A deep plane facelift is an advanced procedure, lifting and repositioning the underlying Musculoaponeurotic System (SMAS) to create long-lasting, natural rejuvenation. However for some patients, a deep plane facelift alone may not be enough. For some to achieve harmony and rejuvenation, we must also account for volume loss, and that’s where meticulous and careful fat grafting becomes very helpful.
Aging isn’t just a descent of tissue; it’s a deflation. As we get older, fat naturally dissipates from key areas like the temples, under-eye troughs, the mid-cheek, and lips, leaving behind a hollowed and deflated appearance that a simple lift cannot fix. Integrating fat grafting—harvesting a patient’s own fat and carefully injecting it—at the time of the deep plane lift is the final, essential step in a comprehensive restoration.
The importance lies in the word “careful.”
The Synergy of Volume and Lift
- Restoring Natural Contours: The deep plane repositions the tissue, providing the foundational lift. Fat grafting acts as the sculptor’s clay, subtly filling deflationary zones. This combination avoids the “pulled” look, instead achieving a beautifully smooth transition from the lower eyelid to the cheek—the so called Ogee curve.
- Precision and Survival: The fat must be processed and injected with precision. Fine droplets must be placed in the deep muscle/periosteal planes, respecting the underlying anatomy. Too much fat, or fat placed incorrectly, can lead to lumps, asymmetry, or an unnatural, puffy result.
- Skin Quality Improvement: Beyond volume, grafted fat is rich in stem cells. Studies show that these cells can improve the overlying skin quality, texture, and colour, adding an extra layer of rejuvenation that complements the surgical lift.
Fat grafting in the face must be done thoughtfully and by an experienced surgeon – I have seen too many patients who have had poor outcomes with lumpiness and irregularities in the skin. These patients can be very unhappy and it is a very difficult thing to surgically correct. Much better to see a surgeon who knows what they are doing, who knows when to use fat graft and when to use other techniques.
Fat grafting has a small but well described risk of fat embolism where the injected fat can spread into the vein of the eye known as the Ophthalmic Vein and can cause blindness. This is very rare and there are no cases in Australia or NZ that I am aware of. During the procedure I take care to compress the vein and use only small aliquots of fat each time which reduces the risk of this complication.
In essence, the deep plane facelift is the structural engineer, and fat grafting is the finishing architect. Performed skillfully, these two procedures work in tandem to not only turn back the clock but also to restore the specific youthful shape that time has eroded. It is a safe procedure in skilled, experienced hands and requires an artistic eye to ensure the fat integrates seamlessly, providing the soft, permanent volume needed for an exquisite and enduring result.