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In recent years, social and mainstream media has made the aging face a battleground, pigeonholing people into taking sides. Are you *Team Filler* (often younger and surgery-averse) or *Team Facelift* (likely older and not scared of the scalpel)?

In reality, the science (and art) of facial rejuvenation is not so black and white. Many women are discovering the downfalls of decades of dermal filler use (those chipmunk cheeks don’t come cheap), while others are disappointed when a facelift alone can’t solve their cosmetic concerns. The truth is, facial aging is a complex conundrum for which there is no single fix — quick or otherwise. To tackle the multidimensional problem, modern plastic surgeons have been increasingly combining tightening and volumizing techniques (both surgical and non-invasive) to improve facial contour.

Today, there are three main ways surgeons restore lost volume: 

1. Repositioning underlying tissues (as in a high SMAS or deep plane [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck)) 
2. [Fat transfer](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting) (a.k.a. autologous fat grafting)
3. Injecting [dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) (most commonly, hyaluronic acid-based)

To learn more about how injectable fillers and facelifts [work together](https://aedit.com/aedition/best-procedures-to-combine-with-a-facelift), we tapped three top plastic surgeons.

## **What Is Facial Aging Exactly?**
Now’s the perfect time to talk about facial aging. For starters, it’s more complicated than you might think. We tend to characterize aging as simply a losing battle against gravity (and, unfortunately, that’s partly true) but other factors, like losing facial bone mass, are involved.

“Sagging is definitely related to volume loss, but it is not entirely due to it,” says [Andrew Frankel, MD](https://aedit.com/provider/andrew-frankel-md-275), a double board certified facial plastic and reconstructive surgeon in Beverly Hills. “The elasticity of the skin and underlying soft tissues plays a role. The underlying supporting ligaments and the bony skeleton also are important factors. As the bone remodels and shrinks the overlying skin and soft tissue begin to sag because they are draping over a smaller shape.”

Simply put: your face isn’t just falling, it’s also going flat, and changing shape, and stretching (oh my). Generally speaking, a [rhytidectomy (a.k.a. facelift)](https://aedit.com/procedure/facelift-rhytidectomy) is a surgical procedure that tightens up the tissues of the lower face. Because this sagging along the jawline (read: jowling) is associated with age, a facelift is pretty much guaranteed to turn back the clock at least a few years.

Plastic surgery techniques have come a long way since the super-taut ‘70s, with aesthetic surgeons today focused more on tightening up the underlying tissues rather than just pulling on the skin. While there are many different types of facelifts — including [deep plane](https://aedit.com/procedure/deep-plane-facelift), [high SMAS](https://aedit.com/procedure/smas-facelift), and the so-called ‘[mini](https://aedit.com/procedure/minifacelift)’ — they all share the common goal of counteracting the aging effects of gravity, genetics, and lifestyle choices that lead to sagging.

## **Does a Facelift Restore Volume?**
Those of you paying close attention already know that, historically, facelifts were primarily about skin tightening. But, too often, just pulling the skin taut resulted in a stiff, angular, unnatural result. This is because stretching skin that’s lost elasticity over an aging bone structure can’t make you look 25 again. 

“Imagine a balloon that loses air and deflates,” explains [David Isaacs, MD](https://aedit.com/provider/david-isaacs-md-912), a board certified oculofacial plastic and reconstructive surgeon in Beverly Hills. “You start to see the creases, wrinkles, hollows, and the balloon starts to change shape.” When you take all those factors into account, you realize the true complexity of the aging process. “Facial rejuvenation has traditionally been approached as a vertical vector, ‘y-plane’ problem, but it's really a three-dimensional problem,” he adds.

With that in mind, you might be wondering what the modern facelift can accomplish. “A facelift elevates tissues and repositions things into a more desirable anatomic position,” Dr. Frankel explains. “It also helps to stretch wrinkles and fine lines and, therefore, makes the skin appear smoother.” 

So, what can’t it do? “A facelift does not add volume, and, oftentimes, fillers are required to soften the patients’ appearance,” he says. “If tissues are tightly stretched across two bony high points, for example, there can be some evidence of the direction of the tension or some folds develop over time in the hollow area between those high points.”

### **Adding Volume with a Facelift** 
Whether using synthetic dermal fillers or fat transfer (more on both below!), here are some of the most common areas of the face where plastic surgeons add volume in conjunction with a facelift:

- **Jawline**: “Some people have indentations on either side of their chin where the jaw narrows a bit before it becomes wider again,” Dr. Frankel explains. “These indentations can exaggerate the degree of jowls and break up an otherwise nice jawline. Placing some filler along the bone in these areas can be helpful.”
- **Lateral Cheeks**: According to Dr. Isaacs, “the high lateral cheeks” are often addressed post-facelift. “This can give more of a sweet-heart shaped face many patients desire,” he says, adding that certain facelift techniques (like a deep plane approach) may achieve those results without filler.
- **Nasolabial Folds & Anterior Cheeks**: These are common areas of concern, but they aren't dramatically affected by a facelift, according to [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon at UCLA. “A deep plane technique does help lift up the cheek a little bit, but, if their cheek is already under volumized, I’d much rather do it with their own natural tissue than with a filler,” he explains. “If somebody has really deep nasolabial folds, I do fat grafting first.”

## **Facial Filler vs. Facial Fat Grafting**
Plastic surgeons are unique in their preferences for using [dermal fillers or fat transfer](https://aedit.com/aedition/comparing-dermal-fillers-vs-fat-grafting-for-facial-rejuvenation-contouring) in conjunction with facelifts. Sometimes, it’s not an ‘either or’ situation. It can be determined on a case-specific basis and will be dependent on the patient’s anatomy and preferences. Here’s a closer look at each:

### **Filler**
Some plastic surgeons like using synthetic dermal filler (like Juvederm® or Restylane®) after a facelift. Dr. Frankel, for instance, says he favors injectable filler over fat grafting procedures because it’s more predictable, is reversible, and doesn’t carry the risks associated with harvesting from a donor site. 

**The 411 on Filler:**

- Lab-created [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler) (based on substance found naturally in the body)
- Temporary and generally reversible
- Predictable
- Less risk of bruising; shorter recovery period
- May clog lymphatics and cause swelling
- Injected 8 to 12 weeks after facelift surgery (once post-op [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) resolves)
- Regular maintenance required

Filler smooths out the junctions and hollows “and also can make the edges of the bony landmarks appear less harsh,” Dr. Frankel notes. Another benefit? “Fillers can also add some height at various key points around the face to improve overall balance,” he says. But it does require a separate appointment. “Approximately eight weeks after the surgery, we reevaluate the need for filler and where it should be placed,” Dr. Frankel explains. “When the filler is injected at this stage, it provides greater projection and does not fall under its own weight. I find this to be much more effective than trying to inject lax skin.”

### **Fat Grafting**
Other surgeons feel strongly that facial fat grafting is the best way to restore volume, especially when performed in conjunction with other facial plastic surgery (think: facelifts). “If you just do a facelift and never rely on fat grafting, you’re holding back on your results significantly," Dr. Jason says. “We all recognize that loss of volume is a huge part of aging — there’s no question about that. So, why would you rely completely on filler when you have that perfect opportunity to be in the operating room and use fat at the same time?”

**The 411 on Fat Grafting:**

- Natural harvested fat cells collected via liposuction from donor site
- Longer-lasting results than synthetic filler
- Injected at the same time as facelift surgery
- May add downtime to facelift recovery due to [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox)
- Little to no maintenance required
- Less costly over time

Dr. Jason believes that using your body's own fat (which contains stem cells) leads to more natural results. “I don’t worry about overdoing somebody with fat grafting," he explains. “Filler is an unnatural substance that takes on a lot of water. At some point, if the percentage of filler starts to become equal to or more than the amount of natural tissue that you have in the area, it’s going to look swollen because it draws in water.” That’s what can lead to an unnatural appearance. “We all know when we see those faces that just look a little swollen and weird,” Dr. Jason says. “That’s from filler, not from fat grafting.”

If you are curious about [cost effectiveness](https://aedit.com/aedition/cost-effective-cosmetic-procedures-for-face-eyes-lips), a facial fat transfer procedure will likely be a larger initial investment than filler but prove to be less costly in the long run. “The beauty of fat grafting is that I am doing a broad, very comprehensive grafting to your whole face,” Dr. Jason says. And the procedure rarely needs to be touched up. “Usually, we’re injecting something like at least 10 cc of fat in a widespread area,” he shares. “That’s like $10,000 worth of filler, but you don't have to keep injecting it.”

