Fat Grafting to Improve Results of Facelift: A Systematic Review of Safety and Efficacy of Current Treatment Paradigms

Background:  Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures.  Despite the widespread prevalence of combined facelift and fat-grafting, there exists significant procedural variation between providers.  The purpose of this systematic review is to provide a summary of all published literature, outcomes, and complications available for fat grafting combined with facelift.

Methods:  A systematic review of the Cochrane Library and MEDLINE databases as completed to identify all clinical reports of fat grafting combined with facelift surgery using the following algorithm: (‘fat grafting’ OR ‘lipotransfer’ OR ‘lipofilling’ OR ‘fat transfer’) AND (‘facelift’ OR ‘rhytidectomy’ OR ‘SMASectomy’ OR ‘facial rejuvenation’).  Data on techniques, outcomes, complications, and patient satisfaction were collected.

 

Results:  The systematic review was performed in April of 2017.  248 articles were identified for review.  After application of exclusion criteria, a total of 15 primary studies were included in this review.  Various facelift techniques were used, including deep-plane or sub-SMAS facelift, SMAS facelift, modified MACS lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy.  The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvement in facial volume and aesthetic assessments.

 

Conclusions:  Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss.  Further research is required to validate and improve existing treatment modalities.