A facelift result that appears natural and has no adverse effects on one’s appearance are the primary objectives of the plastic surgeon.To achieve those goals two problems must be avoided when doing a facelift, avoidance of any hairline disturbances and limiting scars and their visibility. When trying to avoid visible facelift scars, the scar behind the ear can surprisingly be the most difficult.
Many may have heard of the Volumetric Facelift and it is easy to find it on an internet search. While it is a catchy name, it can be confusing for patients as to what that exactly means¦ and if and why it may be an improvement over a more traditional facelift approach.
It is now recognized that how our face looks as it ages is more than just droopy skin alone. The sagging skin is more of a symptom of what is happening underneath it than the sole cause of an older and tired looking face. The real culprits are the looseness of the underlying tissues, known as the subcutaneous muscle aponeurotic system or SMAS and the loss of volume or fat. The balloon, so to speak, becomes deflated and sags as fat is lost and the SMAS support system under the skin gets looser. These three layers (skin, SMAS, and fat) must often be treated simultaneously and by different techniques to get a rejuvenated look that does not look unnatural.
The looseness of the skin and the underlying SMAS are what is addressed by numerous facelift methods. The spectrum of facelift operations used by plastic surgeons goes from more limited procedures such as a short scar facelift or a Lifestyle Lift to fuller facelifts versions that have more extensive incisions around the ears with more extensive SMAS manipulations.
These facelift techniques work on anatomy that has fallen but do little to restore the loss of volume that can occur with facial aging. Here enters the concept of the Volumetric Facelift. This more comprehensive approach involves replacing fat in facial areas where it has been lost (usually below the cheeks and around the mouth) as well as skin tightening and redraping. Together, this approach provides results that in some patients provide a better rejuvenated look as the face is plumped up in volume-depleted areas.
As most everyone can afford to have some fat ‘redistributed’, the Volumetric Facelift does not significantly extend operative time or one’s recovery. In essence, it is a relatively easy thing to do as part of any type of facelift. Where fat should be injected is as much of an art form as science and should be marked out with the patient in detail before the procedure.
The science of the Volumetric Facelift, however, is not as established as that of the surgical technique. How much fat survives and what it does in its new recipient site is variable and open to considerable speculation. We certainly know that injected fat in many facial sites does survive. But it is rarely 100% and some volume loss does occur. A hard number of what amount survives is influenced by numerous factors and will vary in each patient. I tell my Indianapolis plastic surgery patients that about 50% will be retained, give or take. That is why the facial areas are overfilled, accounting for some volume loss after.
Because fat contains stem cells, there is great enthusiasm and hope that these stem cells provide a positive influence on fat survival and changes in the overlying skin. Some have even gone so far as to call their technique a ‘Stem Cell Facelift’. Claims have been made that the stem cells in fat reduce wrinkles and give patients more radiant glowing skin. Suffice it to say that this is marketing which is way ahead of actual science. Just because it seems that it should be true doesn’t make it so. The science of fat-derived stem cells is in its infancy. Whether significant stem cells survive the preparation and injection process has not yet been proven, let alone what complex interactions go on if they indeed do. It has yet been shown that what happens in cell culture actually happens in human faces.
Despite the lack of good science, the Volumetric Facelift makes good theoretical sense for facelift patients that have evident volume loss. Facial fat restoration does not add any significant risks to a facelift  and does make an immediate visual improvement. It can help avoid that tight stretched skin look in thin-faced patients that looks unnatural. Whether stem cells in such fat is the fountain of youth, however, remains to be proven.
Barry L. Eppley, M.D., D.M.D.
Indianapolis, Indiana