A facelift lifts and tightens the muscle layer beneath the skin, but it cannot put back fat the face has lost over time. That's why some patients look refreshed after a facelift, yet still notice hollow or tired-looking cheeks. At the Buckingham Center for Facial Plastic Surgery, Dr. Edward Buckingham and his fellow double board-certified surgeons routinely pair facelift surgery with fat grafting to address both problems at once. Read on to see why the midface ages the way it does, and how combining these two techniques restores a fuller, more balanced result.
What Causes the Midface to Age?
Gravity and loosening ligaments let tissue droop. Sun exposure and collagen loss change the skin's texture. And the fat pads that once gave the cheeks their fullness shrink and shift downward, a factor that often gets less attention than it deserves.
A study published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons, tracked CT scans of the same patients about a decade apart. Midface fat volume dropped by roughly 12 percent over that time, and the deepest fat compartments lost volume even faster than the layer closest to the skin.
Volume loss shows up in predictable places, including:
- Under the eyes, where hollowing creates shadows and a tired look
- The cheeks, where flattened fat pads erase natural contour
- The nasolabial folds and jawline, where sunken tissue can deepen creases
- The temples, which can hollow and pull the brow downward
Why a Facelift Tightens Muscle Instead of Restoring Volume
A facelift lifts and secures the SMAS, the layer of tissue and muscle beneath the skin, along with the platysma muscle in the neck. Buckingham Center surgeons reposition this layer with precision during facelift surgery, which lifts sagging jowls and tightens the jawline; the technique also smooths vertical neck banding.
That repositioning restores structure, not volume. A patient with significant fat loss in the cheeks or temples can still look tired after an excellent lift, regardless of surgical skill.
How Fat Grafting Restores What a Facelift Leaves Behind
Fat grafting, also called autologous fat transfer, replaces lost volume using a patient's own fat. Surgeons harvest it, typically from the abdomen or thighs, then process and reinject it into hollow areas of the face. Because the graft becomes living tissue, it may provide natural-looking fullness that continues to behave like the patient's own fat over time.
Dr. Buckingham has co-authored peer-reviewed research on combining fat grafting with facelift surgery. The work outlines when and how the two procedures work together most effectively, and helps guide which patients benefit most from adding volume restoration to a structural lift.
Combining a Facelift and Fat Grafting for a Complete Rejuvenation
The fullest correction of facial aging often comes from pairing a facelift with fat grafting during the same surgical visit. The facelift addresses sagging skin along the jawline and neck; fat grafting restores the volume that gives the midface its natural shape.
A consultation with a Buckingham Center surgeon determines which combination of techniques best matches a patient's anatomy and goals.
Considering Midface Volumization? Dr. Buckingham and the Buckingham Center Team Can Help
Complete, natural-looking rejuvenation comes from a surgeon who understands both structure and volume. Dr. Buckingham and the double board-certified surgeons at the Buckingham Center for Facial Plastic Surgery have spent more than two decades refining facelift and fat grafting techniques for patients throughout Austin. Schedule a consultation to find out whether combining these approaches fits your goals.
This information is provided for educational purposes only and does not replace a consultation with a board-certified facial plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
