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Adding fat injections to facelifts delivers improved results

The answer to the question, "Why perform facial fat injections and a facelift instead of one or the other?" lies in the multifactorial process of facial aging, according to San Francisco plastic surgeon Timothy Marten, M.D., F.A.C.S.

Dr. Marten
"The face ages in three categories: surface aging of the skin, sagging of the skin and deeper facial tissues, and atrophy or loss of facial fat. A facelift only addresses the sagging component," Dr. Marten says, "and this has been a major weakness of the procedure."

While a surgeon could supplement a facelift with a chemical peel or laser resurfacing to address the skin surface aging component, that, according to Dr. Marten, does not address the atrophy issue. This, he points out, is literally where fat fills the bill.

A 45-year-old woman seen before (left) and two years and four months after simultaneous high SMAS facelift, neck lift, forehead lift, lower blepharoplasty and 50 cc of fat injections (right). Colored areas in the center photo show where fat was placed. Surgery performed by Timothy J. Marten, M.D., F.A.C.S.
"Fat injections allow us to treat the atrophy component, and the advantage of doing this in conjunction with the facelift is that the patient not only gets the lift, but they get a volumetric rejuvenation. Fat injections allow for treatment of volume loss that a facelift never addressed, and this is really a new dimension for us to work in."

Dr. Marten's treatment philosophy is based on fat as an important component of his rejuvenation of the aging face, but an adjunct to, and not a substitute for, his facelift procedures.

"The facelift corrects sagging and redundancy; and the fat restores lost volume and the softness seen in youth," he says. Dr. Marten began combining the facelift and fat injection procedures at the request of his patients who wanted to avoid a second period of recovery associated with a two-stage operation, and when he did so he was stunned at how much better the facelifts were.

"Now, I do fat injections with most facelifts and I feel like I have one hand tied behind my back in instances where patients opt out of the fat injection portion of the procedure," he says.

WHY FAT? The advantage of using the patient's autologous tissue rather than alternative injectable fillers is that fat grafts are not meant to be a temporary solution. "We're grafting living fat cells, so if the graft 'takes,' it's something that the patient isn't going to have to constantly replenish," Dr. Marten says. In addition, fat also contains adult stem cells that produce various important growth factors and messengers, and "fat injections may result in improvement of skin quality mediated through a stem cell effect," Dr. Marten explains.

Fat grafting works best when sagging tissue has been repositioned and redundant tissue has also been removed, according to Dr. Marten. Without correction of sagging and eliminating redundant tissue, he points out, fat grafting can result in an overly large, unaesthetic, and unnatural-appearing overfilled face.

"Simultaneous facelift and fat injections provide a better result than either technique performed by itself. Fat injections are artistically powerful, and they add a healthier, more fit, youthful, sculptural and sensual appearance than if you just did a facelift by itself," he says.

Fat injections are particularly helpful in patients who have problems with poorly supported lower eyelids or support issues in other areas. "Fat injections can lift the area by adding volume-based support," Dr. Marten says.

Fat injections are often more important in patients who are having a secondary facelift than the secondary facelift itself. "I'll touch up the facelift for a patient who seeks secondary improvement, but what really transforms these patients and gives them a stunning result is adding the fat. It provides at least half of the improvement," Dr. Marten says.

Fat grafting through the use of adipocyte stem cells can add volume to an aging face, as it improves skin tone and texture over the course of months and sometimes even years.

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