Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,
Thank you for this wonderful forum. I had a question about fat grafting vs facelifts. It has been suggested to me from other doctors that a lower or mini face lift would help me. I wanted to avoid that because of the scars. Im a male in his early 40's. I wondered when you do fat grafting, does someone get a "lifting" and tightening benefit in the skin from the fat? My face has lost some elasticity resulting in a sagging face and jowls and an overall droopy of the skin. I wondered if you add volume to the face in the upper and outer regions, because there is more material under the skin in these areas, does this help tighten the skin and give a younger appearance to the skin by pulling it up? If I pull up on the skin near my temples and stretch it a little, it looks a lot better especially in my jowls and under my eye. If the fat works in another way, how does it work to give a younger appearance vs a facelift. Can a fat grafting help a mild to moderate sagging jawline by "pulling" the skin by adding fat to the outer jawline and building it back up? I am not overweight (within 10 pounds of ideal weight)

thank you

John

Great questions. I am glad that I have this forum to respond. Hopefully, I will be able to steer a lot of young people like you away from having premature facelifts. Let's consider a few things:
1. We have a really oversimplified view of the aging process. We commit what I call the "2 finger rule" which is holding your skin up and thinking that is what a facelift looks like. First, that is not what a facelift OR fat grafting looks like. That is what your pulling on the skin looks like. A facelift is intended to lift the deeper structure of the face that can bring the jowls and neck up with it. However, a facelift fails in many respects when you say, "Doc, look I pull my face up and the lines, wrinkles, and folds are gone." That would NOT happen with a facelift or even fat grafting. That is a total misrepresentation of a facelift. That's what it would look like for the first 2 to 3 weeks following a facelift because it is swollen and you can't see the wrinkles. Plus, that is what it would look like too since it would look like fat grafting since you would be slightly swollen. That is why I hate these 1 week facelift photographs. They are meaningless and deceiving by these major chains.
2. Oftentimes, people in their early 40s start to look a little tired which is compounded by a little weight gain in their lower face. They start to have a more lower face dominant appearance through the combination of gaining weight and losing it in their upper face. A facelift will not correct this. I truly believe that fat grafting can slim the jawline and make the face look a lot brighter and younger since it brings attention back to the eyes. It can improve a jowl but not entirely get rid of it. However, I believe in 85% of the time, a facelift is way overkill in a 40 something year old person and also won't establish what you really desire. I recently performed a fat grafting, facelift, and chin implant in a 40 something year old man but the fat grafting was for rejuvenation and the facelift/neck contouring/chin implant were intended to rebalance a very weak lower face that he always had. Of course, this is not always the case, bad genes and even more importantly bad lifestyle (smoking and sun exposure) may mandate an earlier face lift for you.
I know a lot of this really does not make sense to you until I meet with you in person and do a personal consultation. However, please hold off on the minilift, as you most likely do not need it at all. Now, why do perfectly good surgeons offer a minilift to someone on the younger end of the spectrum? Because that is all they know how to do. I look at a facelift as an important adjunct to the aging face principally in people over 50 and almost definitely in someone over 60 and beyond.
hope that helps a bit,
sml