## **Do I Need Filler, a Facelift, or Both?**
At the end of the day, our experts agree that the only way to determine whether a patient needs filler (be it fat or synthetic), a facelift, or both to meet their aesthetic goals is to consult with a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon. “The degree of facial volume needed for optimal rejuvenation is highly variable,” Dr. Frankel says. 

Even so, there are some genetic and lifestyle factors that may shed some light on the [decision-making process](https://aedit.com/aedition/facelifts-vs-injectable-dermal-fillers-which-one-is-right-for-me). “In general, people who were born with a full face tend to age better, as the volume diminishes and their features become more defined,” Dr. Frankel shares. In such cases, the patient may “not need much or any additional volume” and would instead “benefit from redistributing their existing volume to achieve a more youthful appearance,” he says. 

On the contrary, if someone has chiseled features in their twenties, “they are more likely to require additional volume as they age,” Dr. Frankel notes. In these cases, it’s important to [seek a skilled injector](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) that understands the subtleties of the face. “Caution should be used when injecting these patients so as not to add too much volume or place it into areas that would change their original look,” he says.

Aesthetics

Facelifts primarily address skin laxity concerns, but what about volume loss? Here’s what you need to know about injecting synthetic filler or autologous fat after a facelift.

A Guide To Dermal Fillers And Fat Grafting After A Facelift

The Truth About Facial Fillers After A Facelift

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Call it the ‘[Zoom effect](https://aedit.com/aedition/aedit-survey-reveals-how-2020-altered-aesthetic-landscape)’: Many of us are spending more time than ever staring at our faces on videochat cameras each day, and, perhaps due to all those hours spent studying our own features, plastic surgery requests have skyrocketed. According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), 70 percent of facial plastic surgeons have seen an uptick in bookings during the pandemic. And patients are looking for more than just injectables — a [recent report](https://www.aafprs.org/Media/Press_Releases/PageTemplates/New%20Survey%20Results%20Announced%20Feb.%201,%202021.aspx) says that demand for surgical procedures, like facelifts, is on the rise. 

Once you’ve reserved that time on your surgeon’s table, you want to make it count. Choosing to undergo multiple procedures at once helps [minimize recovery time](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments), saves the (even slight) COVID-19 risk of visiting a doctor in-person again, and, maybe most importantly, maximizes the impact of the results. The tried-and-true rhytidectomy (read: [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck)) is one such surgery that can greatly benefit from strategic pairings, and we spoke to top plastic surgeons about the procedures they most often combine with facelifts. 

## **Why Combine?**
“It’s important for patients to understand that facelifts alone do not address the perioral areas [around the mouth] and, in general, do not address nasolabial folds,” says [Charles Pierce, MD](https://www.normanrowemd.com/our-practice/dr-charles-pierce/), a double board certified plastic and reconstructive surgeon at [Rowe Plastic Surgery](https://www.normanrowemd.com/). To put it in layman's terms: A facelift isn’t a be-all, end-all solution for signs of aging around the face. This distinction highlights the utter importance of making sure you and your doctor have an honest conversation about desired results. 

If you’re hoping for tighter, more youthful-looking skin around the nose and mouth or have concerns about your upper face, you may be better suited for a combination procedure — and your doctor should walk you through the possibilities and projected results step by step. “One of the things I love most about plastic surgery is that I have the tools and the creativity to help patients on their journey to accomplish their goals,” says [David Shafer, MD](https://aedit.com/provider/david-shafer-md-153), a double board certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City.

## **What to Combine with a Facelift** 
As we’ve learned, the best pairing for your facelift depends on your aesthetic goals, but there are some common surgical and non-surgical combos that address a wide array of cosmetic concerns. “Facelifts reposition tissues but do not replace volume lost with age, relax facial muscles, or resurface skin,” explains [Adam Schaffner, MD](https://aedit.com/provider/adam-schaffner-md-33), a triple board certified plastic and reconstructive surgeon in NYC. “It may be of benefit in some patients to combine a facelift with non-surgical or minimally invasive procedures.” 

Bring these suggestions to your own [consultation](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation), so your surgeon can work with you individually to customize a combination tailored to your desired results.

### **1. Facelift + Blepharoplasty** 
[Blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) (a.k.a. eyelid surgery or eyelid lift), is combined with facelift about 50 percent of the time in Dr. Shafer’s office. Because a facelift focuses on the lower and mid-face, patients with [aging or tired eyes](https://aedit.com/concern/aging-and-tired-eyes) may not see the results they desire in the upper portion of the face without additional intervention. The blepharoplasty procedure removes excess fat and sagging skin around the upper eyelids, lower lids, or both. In conjunction with a facelift, it creates the appearance of a [rejuvenated eye area](https://aedit.com/procedure/eye-rejuvenation-solutions) and overall refreshed look.

### **2. Facelift + Brow Lift**
Like a blepharoplasty, a [brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye) (a.k.a. forehead lift) can improve the appearance of the upper face. “Usually, the aging face isn’t just plagued by sagging, loose skin,” says [Lauren Chmielewski, MD](https://aedit.com/provider/lauren-chmielewski-md-143), a board certified plastic and reconstructive surgeon in NYC. To truly meet the patient’s needs, additional ‘lifts’ are needed, and a brow lift can tighten excess skin in the upper third of the face, restoring sagging brows and helping to get rid of the wavy lines on the forehead.

### **3. Facelift + Necklift**
Procedures that address the upper face aren’t the only add-ons. “Usually, when I’m treating the aging face, I concentrate on the face and neck,” Dr. Chmielewski says. A taut, youthful-looking face can look off atop a sagging neck. Since the neck often ages faster than the face, pairing a rhytidectomy (facelift) with a [lower rhytidectomy (neck lift)](https://aedit.com/procedure/neck-lift-lower-rhytidectomy) can address any discrepancies in one fell swoop. Performed alone or in conjunction with a facelift, a [neck lift](https://aedit.com/aedition/mini-neck-lift-procedure-results-side-effects) tightens and eliminates the excess skin, fat, and/or banding that often forms as we age.

### **4. Facelift + Chin Implant**
We’ve already covered the benefits of [combining chin augmentation and rhinoplasty](https://aedit.com/aedition/combining-rhinoplasty-and-chin-augmentation), but [enhancing the chin](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures) can improve facelift results, too. Dr. Shafer says it helps to “strengthen the chin projection,” which improves the balance and harmony of the entire face. While filler and fat grafting (more on that below) can also be used to augment the chin and jawline, a [chin implant](https://aedit.com/procedure/alloplastic-chin-implant) involves placing a synthetic implant on or around the chin to alter the shape of the face.

### **5. Facelift + Fat Grafting**
“Fat transfer or using injectable fillers, such as Restylane®, Juvéderm®, or RHA® products, will help to restore facial volume,” Dr. Schaffner shares. [Fat grafting](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting) involves taking fat from one area of the body (i.e. a donor site) via liposuction and repurposing it elsewhere. The donor site is often the thighs or stomach (basically, anywhere you have [excess fat](https://aedit.com/concern/excess-fat)), and, once processed, the fat can be used to plump the cheeks, under eyes, lips, chin, hands, and even earlobes. Unlike synthetic fillers that are temporary, [fat grafting](https://aedit.com/aedition/comparing-dermal-fillers-vs-fat-grafting-for-facial-rejuvenation-contouring) is considered a permanent solution with no risk of rejection. With that said, the final results of fat grafting can take three to six months to reveal themselves. This is the length of time it takes for the graft to become established in its new location, and, during that period, the body re-absorbs a percentage of the fat (usually around 30 to 50 percent). 

### **6. Facelift + Neurotoxins**
Another injectable that can be paired with a facelift? [Neurotoxins](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin). “Using Botox®, Dysport®, Jeuveau®, or Xeomin® will help relax muscle causing facial wrinkles associated with repeated movements,” Dr. Schaffner says. These neuromodulators can be employed to treat the areas of the face not addressed by the facelift surgery — like horizontal forehead lines, glabellar lines (i.e. frown lines), crow’s feet around the eyes, and more.

### **7. Facelift + Lasers**
Sure, a facelift addresses the *shape* of the skin, but it can’t do anything about the *look* of it. Enter lasers treatments. “Lasers can be used to help resurface the skin to reduce wrinkles,” Dr. Schaffner explains. There are many types of lasers, but, for patients with the right [skin tone](https://aedit.com/aedition/best-laser-skin-hair-removal-treatments-for-darker-skin-tones), ablative devices can resurface the skin, diminish dark spots, minimize the appearance of scars, and promote collagen production. “Because there is some downtime after a facelift, getting an [ablative laser treatment](https://aedit.com/aedition/guide-to-ablative-laser-skin-resurfacing) at the time of your facelift is a great way to refresh your skin as well,” Dr. Pierce says. 

