When patients come to see me for a facelift consultation one of their biggest concerns is that the result will somehow appear unnatural or over-pulled. I tell these patients that I am equally concerned with these issues. Unnatural facelifts tend to stand out in a crowd while natural ones tend to blend in seamlessly. What then is the key to achieving a natural facelift?

The Two Golden Keys

I think that there are two key issues to achieving a natural facelift. The first issue is that the facial structures must be moved back into their natural and harmonious position with the lifting process. The second issue is that the volume that was lost with the aging process needs to be carefully restored.

As we age the structures of the outer brow, the cheek, the jawline, and the neck get loose and descend. In a natural face lift these structures are simply brought back to the position that they occupied in the past. Rather than distorting a face, careful lifting will bring the face back to its natural state. I would argue that after a successful face lift a face is more like its natural self than it was before the operation.

I am pleased to see that more and more surgeons are becoming aware of the importance of volume in facial rejuvenation. I have integrated volume restoration by means of fat transfer into my process of facial rejuvenation for more than 15 years

Why is facial volume restoration so important? As we age the beautiful curves and fullness of the face become sunken and hollow. This is particularly true, unfortunately, in people who are quite athletic. They may maintain beautiful body form, but their faces somehow look tired and gaunt. All of the lifting in the world, even if it is done in the right direction, will not correct this.

Where Do Our Faces Lose Volume?

There are several areas that typically lose volume with the aging process. These include the cheek, the junction of the cheek and eyelid, the temple, the angle of the jaw, the chin, and the framing zone around the lips. Careful volume restoration of these areas can be incredibly powerful.

The best volume replacement is your own natural fat. It comes from you, it lasts a good long time, and it carries with it an abundant source of stem cells, which tend to improve the quality of the overlying skin.

The fat transfer procedure is essentially a miniature very gentle liposuction. I obtain the fat cells, concentrate them, and then very carefully transfer them into the areas that are missing volume.

I also carry out fat transfer as a separate procedure from face lifting. It is relatively common in patients who are in their late 30s to early 50s to still have relatively good to deep structural position but a relatively hollow look from fat loss. Fat transfer alone can be tremendously helpful for these people. Another use of fat transfer can be in a patient who has already had a face lift but needs some volume replacement a number of years after the original face lift.

I love to study pictures that my patients bring into the consultation that show their faces over a long stretch of time. Some even bring in their high school graduation pictures. These pictures help me to understand how the aging process has affected each person’s individual appearance. I can understand how much comes from structural descent and how much comes from the aging process.