The human face constantly loses volume in the aging process and volume loss is highly effective in facial aging - two major discoveries of the 90s. Since the face was losing volume as it aged, replacing that volume should have been a priority.

For the next 30 years, we pondered how we could reconstruct facial volume. Hundreds of different fillers were launched for medical use, dozens of them being subsequently taken off the market. Tissue transfers to the face were also introduced and flourished back then before taking their modern form.

Today, there are thousands of pages of literature consisting of books and articles that you can access and read for reference to fat injection to the face.

When the interest in volume peaked in facial rejuvenation, facelift surgery techniques also got their share. Volumetric facelift techniques emerged and increased in number. By the second half of the 2000s, the results of facelift surgeries combined with fat injection blew everyone's minds. We saw surgical results so successful that they had never been achieved with any surgical technique before. We were fascinated and we sanctified those who had those results.

It was the last years of my residency, and as a surgeon at the start of his career, I read the scientific articles on these influential techniques. After completing my residency at Hacettepe University in 2010, I went to the Cleveland Clinic as a fellow and had the honor of working with James Zins, MD. I'm talking about a surgeon who has been performing 100-120 facelift surgeries a year for the last two or three decades. He is my mentor or more like a father when facial aesthetics is concerned. Back then, we integrated mild adipose tissue transfer into the surgeries we performed but not at a level done by surgeons producing those "fascinating results" I mentioned earlier. When one is young, one can interpret the cautiousness of more experienced surgeons as discouragement in trying new things or as a kind of conservatism. Of course, it was not as I thought. First of all, Zins was a very experienced scientist who had read almost everything that had been published in the literature until then and had accumulated enough experience to not get carried away with some cool pictures. However, there was consensus in all the international congresses I attended that "a modern facelift surgery could not be performed without fat injection", which ignited my urge to try out new things.

Between 2010 and 2015, I started to liberally use fat injection simultaneously with facelift surgeries and began to get really good results. The patients looked simply great during postoperative follow-up in month 3. Most of them looked fine at month 6 and year 1. The surgeries I performed had leveled up.

However, in some patients, that “perfect result” in month 3 was not permanent in the long run. Although fat injection is one of our most effective weapons, it is unfortunately not a predictable and stable practice by nature. In some patients, 30% of the injected fat survives, while the rate of survival is 5% in others. Sometimes the opposite is the case, and more tissues than anticipated survive. Another problem is that when we transfer fat tissue simultaneously with facelift surgery, the fat tissue we add to the face stretches the face by creating an extra volume. This stretching may result in facial laxity again if the fat is absorbed. In other words, there is a mechanism that works contrary to the tightness that we try to achieve with facelift surgery.

In summary, I found that in at least 10% of patients, there was a serious mismatch between the quality of outcome at month 3 and year 1. In addition, there was a significant difference between the appearance of the patients in the photographs and their actual appearance in real life. Patients looked prettier in static photos than in real life, but when the face was in motion and mimics were active, there was a feeling of “strangeness” that was difficult to describe.

Last but not the least, I could not match a fuller and voluminous facial structure with the ideal of a middle-aged beauty that I wanted to achieve. Fine, the face was losing volume as one got older, but none of the middle-aged beauties had overly plump faces. It was very important to maintain the graceful and thin structure of the face while filling in the critical areas.

As a result of such observations, I stopped the practice of “high-volume adipose tissue transfer to the entire face during facelift surgery” in 2016.

In my current practice,

In my patients with severe volume loss, I apply multiplanar and high-volume adipose tissue transfer to the entire face in a secondary session after facelift surgery.

In my patients with mild to moderate volume loss, I only work on critical volume-deficient areas in mini sessions under local anesthesia during follow-up examinations.

As of today, during facelift surgery, I only transfer fat tissue to areas such as around the eye, midface, forehead, around the mouth, lips and chin, which are all outside the scope of facelift surgery.

This does not affect the dynamics of facelift surgery and creates a "complementary" effect in areas outside the scope. We decide on whether we will volumize the facelift surgery area “on a case basis” during month 3, 6 and 12 follow-up appointments.

By the way, the surgical technique is of vital importance in fat injection. Any random technique for adipose tissue transfer cannot be used in any random area. Each region, tissue depth and functional unit has a unique application technique/volume calculation/number of sessions/donor site.

This post was written for my candidate patients who ponder the following:

- Will I also have fat injection to my face during my surgery?

- I'm confused. I have concerns.

In summary,

Fat injection during facelift surgery can successfully complement the facelift surgery or it can spoil a well-done facelift surgery.

However, you should definitely know that fat injection can never turn a weak facelift surgery technique into a stronger one.

Highly satisfactory results can be obtained in the early period by adding plenty of fat injections to mini facelifts performed under local anesthesia in a few hours. However, the majority of patients will be inevitably disappointed in the medium-long run.

Feel free to contact us for detailed information on the role of adipose tissue transfer in facial rejuvenation surgeries and to find out whether your face is eligible for that procedure.

Take good care...

... of yourself and your beauty.

OB