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