When patients are considering facelift surgery we need to firstly ascertain whether the problem is only with the Mid Face being from the temple down to the jawline or Full Face which also includes the neck. In many younger patients the mid face is the main issue as their neck still has quite good tone. There are many techniques used to perform a mid face lift and each surgeon has there own personal preference.
In younger patients I prefer to use a premasseteric space lift to raise the tissues off the chewing muscle. I then use a deep plane technique to maintain the internal fixation and then plicate the deep SMAS layer, which, gives a good longterm result for the patient.
Fat grafting has become an important part of facial surgery over the last 5-10 years. In the early days of facelift surgery it was thought that everything dropped down, but now there is a real sense that there is a loss of volume and deflation of all facial tissues and this is why facial fillers have now become so important. When we do the elevating in a facelift, we always need to plump out, augment and add volume with fat grafts. Fat grafts can be taken from the stomach, thigh or inside of the knee and can be placed in all areas of the face. This can be placed either superficially or in the deep compartments which adds volume and rejuvenates the face for a more youthful appearance.
Some of this fat will continue to grow and some will fat dissolve, although it will leave the collagen and vascular matrix behind making a scaffold for any tissues to grow. Some fat will act as a spacer and some will have stem cells that will also continue to grow long term as the majority of the fat absorbs.
In this patient we have demonstrated the early pre-operative course and her post-operative results from a mid face lift in conjunction with fat grafting to restore the facial contour. She now has a firm jaw line, more volume in the upper face and a more youthful look.
I now include Fat Grafting in all my face lift patients as this ensures that the surgery results in the best contour. Fat grafting can also be used without a face lift to restore volume and rejuvenate the face without undergoing invasive surgery and this is a great technique that everyone has available to them.