### **8. Facelift + TCA Peel**
If you're looking for another way to address the tone and texture of the skin, a chemical peel may be it. Short for trichloroacetic acid, a [TCA peel](https://aedit.com/procedure/tca-peel) is a medium-to-deep intensity chemical peel that addresses fine lines and wrinkles, hyperpigmentation, melasma spots, and skin texture. Dr. Shafer performs this non-invasive procedure in conjunction with facelift quite often — about 75 percent of the time. Like laser resurfacing, combining a chemical peel with a facelift allows you to make the most of your [downtime and recovery period](https://aedit.com/aedition/facelift-recovery-healing-process) and more holistically address the quality of the skin. 

The facelift is a classic for a reason, but, depending on your aesthetic goals, the surgery can benefit from strategic procedure pairings. Here, top plastic surgeons share their go-to combos.

Best Cosmetic Procedures To Combine With A Facelift

The 8 Best Procedures To Combine With A Facelift

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When it comes to making decisions about having plastic surgery, [cost is undoubtedly part of the equation](https://aedit.com/aedition/how-much-cosmetic-surgery-costs). Of course you need to understand your aesthetic goals, possible results, and [find the right provider](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist), but your budget will play a big role in determining which solutions will best treat your needs. *How are you going to fund the surgical or non-surgical procedures? Which ones will prove to be most cost-effective in the long run?* 

Consultations with [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) dermatologists and plastic surgeons are the best way to get a sense of what treatment options exist and how much they will set you back based on your unique anatomy and vision. But, to give you a general sense of how to maximize your budget to correct common facial aesthetic concerns (think: [eye rejuvenation](https://aedit.com/concern/aging-and-tired-eyes), [lip volume](https://aedit.com/concern/lip-size), [fine lines and wrinkles](https://aedit.com/concern/fine-lineswrinkles)), we’ve asked two top facial plastic surgeons for their take.

## **How to Discuss Your Budget with Your Provider** 
If you’ve seen our guide to the [best questions to ask](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) during a plastic surgery consultation, then you know we suggest inquiring about a range of topics — from the [provider’s background](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) to [post-op care](https://aedit.com/aedition/preparing-for-a-smooth-recovery-from-plastic-surgery) — and the cost of your procedure(s) is on that list. While your doctor or surgeon may present all possible treatment options available, understanding how much you are willing and able to spend will allow them to recommend the best course of action given your aesthetic goals, anatomy, and budget.

Since the majority of cosmetic surgeries and procedures are [not covered by insurance](https://aedit.com/aedition/insurance-coverage-for-plastic-surgery-cosmetic-procedures), providers are very accustomed to having conversations with patients about finances. Some practices work with companies that offer financing options, and it’s not uncommon for candidates to save for months or even years before moving forward with their procedure. According to [Farhad Ardesh, MD](https://aedit.com/provider/farhad-ardesh-md-19202), a double board certified facial plastic and reconstructive surgeon in Los Angeles, many patients decide to cut back on discretionary spending (think: their daily cappuccino order) and put the savings towards making an investment in their appearance. 

## **Non-Surgical vs. Surgical: What’s Most Cost-Effective?**
Generally speaking, non-surgical procedures cost less than surgical ones, but, when you factor in the maintenance many of them require, the savings may turn out to be nominal. Even so, a patient’s age, medical history, and aesthetic concerns and goals should all be taken into consideration when developing both short- and long-term treatment plans.

On the non-surgical end of the spectrum, injectables like [Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and [dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) are often the first things that come to mind. “Botox® and other fillers have a place in the market,” says [Thuy-Van Tina Ho, MD](https://aedit.com/provider/thuyvan-ho-md-25248), a double board certified facial plastic and reconstructive surgeon in Philadelphia, but she also acknowledges that these procedures are “a temporary solution only.” Depending on the candidate, such procedures may be used [preventatively](https://aedit.com/aedition/can-you-be-too-young-for-botox) or to complement more invasive ones. “Botox® is a necessary part of most rejuvenation plans, in order to reduce wrinkles and give a youthful, fresh appearance,” Dr. Ardesh notes. “The secret to Botox® is to have a little placed in all parts of the upper portion of the face, which creates a balanced and natural enhanced look.” 

It’s important to note that while it may be tempting to [search for a bargain](https://aedit.com/procedure/botox/cost) on recurring treatments such as neurotoxins and fillers, now is not the time to Groupon. Finding a skilled injector who has a deep understanding of facial anatomy is the best way to prevent potential complications. While these procedures may seem routine, an untrained practitioner could inject into a blood vessel or damage a nerve, which would have lasting effects. 

But injectables aren’t the only minimally invasive treatment options on the market. From non-surgical fat reduction to energy-based skin tightening, there are plenty of ways to avoid going under the knife. So, how can you get the most bang for your buck? Our experts share their thoughts on a few of the most popular facial treatment areas:

### **1. Eyes** 
Even before [COVID-19 face coverings](https://aedit.com/aedition/influence-of-covid-19-face-masks-on-medical-aesthetics-trends) put our collective attention squarely on the [upper third of the face](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19), the eyes have always been a cause of cosmetic concerns. Dr. Ho says that [periorbital neurotoxin treatments](https://aedit.com/procedure/periorbital-botox) and [under eye filler](https://aedit.com/procedure/under-eye-filler) can temporarily address crow’s feet and bags, while [laser treatments and chemical peels](https://aedit.com/aedition/best-aesthetic-procedures-to-minimize-dark-circles) can help resurface aging (read: crepey) skin. To consistently treat dark circles, Dr. Ardesh says [prescription skincare](https://aedit.com/aedition/eye-creams-serums-to-treat-crows-feet-dark-circles-puffiness) may be best.

As an alternative to synthetic filler, which Dr. Ardesh says “can create irregularities and strange, unwanted appearances” in patients with lower eyelid hollows or bags,” both he and Dr. Ho like [fat transfer](https://aedit.com/aedition/comparing-dermal-fillers-vs-fat-grafting-for-facial-rejuvenation-contouring) as a means to restore volume. While the fat is ultimately placed like an injectable, fat grafting is technically a surgical procedure because it involves harvesting fat from a donor site via liposuction before transferring it to the desired area. In this case, Dr. Ardesh likes to perform a nano-fat transfer where fat is taken from the belly button region before being processed into a fine liquid and injected around the eyes. “This procedure can help with hollows and also improve skin color and quality,” he says.

Unlike hyaluronic acid-based dermal fillers that need to be touched up every six to 12 months, fat transfer is permanent after the initial recovery period. For the first three to six months, the fat must become established in its new location, and the body reabsorbs a portion of it (usually about 30 to 50 percent) during that time. As such, providers may suggest a revision down the line to address volume loss.

But fat grafting isn’t the only way to enjoy a long-lasting solution. Dr. Ho recommends [eyelid surgery](https://aedit.com/procedure/blepharoplasty-eyelid-surgery), which can easily be combined with a [neck lift](https://aedit.com/procedure/direct-neck-lift) or [facelift](https://aedit.com/procedure/facelift-rhytidectomy/cost). Depending on the patient’s concerns, Dr. Ardesh says the most cost-effective eye rejuvenation procedure may be removing a small amount of lower eyelid skin through surgery. A [lower eyelid blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery/cost) can be performed as an outpatient procedure in under an hour and correct common age-related eye concerns, like dark circles and bags.

### **2. Lips** 
Whether your concern is [lip shape](https://aedit.com/concern/lip-shape) or size, [lip augmentation](https://aedit.com/procedure/lip-augmentation-solutions) procedures are consistently among the top-performed in the United States every year. [Temporary lip fillers](https://aedit.com/procedure/temporary-lip-fillers) are the perhaps the most well-known treatment option (check out our guide to what to know before your [first time getting lip filler](https://aedit.com/aedition/what-to-know-before-getting-lip-filler-for-the-first-time)), but fat transfer is an option here as well. “Filler enhancement can be performed in the office during a 20-minute visit and costs about $800,” Dr. Ardesh says, noting that they usually last up to a year. 

