck.
Fat grafting, on the other hand, is performed to restore volume to areas that have become deficient and to improve facial volume and three-dimensional contour.
However, combining facelift surgery with fat grafting requires careful consideration.
A facelift alone can reposition sagging cheek tissues upward, which may make certain areas appear fuller.
If a significant amount of fat is then added on top of this, the face may appear excessively full, or the result may become more corrected than intended.
For transplanted fat to survive, the grafted fat cells need to receive an adequate blood supply from the surrounding tissues.
Because facelift surgery involves tissue dissection and can temporarily alter local blood flow, fat graft survival may be affected
How Can Hollowing of the Lateral Cheeks
and Nasolabial Folds Be Improved During a Facelift?
There are several methods for improving
volume deficiency in areas such as the lateral cheeks and nasolabial folds,
including fat grafting, autologous tissue augmentation, dermal fillers, and
implants.
One option that may be considered is using SMAS
tissue obtained during the facelift procedure to provide additional volume
to selected areas
What Is the SMAS?
SMAS stands for Superficial
Musculoaponeurotic System.
Simply put, it is a fibrous and fascial
layer of soft tissue located beneath the skin of the face. It plays an
important role in supporting and coordinating the movement of the skin,
surrounding soft tissues, and facial expression muscles.
During facelift surgery, rather than simply
pulling the skin, the SMAS may be dissected, repositioned, or otherwise
adjusted depending on the patient's condition and the surgical technique being
used.
In some techniques, a portion of the SMAS
may be removed during this process.
Instead of discarding this tissue, it can,
in selected cases, be carefully shaped and utilized to help restore volume to
areas such as the lateral cheeks or nasolabial folds.
What Are the Advantages of SMAS
Grafting?
One of the potential advantages of SMAS
grafting is that it uses the patient's own tissue to restore volume to
areas that appear deficient.
When performed together with a facelift, it
may not require a separate incision or additional tissue-harvesting procedure.
It may also help minimize the discomfort
associated with introducing foreign materials while providing volume to areas
such as the nasolabial folds and lateral cheeks.
By restoring volume in carefully selected
areas, it can help enhance facial three-dimensionality and improve overall
facial contours.
Compared with some other types of grafting
material, autologous SMAS tissue may also have favorable tissue integration
characteristics.
However, the structure and thickness of the
SMAS vary depending on the facial region, and whether SMAS grafting or fat
grafting is more appropriate should be determined after evaluating the
patient's individual facial anatomy and condition.
A Facelift Is More Than Simply Removing
Excess Skin
Facelift surgery is not simply a procedure
in which loose skin is pulled tight and excess skin is removed.
The goal is to restore facial balance by
comprehensively considering age-related changes in the skin, soft tissues,
SMAS, tissue position, and volume.
In particular, nasolabial folds and
hollowing of the lateral cheeks are often difficult to explain solely by skin
laxity.
Rather than simply choosing between a
facelift and fat grafting, it is important to first determine the underlying
cause of each concern.
Facelift surgery and fat grafting can be
performed simultaneously in selected cases. Alternatively, depending on the
surgical technique and the patient's anatomy, SMAS tissue obtained during the
facelift may be utilized to provide additional volume to areas that requiring
augmentation.
Ultimately, the most important question
is not simply which procedure to perform, but rather what has become lax and
what has lost volume in your individual face.
If you are considering a facelift and are
also concerned about nasolabial folds or hollowing of the lateral cheeks, it is
advisable to separately assess tissue laxity and volume deficiency
before determining the surgical approach that is most appropriate for you.
Written by Seong-Hyeok Yang, MD, a
board-certified plastic surgeon specializing in facial rejuvenations at HUGOPS
