almost a century, plastic surgeons have believed that lifting and tightening could fix all of the problems associated with the aging face. That turned out to be a tall tale, according to San Francisco plastic surgeon Timothy Marten, M.D.
“Now we know that we cannot lift our way out of all of the problems seen on the aging face,” says Dr. Marten, who was one of the first plastic surgeons to champion the use of facial fat injections in facelift patients more than 15 years ago. “Experience has shown that patients with significant facial atrophy and age-related hollowing from facial fat loss will generally achieve suboptimal improvement from surgical lifts alone.”
Surgeons now recognize that the face ages in three ways: The surface of the skin ages, facial features sag and skin becomes loose, and the face undergoes a process of atrophy, and shrinks and becomes hollow.
A 75-year-old patient before (left) and one year and seven months after facelift and fat injections. A total of 90 cc of fat was injected. (Photos credit: Timothy Marten, M.D.)
“Traditional facelifts just treated the laxity and looseness; they didn’t address atrophy,” Dr. Marten says. “Fat grafting is really our first good tool to address that shrinkage.”
Dr. Marten says that while a surgeon can insert a cheek implant or use nonautologous fillers to restore cheek volume and make the face look fuller, these will typically not create the soft, natural, feminine, healthy appearance that fat does.
Ultimately, Dr. Marten says, neither facelifts nor fat injections alone produce results that are as satisfactory as those attained with a combination of the two.
TURNING BACK TIME Despite the fact that facial fat injections still have critics whose primary objection to the technique is its purported inconsistent “take,” Dr. Marten says there is an expanding body of evidence that the technique produces a predicable and sustained improvement that has resulted in the procedure becoming increasingly attractive to surgeons as well as patients.
“It has caught fire. Just a few years ago, surgeons didn’t believe in this, and now it has a major following,” Dr. Marten says. “A decade ago, if I told a patient who wanted a facelift that she needed some fat in her face, she didn’t really understand that. She would say, ‘Doctor, I’m already too fat. I don’t want to look fatter.’ Gradually, patients began to learn about atrophy as a part of the aging process. They read about it in magazines, and they experienced the improvement they could get with artificial injectable fillers.”
Before patients understood and accepted the use of fat injections as a means of obtaining a more youthful appearance, Dr. Marten says he would perform the facelift first and evaluate the patient later to determine whether they could benefit from and agree to a follow-up treatment with fat injections. Once patients came to understand the treatment and its benefits, however, Dr. Marten began receiving requests to have the facelift and fat injections done together to minimize downtime.
“When patients started letting me do that, I was stunned at how much better the facelifts were,” Dr. Marten says. This, he says, may be due in part to a not-yet-clearly defined “stem-cell effect” that results in fat injections actually inducing improvement in facial tissue quality. “Now people seek me out because I do both procedures at once,” he says.