[Lip augmentation with fat transfer](https://aedit.com/procedure/lip-augmentation-with-fat-transfer), on the other hand, rings in at about $5,000, he shares, but you can expect permanent results. When you consider that one syringe of filler can cost up to $1,200, fat transfer may prove to be more cost effective. Dr. Ardesh transfers between 10 and 60 milliliters of fat and estimates 50 to 70 percent of it survives. “The benefits of fat transfer include that the fat can also be transferred to other parts of the face that need volume at the same time, like the cheeks, jawline, and temples,” he adds. 

### **3. Chin & Jawline**
Speaking of the jawline, Dr. Ardesh says temporary filler is a popular way to add definition here, too. At about $900 per one milliliter syringe, however, the cost of maintaining those results adds up quickly. In addition to fat transfer, he often recommends a permanent implant to patients looking for [chin and jawline enhancement](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). “A chin implant is the equivalent of at least four vials of filler, so the [chin implant surgery](https://aedit.com/procedure/alloplastic-chin-implant) can be significantly more cost-effective for about $4,000,” Dr. Ardesh says. Not only can the implant prove to be more budget-friendly in the long term, but it also may yield more satisfactory results. “The chin implant may have better aesthetic outcomes than getting jaw filler injections every year,” he says.

### **4. Neck**
We can save the lecture on how craning over our electronic devices is speeding up the aging process for another day, but there is no denying that the [neck](https://aedit.com/concern/neck-and-jawline-definition) often raises a host of aesthetic concerns for patients of all ages. “Procedures such as [Kybella®](https://aedit.com/procedure/kybella), [CoolSculpting®](https://aedit.com/procedure/cool-sculpting), and neck liposuction can all be costly and provide mild, temporary improvement of double chins and neck fullness,” Dr. Ardesh says. While these minimally invasive treatments address the superficial fat under the skin, they do not correct the “deep fat under the loose muscle,” he cautions. 

As a result, a [surgical neck lift](https://aedit.com/procedure/neck-and-jawline-definition-solutions) often proves to be both cost-effective and the best way to achieve the look a patient desires. “The vast majority of patients that come to see me for a neck lift surgery have had previous non-surgical treatments within the last one to two years,” he explains. “These patients would have saved significant money and achieved the result that they originally desired, if they first had surgery.”

### **5. Skin** 
The most budget-friendly way to care for your face in the long run? A healthy lifestyle and good skincare routine. “Regular [sunblock](https://aedit.com/aedition/how-to-apply-sunscreen-and-not-miss-a-spot) and sun avoidance are a must, in addition to [good nutrition](https://aedit.com/aedition/best-diet-for-healthy-beautiful-skin), [avoiding tobacco products](https://aedit.com/aedition/impact-of-cigarette-smoking-vaping-on-skin-hair-teeth-health), [reducing stress](https://aedit.com/aedition/impact-of-stress-on-skin-acne-wrinkles-dryness), and [getting enough sleep](https://aedit.com/aedition/impact-of-beauty-sleep-on-skin-health-nighttime-skincare-products),” Dr. Ardesh says. When it comes to your skincare regimen, reach for tried-and-true active ingredients (think: [retinoids](https://aedit.com/aedition/guide-to-vitamin-a-retinol-retinoids-in-skincare), [vitamin C](https://aedit.com/aedition/guide-to-topical-vitamin-c-in-skincare), [hyaluronic acid](https://aedit.com/aedition/guide-to-hyaluronic-acid-in-skincare-dermal-filler), and [peptides](https://aedit.com/aedition/guide-to-topical-peptides-in-skincare)) and consider updating your arsenal through your [twenties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-20s), [thirties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-30s), [forties](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-40s), and [after 50](https://aedit.com/aedition/best-skincare-routine-products-ingredients-for-50s-60s-70s) to keep up with the evolving needs of your complexion.

Because [at-home skincare can’t do it all](https://aedit.com/aedition/aesthetic-skin-aging-concerns-skincare-cannot-treat), our experts recommend a [chemical peel](https://aedit.com/aedition/guide-to-superficial-medium-deep-chemical-peels) once or twice per year to improve skin tone and texture. Starting off a [preventative Botox® routine](https://aedit.com/aedition/everything-you-need-to-know-before-getting-botox-for-the-first-time) in your late twenties and early thirties, meanwhile, can help prevent deeper wrinkles from forming down the line. How will you know it’s time? When your expression lines no longer disappear like they once did. 

## **The Takeaway**
While this article hopefully shed some light on the different procedures that exist at different price points to address any number of facial concerns, every patient is entirely unique and there is no such thing as one-size-fits-all in aesthetic medicine. In order to be sure you are maximizing your budget and possible results, be honest with your provider about your budget and what you hope to achieve. They will be able to walk you through all of your treatment options. Ultimately, it’s important to remember that no professional procedure will replace the virtues of a healthy lifestyle, so investing in your physical and mental wellbeing will pay dividends when it comes to maintaining a youthful appearance.

Expert Opinion

When it comes to making decisions about plastic surgery, cost is undoubtedly part of the equation. To give you a sense of how to maximize your budget, we’ve asked two top facial plastic surgeons for their take.

Cost Effective Cosmetic Procedures For The Face, Eyes, Lips

The Best Ways To Invest In Your Face According To Facial Plastic Surgeons

haley-lawrence-6ugQ978v-zg-unsplash

From facial thirds (and fifths!) to the infamous golden ratio, pop culture has been seeking facial harmony’s magic formula for millennia. Between the ancient Greeks, Renaissance artists like Leonardo da Vinci, and [today's social media set](https://aedit.com/aedition/march-2020-study-shows-relationship-between-social-media-cosmetic-surgery), there's no shortage of hypotheses about what constitutes a well-balanced countenance. But the whopping number of requests for Kate Middleton’s nose (once deemed to be the “world’s most perfect”) proves that many people still don’t have an accurate grasp of the concept.

In a nutshell, facial harmony is about [ideal proportions, not perfection](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection). “It’s not so much about direct measurement; proportions are way more important,” says [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), a board certified plastic and reconstructive surgeon and associate clinical professor at UCLA. “When we’re evaluating a face, you’re really looking at that face relative to itself.” In other words, the measurements of individual facial features are less important than the interaction between those features, and we’ve gone straight to the experts to better understand what that means for facial aesthetics.

## **What Is Facial Harmony?**
When we think of facial harmony, most of us think about beauty — but it’s really much more basic (in every sense) than that. “It really comes down to the fact that the most attractive faces are those where everything falls into the average,” Dr. Jason explains. “Philosophically speaking, when one part falls out of the norm, it’s alarming for potential disease.” If a person has a deficient jaw, for example, it’s an indication of certain ailments, he adds.

And, when it comes to attraction, it’s all about survival of the species. “If, in essence, what we’re doing is looking for a partner to mate with, the ideal mating partner is somebody who seems ‘normal’ across the board,” he says. In the most primal sense, we’re programmed to gravitate toward facial symmetry and harmony because they convey good health.

As it relates to aesthetic medicine and plastic surgery, providers have — no surprise here — a very precise understanding of facial proportion. “We mean balance and a subjective sense of normalcy,” explains [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a Nashville-based board certified plastic and reconstructive surgeon and assistant professor of plastic surgery at Vanderbilt University. “If you overly highlight a feature or ignore a feature in the face, it will draw the eye negatively.” 

Sure, a surgery or procedure may focus on one part of the face, but the goal of said treatment is balance. “We aim for improvement in facial aesthetic surgery, but the key to doing it well is understanding facial anatomy and relationships,” Dr. Unger says.

### **Facial Harmony vs. Beauty**
Before we move on, you might be wondering: is facial harmony the same as beauty? According to our experts, the basic tenets of facial harmony have remained largely unchanged. Beauty standards, on the other hand, are infamously ever-changing. “Harmony is less subjective than beauty,” Dr. Unger shares. As he explains it, beauty evolves with the times and trends, but harmony and proportion are less beholden to what is en vogue. “Balance, harmony, and the golden ratio has indicated what is naturally aesthetically pleasing to the human eye and mind since it was first described — and that was thousands of years ago,” he says.

But how do modern beauty trends (think: super plush pouts) fit in with the idea of facial harmony? “There are certain features that you may want to augment compared to average because they have some underlying innuendo with them,” Dr. Jason explains. “But it’s very clear to see that, when it gets too out of proportion, you lose the attractiveness again.” In other words, cosmetic surgery can push certain boundaries to meet beauty standards, but only to the point where the enhancement or augmentation is not disrupting the overall harmony of the face.

