Q: Dr. Eppley, I had a facelift and upper and lower blepharoplasty a year ago. I always had a youthful round face. The facelift did give me a nice neckline and tighter skin, but changed the shape of my face which now looks thinner and older. Now I am considering fat transfer to restore my face to a more rounder look. Should I have the fat transfer in the malar area or submalar or both. Iam afraid I could get my jowls back. My face used to have the shape of Valerie Bertinelli’s if you know that actress. Thanks for your advice.
A: While facelift do a nice job of redefining the jawline and neck, tightening facial skin in some patients can make their face more gaunt in appearance. This can counteract the favorable anti-aging effects of the skin tightening. This is particularly prone to occur in Caucasian females who have a thinner face to begin with. This is why many plastic surgeons today, myself included, advocate a combination of fat injections for volume and less skin tightening for this type of facelift patient. The injections will usually be in the submalar and lateral facial area. Whether the fat injections should extend up onto and across the malar area would depend on what your facial skeletal structure is like. Flatter cheeks would benefit by some volume but strong cheekbones will not. The real benefit of fat injections in facial rejuvenation/facelifts is in the submalar or buccal area and extending outward and down from that area. I would have no concern about recurrent jowling from the fat injections as they do not fall because of their linear placement.
Dr. Barry Eppley