## **How Does Plastic Surgery Achieve Facial Harmony?**
“We, as plastic surgeons, must take a holistic approach towards facial beauty and harmony,” Dr. Unger explains. And that often requires a bit of patient education. “We have to make sure we are not just improving the one item that may be the focus for the patient, but explaining how the structures of the face are interrelated,” he continues. As such, candidates must understand that “gentle adjustments in the surrounding areas” may be needed in order to ensure the desired results of more refined shape will look, as he describes, “elegant and balanced.” 

That holistic view ensures facial features remain proportional to each other. “Within a structure like the nose, any expert will explain that just because you don’t like something — a [dorsal hump](https://aedit.com/procedure/nose-bump-solutions), for instance — doesn’t mean that correcting that one issue will look good,” Dr. Unger says. “In fact, it will probably look very unnatural, unbalanced, or not harmonious if you impact one particular concern. This is because everything is interrelated.”

If you’re getting the sense that facial plastic surgery is like aesthetic Tetris, you’re on the right track. “Once you make one move, it may change the proportions and, therefore, you have to make the other move to make the two meld together better,” Dr. Jason says. Essentially, it's all about finding the sweet spot between enhancement (whether it's highlighting or downplaying a feature) and rejuvenation. “This deep understanding of the face is what sets [board certified plastic surgeons](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons) apart from untrained practitioners who do not have deep training or experience in overall facial shape, anatomy, and symmetry,” Dr. Unger adds. That lack of expertise is what leads to “many of the strange looking faces, lips, and cheeks we see walking around all the time,” he says.

The net net: When it comes to finding facial harmony, the whole is indeed much greater than the sum of its parts. Below, we break down some of the most common surgical combos that achieve a more balanced facial appearance:

### **NOSE + CHIN**
Evaluating patients for [rhinoplasty surgery](https://aedit.com/aedition/reinventing-rhinoplasty-whats-different-about-modern-nose-jobs) provides a perfect example of how surgeons consider facial harmony on both a macro level (how a feature relates to all of your other features) and micro level (how a feature’s individual elements relate to each other). “When you fine-tune or reshape a feature that the patient does not like, it will likely require changes to the related parts of the nose or face to ensure everything is balanced and looks appropriate together,” Dr. Unger notes. An example? “A big dorsum, when reduced, will likely expose a too broad nasal tip or too full tip because the relationship will be off,” he says.

Changing the nasal proportions can also [highlight the eyes](https://aedit.com/aedition/popularity-of-eyelid-surgery-cosmetic-eye-procedures-during-covid-19) and make the [chin appear more prominent](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures). It may happen naturally — “sometimes, adjustments to the nose alone are sufficient to meet a patient’s aesthetic goals,” Dr. Jason says — or it may require a bit more refinement. “Other times, we also need to perform a [chin augmentation](https://aedit.com/procedure/chin-enhancement-solutions) to get the results they want,” he adds. “A nose looks more or less prominent based on where the facial plane sits relative to it, so bringing the chin forward can also make the nose look less prominent.”

### **EYES + BROWS**
Another common area where proportions are particularly important? The eyes. [Blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty) (a.k.a. eyelid surgery) is one of the most popular surgical procedures for both women and men seeking to restore a more youthful, awake appearance. But removing eyelid skin isn’t always the best (or sole) solution. “Some patients who come in thinking they want blepharoplasty don’t actually have much excess eyelid skin,” Dr. Jason explains. “Instead, what they have is a sagging brow that’s making the lids look heavy.” If the surgeon simply cut away the skin without elevating the brow, the results will not be optimal, he says. As a result, [eye rejuvenation](https://aedit.com/procedure/eye-rejuvenation-solutions) often involves pairing eye and brow procedures.

### **UPPER + LOWER FACE**
The term ‘facelift’ can be confusing because the procedure focuses on restoring the lower to midface and jawline (i.e. the dreaded jowls) — not the entire face. [Facelift surgery](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck) alone works well for patients whose concerns are relatively isolated to those areas. But, for those who also have significant signs of aging in the upper face (think: above the cheekbones, the eyes, and brows), a facelift by itself may leave them looking unbalanced. 

As Dr. Jason explains, if you’re getting a facelift, a [brow lift](https://aedit.com/aedition/theres-more-to-a-brow-lift-than-meets-the-eye) often makes sense, too. “You don’t want to make it look piecemeal or unharmonious because you lifted one part and left the rest,” he shares. Patients with a sagging brow, for example, may end up looking, as he describes, “squished in the middle” without the complementary treatment. 

## **Is AI the Future of Evaluating Facial Harmony?**
[Artificial intelligence](https://aedit.com/aedition/study-shows-how-artificial-intelligence-is-bringing-objectivity-to-aesthetics) (read: machine learning) is emerging as a compelling tool for objectively evaluating the elusive trifecta of beauty, youth, and proportion in the human face. But, according to our experts, automated facial analysis still can’t replace the eye of an expertly trained plastic surgeon — and it maybe never will. 

“It is still an analog approach that is honed with education, training, and experience to create shapes and contours that highlight and accentuate without overly stylizing and, thus, looking artificial,” Dr. Unger says. So, while he admits AI may help us better articulate what experts create with their eye and technique, he maintains that we are “likely very far away from a complete algorithmic or pre-planned approach that can be easily enacted on an actual human created from a computerized map.”

At the end of the day, the ‘art’ of plastic surgery cannot be underestimated. “This is what I tell my patients all the time — especially with rhinoplasty — it truly is art, and it doesn’t really matter what anybody else says,” Dr. Jason explains. “At the end of the day, only you can decide what you think looks good.” Regardless of how far the technology comes, honestly portrayed [before and after results](https://aedit.com/aedition/importance-of-before-and-after-photos-in-plastic-surgery) are still the most important factor when [choosing the right plastic surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) and, by extension, the right aesthetic for you.

Facial harmony is about proportion, not perfection, and we’ve gone straight to the experts to better understand what that means for your next plastic surgery consultation.

Importance Of Facial Harmony And Proportion In Plastic Surgery

The Importance Of Facial Harmony In Aesthetic Medicine

shutterstock 1401887156

At this point, you’re likely familiar with the idea of dermal fillers. Not to be confused with [neurotoxins like Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) that temporarily reduce the appearance of lines and wrinkles by paralyzing the muscle responsible for movement, fillers are used to contour the face by restoring volume to areas that show signs of aging or reshaping certain features (think: nose and lips). 

Depending on the type of filler used, touch ups may be needed as frequently as every six months. For patients seeking a longer lasting solution that doesn’t involve a foreign substance, fat grafting offers similar facial rejuvenation without the risk of rejection.

So, what are the pros and cons of each procedure? And which one might be best for you? A board certified dermatologist and two patients weigh in on how dermal fillers and facial fat grafting work.

## **What Are Dermal Fillers?**
[Dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) or ‘fillers’ as they’re commonly known, are substances that are injected into the skin to restore volume or reshape a particular area. “Fillers require no surgical procedures, and you can just come in and do the injection,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), a board certified dermatologist in New York City. “Most fillers can be dissolved. So, if you don't like the results or have an unusual reaction, it can be removed.”

Made of hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA) to name a few, fillers have varying degrees of permanence. While HA fillers like Juvederm® and Restylane® need to be touched up every six to 12 months, semi-permanent options like Sculptra® (a PLLA filler) Radiesse® (a CaHA alternative) can deliver results for upwards of two years or more.  

### **What Are Fillers Used For?**
Fillers are used to rejuvenate areas of the face that have lost volume due to the natural aging process. Commonly used to [plump the lips](https://aedit.com/procedure/temporary-lip-fillers), volumize the cheeks, and minimize the appearance of [under eye bags](https://aedit.com/procedure/under-eye-filler), filler can also be used to alter refine the shape of the nose (a.k.a. [liquid rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-liquid-rhinoplasty)) and define the jawline. For patients with atrophic (read: depressed) scarring, a small amount of filler may be injected to smooth the skin. 

### **What Is the Procedure and Recovery Process?**
Downtime after fillers is minimal. Normal activity can be resumed immediately (though you may be told to refrain from working out for 24 hours). Patients are often able to schedule the procedure during their lunch break, but it should be noted that swelling and bruising at the injection site is possible and usually resolves over the course of five to seven days. Unlike neurotoxin injections that take a week or more to kick in, filler results are immediate. 

### **How Much Do Dermal Fillers Cost?**
The cost for fillers varies greatly depending on which product is used and how many units is required. Generally speaking, cost varies between $250 and $1,500 per syringe. 

## **What Is Facial Fat Grafting?**
Also known as lipoinjection and autologous fat transfer, [facial fat grafting](https://aedit.com/aedition/what-its-really-like-to-get-facial-fat-grafting) offers an alternative to dermal filler. Rather than having a forgeign substance injected into the face (like the ones described above), fat grafting involves the injection of a patient’s own fat cells to plump areas of the face that show signs of aging. As such, there is no risk of your body rejecting the graft. 

Unlike the immediacy of fillers, the final results of fat grafting can take three to six months to reveal themselves. This is the length of time it takes for the graft to become established in its new location. During that time, the body re-absorbs a percentage of the fat (30 to 50 percent) that was injected, which is why providers often ‘overfill’ the area to start. Once the process is over, the graft is permanent, though revision procedures may be considered down the line. 

### **What Is It Used For?**
Fat grafting is used for facial rejuvenation, including volumizing the cheeks, plumping the lips, filling in the under eye area, reshaping the nose, defining the jaw, and even [augmenting the breasts](https://aedit.com/aedition/hybrid-breast-augmentation-with-implants-fat-transfer). 

### **What Is the Procedure and Recovery Process?**
Lipoinjection is a two-part process. First, fat cells must be surgically harvested from one part of the body, so they can then be purified and then injected into the face. Fat is generally collected from the hips, thighs, or stomach. Both of these procedures can be carried out as outpatient surgery under local anesthesia (some providers and patients may prefer general anesthesia to control pain).

Bruising and swelling can be expected at both the donor *and* recipient sites, and advice on how to manage this will be explained during preoperative consultations. “Both [filler and fat grafting] have minimal pain and discomfort during the injection, which can be easily managed with topical numbing gel,” Dr. Jaber says. “You may be slightly more swollen for a few days with fat transfer, and both procedures can result in mild bruising.”

### **How Much Does Fat Grafting Cost?**
The average cost of a facial fat transfer is $5,000, though this varies depending on the area being treated.

## **Patient Perspective**
Here, two patients share their experience with facial fat grafting. In one case, the treatment replaced a high-maintenance filler habit. In the other, it delayed the need for a more invasive facelift.

### **Mila, 35, New York, NY**
*Mila started her facial contouring journey with HA-based Juvederm® fillers. As time went on, she decided she would like a longer term solution and opted for facial fat grafting about a year ago.*

<Dialogue>
  <Question party={The AEDITION}>
    How did your filler experience differ from fat grafting?
  </Question>
  <Response party={Mila}>
    I started getting fillers when I was 25, so I spent close to 10 years getting injections topped off every eight months or so. The procedure for getting fillers is very straightforward. I used to have them during my lunch hour at work! With fat grafting, the process is somewhat more involved. They have to collect the cells, which is a procedure in itself, and then inject them. The collection procedure was new to me, but it was straightforward and painless. I would say the fat injections were a little more painful than fillers, but still absolutely manageable.
  </Response>
  <Question party={The AEDITION}>
    How did you find the fat grafting process, from the procedure to recovery?
  </Question>
  <Response party={Mila}>
    Both parts of the procedure went very smoothly for me. I had local anesthesia for both parts. There was some discomfort, but I didn’t feel any pain whatsoever. In terms of recovery, I found that I felt quite tired for the first couple of days. It could have been stress from the lead up to the procedure or the actual surgery. I’m not sure. I had a fair amount of bruising but not too much pain. I followed my surgeon’s directions regarding pain management, and it worked very well for me.
  </Response>
  <Question party={The AEDITION}>
    In terms of results, how were they different for each treatment?
  </Question>
  <Response party={Mila}>
    I have found the results from the graft to be softer than the results achieved from fillers. It could simply be because I went to a different practitioner though. The main drawback for me was the length of time between the procedure and being able to see the final results. I had to wait a good few months for the area to completely settle, which is a contrast to quick-fix fillers.
  </Response>
</Dialogue>

### **Sonia, 43, Long Island, NY**
*Sonia opted for fat grafting after discussing rejuvenation options with a plastic surgeon. As she noticed her face beginning to lose volume as she aged, she thought it was time for a [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck), but the injections have so far offered the results she was looking for.*

<Dialogue>
  <Question party={The AEDITION}>
    What led you to consider facial fat grafting?
  </Question>
  <Response party={Sonia}>
    I found myself becoming increasingly bothered when I looked at my face in the mirror. I was seeing deeper and deeper wrinkles, my skin had lost its youthful appearance, and I was generally looking for a do-over. My cheeks had previously been very plump and were a real trademark for me when I was younger. Not seeing them when I looked in the mirror anymore was pretty disheartening.
  </Response>
  <Question party={The AEDITION}>
    How did you find the experience of having the procedure?
  </Question>
  <Response party={Sonia}>
    I had initially been considering having a facelift, so, by comparison, this was a real walk in the park! Both parts of the procedure were straightforward, and I was taken care of very well by my surgeon and his team. I opted for local anesthesia, which allowed me to have a somewhat quicker recovery than I would have had with general anesthetic involved. The process is painless, and I can’t even say I was uncomfortable at any point. I was asked continuously if I was in any pain, so the team was very careful to take care of that.
  </Response>
  <Question party={The AEDITION}>
    Are you pleased with the results?
  </Question>
  <Response party={Sonia}>
    I really am. For me, it was the perfect solution for what I was looking for. It’s a treatment that will tide me over until I have a facelift when the time is right. The results make me look better than I could have imagined — better than I did in my younger days even! The fact that they will stay like this for some time is a relief and having my next procedure in mind for whenever I am no longer satisfied with the results from this one is very reassuring.
  </Response>
</Dialogue>

## **The Takeaway**
Dermal fillers and fat grafting both offer facial rejuvenation and contouring results in an injectable form. While filler provides an immediate result, it requires regular maintenance. Fat grafting is a slightly more involved procedure because it is a two-step process and results take three to six months to take effect. Once the graft becomes established, it is permanent (though touch ups may be needed down the line). Consulting with a board certified dermatologist or plastic surgeon will ensure you receive the best treatment for your aesthetic goals. 

Patient Perspective

Facial rejuvenation and contouring is possible with both dermal fillers and autologous fat transfer. So, which injectable solution is best for you?

Comparing Dermal Fillers And Fat Grafting For Facial Rejuvenation And Contouring

Dermal Fillers vs. Fat Grafting: What’s Best For You?

shutterstock 1189798375-min

Before I reached a certain age (let’s just say, it rhymes with “sporty”), I’d only ever cared about what I considered to be an excess of body fat. I had, admittedly, never given much thought to the fat in my face — until it started to disappear. It hardly seemed fair: Did I really have to choose between a slim physique and a smooth face?

To see if I could bring back a bit of my baby face, I met with board certified UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449). He explained to me that [facial aging](https://aedit.com/aedition/how-your-phone-might-be-aging-you) isn’t just caused by gravity, but also by the redistribution and loss of fat throughout the face. The result: wrinkling and irregularities. 

[Fillers](https://aedit.com/procedure/temporary-lip-fillers), he explained, can restore some of that lost facial volume and refresh the youthful contour temporarily. After discussing all of the risks, I decided to give it a try — peppering Dr. Jason with questions as he thoughtfully examined my face, injecting hyaluronic acid filler into my tear troughs and cheeks.

I tried not to wince as I wondered aloud: How often am I going to have to do this? “It varies from patient to patient,” Dr. Jason told me. “But plan on dermal fillers lasting about six months to a year.” 

While I’d never been stellar at mental math, it seemed obvious that, as a sporty-something-year-old, this was going to get pretty pricey by my golden years. “Once you get older, you’re better off getting a facelift with fat grafting,” explained Dr. Jason, “which will take care of the skin laxity and the volume loss at the same time.”

He had me at “[fat grafting](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting).”

## **The Technique Used In Facial Fat Grafting** 

Sure, I’d heard about the [Brazillian Butt Lift](https://aedit.com/procedure/brazilian-butt-lift) (during which plastic surgeons transfer [liposuctioned](https://aedit.com/procedure/power-assisted-liposuction) fat from the belly and flanks to bulk up the booty), but I had no idea that similar fat injection techniques were being used to permanently plump up cheeks, lips, under eyes — basically, anywhere that [facial fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) were gaining fame. 

I needed to know: Why isn’t everyone doing this? “First off, it’s a surgical procedure that includes all of the associated risks and recovery time,” Dr. Jason explained. “Secondly, because fat is a living tissue, it’s less predictable — though, at the end of the day, using your body’s own fat as filler is always going to be the gold standard.”

When pressed for more details, Dr. Jason told me that although some doctors perform facial fat transfer procedures under local anesthesia, he prefers to use general to ensure patient safety and comfort. “We have to be very careful with our technique,” Dr. Jason told me. “Imagine we’re taking tiny seeds of purified fat and dispersing them throughout the area to give them the best chance to grow and survive, while providing a smooth, even result over time.” He said that plastic surgeons generally overfill areas of the face during a fat grafting procedure because it is not unusual to lose about 30 (or even as much as 50) percent of the transferred fat cells over time.

When I asked about possible complications associated with facial fat grafting, Dr. Jason pointed out that because a patient’s fat is their own tissue (known as “autologous fat”), there’s no risk of adverse reaction — though swelling and bruising are typical and may be quite pronounced. “Because we’re distributing the fat throughout a given area through a very small incision, we end up affecting a lot of tiny blood vessels, which is bound to cause bruising,” he shared.

## **The Facial Fat Grafting Procedure**   

Full disclosure: I don’t think I was totally listening at this point. Instead, I was already fantasizing about the fate of my face and whether it was possible to tack on this fat transfer treatment to an unrelated procedure I had coming up. Since I was going under anesthesia anyway, why not wake up looking younger? Dr. Jason told me that the facial fat grafting would add about 45 minutes to my existing surgery and that the recovery typically takes about two weeks. I decided to give it a go.

Right before my fat grafting surgery, I came face-to-face with Dr. Jason and his purple surgical marker. He sat in front of me, considering the peaks and valleys of my face before tracing a pattern along my contours. We then discussed possible donor sites during an informal body fat analysis (which I can only liken to swimsuit shopping with a stranger) to determine exactly where Dr. Jason would be harvesting the filler for my face. 

He planned to make a total of four small incisions: one in each thigh to collect the fat and then one in each cheek about halfway between my mouth and nose. It’s through the latter that he’d inject the fat after purifying it in the operating room.

## **Recovery After Facial Fat Grafting**

The next thing I knew I was lying in recovery with a surgical glove filled with ice water splayed across my face. I was too groggy to even wonder about my results. After about an hour, the nurse cleared me to leave, sending me and my husband home with instructions to apply cold packs consisting of gauze soaked in ice water for the first 48 hours and to sleep as upright as possible to prevent swelling.

Standing before my bathroom mirror, I looked like I’d passed out after a fraternity hazing: bloated, a little bruised, and covered in Sharpie babble. But my skin was so smooth, plump, wrinkle-free, and refreshed. Though Dr. Jason had told me that the initial swelling from the procedure would obscure the final result, I was already pleased.

For the first 48 hours, I was totally unproductive. The cold packs made reading or even watching TV too challenging, but, after a couple of days, I was able to be up and about around the house — albeit with soreness in my cheeks and at the donor site. I’d also developed moon-shaped magenta bruises across each tear trough that seemed to be growing larger and darker daily. 

I realized that not being equipped with the proper concealer was going to be problematic. I threw on a baseball cap, pulled the brim down extra low, and ran to CVS to grab a tube of a color corrector. I dabbed the makeup over the bruises, took a step back, and saw a woman with purplish-green shiners staring back at me. But, man, she looked so young.

## **The Results After Facial Fat Grafting**

Over the subsequent weeks, I became pretty adept at camouflaging my ever-changing bruises as they morphed and shrank unevenly from red to purple to blue, green, and yellow before finally fading away. If anyone noticed my technicolor transformations, they didn’t let on (with the exception of my mother-in-law, who deadpanned, “You look like you’ve got two black eyes”). 

When I asked Dr. Jason whether or not it was typical for patients to have lingering bruising, he said it generally “clears up completely within 10 days or so. But every patient is different.” For me, caking on the concealer for a few weeks seemed a small price to pay in exchange for a positive, permanent result.

Dr. Jason also told me that it would take about three months for the swelling to subside completely and the surviving fat to become established. With the passing weeks, every sign that appeared from my “old” face made me wonder: Would I end up looking happily refreshed or disappointingly unchanged? 

I felt strangely conflicted. On the one hand, I was incredibly satisfied with my initial appearance, but on the other, I was equally reluctant to invest too much in the outcome. Notes from my journal about one-month post-op capture the conundrum: “Woke up this a.m. and the left smile wrinkle was back. Ugh. Yesterday went shopping without any concealer — felt amazing.”

By the time I saw Dr. Jason for my three-month follow-up, the soreness in my cheeks and thighs (initially akin to a pulled muscle), and small red scars from the incision sites had completely resolved. Much of the fullness in my cheeks and the evenness under my eyes remained. As Dr. Jason evaluated the outcome, I held the hand mirror and saw no apparent signs of plastic surgery other than a slightly younger selfstaring back at me, smiling.

After growing weary of the price and upkeep associated with dermal fillers, one writer decided it was time to try something a bit more permanent.

What It's Really Like To Get Facial Fat Grafting 

shutterstock 1097196746-min

Minimally invasive procedures including dermal fillers are becoming increasingly popular and accessible, but it can be hard to figure out exactly how they work, what all of the different products do, and which option is best to achieve the results you want. This guide will give you all of the information you need to understand the differences between hyaluronic acid fillers and collagen-based fillers, how long you can expect the results to last, and how each product achieves optimal results. 

## **What Are Dermal Fillers and How Do They Work?**
Dermal fillers work to restore lost volume in certain areas of the body and enhance areas, such as the lips or [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers), by adding volume in a controlled way. A decrease in collagen is one of the biggest causes of fine lines and wrinkles and experts believe the breakdown begins when people are around 25 years old. 

Dermal fillers are versatile, minimally invasive, and relatively low risk, which makes them a popular option for people who are looking to get the upper hand on signs of aging. They are not the same as neurotoxins like [Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and work in a completely different way, but they do treat similar skin complaints. Fillers are FDA approved to address the following concerns:

- Brow Furrows
- Crow’s Feet
- Frown Lines
- [Under Eye](https://aedit.com/procedure/under-eye-filler) fine lines
- [Acne Scarring](https://aedit.com/procedure/acne-scar-treatment-dermal-fillers) 
- Pronounced Nasolabial Folds
- Fine Lips
- [Aging Hands](https://aedit.com/procedure/hand-rejuvenation-with-dermal-fillers)
- Vertical Lip Lines
- Cheek Enhancement

## **Types of Dermal Fillers**
Dermal fillers come in various forms and can be made from different ingredients to serve a variety of purposes. These are the most common types.

### **Calcium Hydroxylapatite (CaHA)**
Calcium Hydroxylapatite is  similar to a mineral and is naturally found in human bones. The most common brand of CaHA filler is Radiesse® and is used for enhancing volume in the cheeks (and other areas of the face) and plumping frown lines and nasolabial folds (deep lines from the nose to mouth).

The product is potentially suitable for vegans since it is made using biosynthetic processes and no animals or animal products are used in its production. Not only is this preferable for some people on an ethical basis, it can also reduce the chances of an allergic reaction. CaHA fillers are renowned for being safe, producing a natural-looking result, and were initially used in reconstructive surgery. Though they have a long history of safety, patients must still ensure that the person administering the product is properly trained and that the procedure takes place in a sterile medical setting. 

Depending on how fast your body metabolizes the product, CaHA fillers like Radiesse® should provide visible results for 12 to 24 months. It is common for results from your first filler procedure to last a little less time than subsequent procedures, but your practitioner will be able to give you an accurate estimate based on the condition of your skin, your lifestyle, and other factors.

### **Hyaluronic Acid (HA)**
Hyaluronic acid is the most common type of filler used in the U.S. and is made from another substance that can be found naturally in the body in areas such as the joints, skin, and even eyeballs. Hyaluronic Acid fillers are produced under a number of brand names, including: 

- Captique®
- Esthelis®
- Elevess®
- Hylaform®
- Juvederm®
- Perlane®
- Prevelle®
- Puragen®
- Restylane®

HA fillers are extremely versatile. They can be used on fine lines and wrinkles on most areas of the face (including crow's feet, smile lines, and worry lines) and can also be used to treat a wide variety of skin complaints including some types of scarring and redefining lips.

The substance is widely used in the medical profession and is the same product injected in the joints of those suffering from arthritis. The body produces HA naturally, but the formulations injected as fillers are extracted and processed before being used for cosmetic purposes. Most HA fillers are also infused with the numbing agent lidocaine which helps minimize the discomfort caused by the injection procedure as well as reducing pain afterward. Results from HA fillers are temporary and generally last between six and 12 months. That can be great if you’re unsure of whether or not you’ll like the results, but it also means you need to be aware of the potential financial commitment of keeping up the results.  

### **Poly-L-lactic Acid (PLLA)**
Poly-L-lactic Acid is a biodegradable synthetic substance that is safe for use in the body. It is used to make a range of medical devices including dissolvable stitches. It is classified as a collagen stimulator because the main role of the substance is to help your skin rebuild collagen on its own. The filler itself dissolves after a few days, but the results generated by the increased collagen production can last over two years. The treatment is usually carried out in several sessions because a single treatment may be insufficient to stimulate enough collagen to achieve the desired result. It is generally used for lips and deeper wrinkles like laughter lines and nasolabial folds.

The most common brand of PLLA filler is Sculptra® and its ability to stimulate collagen production makes it unique. Also unlike other fillers, results take longer to show. The course of treatment is usually once a month for three months and, after the full treatment period, it can take up to six weeks for the full effects to be visible. It is, however, considered a semi-permanent solution, so unlike other forms of fillers that will definitely need topping up on a relatively regular basis, those receiving PLLA fillers can expect longer-term results.

### **Polymethylmethacrylate (PMMA)**
Polymethylmethacrylate fillers are a semi-permanent solution used to treat medium-to-deep lines, wrinkles, and furrows. The most commonly used PMMA brand is Bellafill® and is used to treat nasolabial folds, pitted scars from acne, and lips.

It is used for patients who are seeking a more permanent solution to their skin complaints, but it does take a fair number of injections to achieve the desired results. Your practitioner will likely use a method called threading in the dermal subcutaneous junction which should prevent any visible signs of the injections. However, the most significant drawback of PMMA over other filler products is the risk of the filler itself being visible under the skin. To avoid this, your practitioner will most likely use less product on your first treatment, which means you will not see the full results you are expecting immediately, but more product can be added at a later date. It is a good option for those who are looking for a permanent solution to signs of aging, but the process is somewhat more lengthy than other more temporary dermal fillers.

## **What is Getting Dermal Fillers Like?**
An injection procedure is generally carried out after a consultation with a board certified dermatologist or plastic surgeon. During the consultation, the practitioner will not only discuss your skin concerns, but they will also look at how your face moves and your natural facial expressions to assess which treatment options are right for you. 

During the procedure, the practitioner may apply a topical anesthetic (numbing cream) to the areas that will be injected. Some practitioners may also inject a local anesthetic. If you are concerned about pain during the procedure, discuss this option with your provider during your consultation. They will then inject the filler below the skin with a needle or a catheter depending on the area and results desired. The procedure is quick and downtime is minimal. Some patients experience some bruising or swelling straight after the procedure, but it typically subsides after a couple of days.

Results are generally seen immediately, but full results can be seen a few days after the procedure. The length of time that results will stay visible depends on a few factors including where the filler is injected, which product is used, and your own metabolism.

## **Recovery and Side Effects**
Recovery from dermal filler injections generally takes up to a week with swelling and potential bruising being the two most common side effects. Your practitioner will explain any potential side effects specific to the injection site, but in general, dermal fillers are safe and effective. According to the American Society of Plastic Surgeons, there are some more severe, but rare, side effects including allergic reactions and infection at the injection site which should be considered. There is also the potential for fillers to leave an asymmetrical result, but if they are injected by an experienced, board certified plastic surgeon or dermatologist, these risks are minimal. On the whole, fillers are a popular and effective way to preserve a youthful appearance.

Minimally invasive procedures including dermal fillers are becoming increasingly popular but it can be hard to figure out how exactly they work, what the different products do, and which option is best for you. Here's everything you need to know. 

Everything You Need To Know About Dermal Fillers

PG46053-5252BD49-EEA6-41A0-9A6E-7749001C38D2

It is easier than ever to make your outer appearance a better reflection of your inner self. Facial feminization procedures have been gaining popularity among men hoping to look more approachable or transition to female, as well as among women hoping to have a more feminine appearance. 

Fortunately, altering facial features to create a softer, feminine look does not have to require facial feminization surgery (also known as FFS). Below are the most common non-surgical procedures to achieve facial feminization without plastic surgery. 

### **1. Re-Defining the Jaw**
“Men have square and lower jaws, strong mid faces, and a more hallowed face,” West Hollywood-based board certified dermatological surgeon [Jason Emer, MD](https://aedit.com/provider/jason-emer-md-722), explains, “women need to be more full, lifted, with a heart-shaped look.” While many people jump to jaw reduction plastic surgery to re-contour and re-shape the mandible bone, there are less invasive and non-permanent options as well. [Botox®](https://aedit.com/procedure/jawline-slimming-with-botox) of the masseter muscle is an injectable that can also narrow the jawline. The masseter muscle wraps around the jaw and can be temporarily contracted with Botox® injections, leaving patients with a more narrow jawline. While Botox® will take a few sessions to achieve your desired look, and requires continued injections, compared to jaw reduction surgery it is significantly less risky. When consulting with a board certified plastic surgeon, make sure to discuss the risks of jaw reduction surgery, like the potential of a damaged the mental nerve (the sensory nerve which provides sensation to the front of the chin, lower lip, and teeth).

Another minimally invasive technique is a [PDO thread lift](https://aedit.com/procedure/pdo-thread-lift), which uses threads to lift any sagging tissues in the neck or face, such as the cheek, chin, and jaw bone. By lifting the loose tissues, you can re-define the appearance of the desired area. Like Botox®, a PDO thread lift is temporary, lasting about six months.

### **2. Volumizing the Cheeks**
Usually, women have fuller, more forward projected cheeks compared to men. [Cheek augmentation](https://aedit.com/procedure/cheek-augmentation-with-implant) can be done surgically with permanent cheek implants, where patients can choose from varying sizes and shapes to achieve the right degree of fullness and forward projection they desire. Non-surgically, [dermal fillers](https://aedit.com/procedure/cheek-augmentation-with-fillers) like Voluma® or Radiesse® are also a good option. Dermal fillers work with the cheek’s native tissue to give a natural appearance. While dermal filler requires more maintenance than cheek implants, there is a lower risk of infection, migration, and asymmetry. 

### **3. Chin Augmentation**
Because of men’s square jawlines, their chins are usually not as pointed as women’s and do not create a triangle with the two cheekbones. The options for [chin augmentation](https://aedit.com/procedure/chin-augmentation) are very similar to those for the jaw and cheeks. There is reconstructive plastic surgery available to resculpt the chin bone as well as Botox® and dermal filler to provide a non-surgical and non-permanent option. Botox® works with the mentalis muscle to turn the chin down and [dermal filler](https://aedit.com/procedure/chin-augmentation-with-soft-tissue-fillers) adds fullness to make a more pointed chin. Since jaw redefinition, cheek volumization, and chin augmentation all require Botox® and/or dermal filler, often patients will choose to do all three together for a more symmetrical and feminized face.

### **4. Reshaping the Nose**
Believe it or not, a [rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty) (a.k.a. nose job) is not the only way to restructure the nose. Small amounts of dermal filler, including long-lasting Bellafill®, can help feminize the nose too. While dermal filler isn't able to reconstruct the nose (e.g. make the nose smaller or narrower), it can enhance feminization by lifting the tip of the nose and reducing the appearance of dorsal humps. 

### **5. Lip Augmentation**
Lip fillers like Juvéderm® Volbella, or Restylane® Silk, are another non-invasive way to instantly feminize the face. It takes about 15 to 20 minutes for a dermatologist to inject the dermal filler, the results are immediate, and it can last around four to six months. Due to recent celebrity trends, [lip augmentation](https://aedit.com/procedure/lip-implants) has been overwhelmingly popular, especially for women. Different types of filler will give different results — from volume to smooth vertical lines around the mouth. 

### **6. Facial Hair Removal** 
[Removing facial hair](https://aedit.com/procedure/laser-hair-removal) is a good first step for those transitioning, particularly for transgender women who are not undergoing hormone therapy. When transitioning to female, hormone therapy includes lowering testosterone levels and increasing estrogen into a typical female range. Lowered testosterone is responsible for the thickening of facial hair and, if lowered, can result in lessened hair growth. However, trans women not undergoing hormone therapy can eliminate facial hair through laser hair removal. While it can take anywhere from six to 12 sessions to see a significant reduction in facial hair growth, the results are long-lasting and only require occasional maintenance. The procedure is non-invasive and produces stronger results than waxing or shaving. Be sure to speak with a dermatologist to determine which type of laser is best suited for your hair type.

### **7. Eyebrow Shaping**
Another noticeable difference between the male and female face is the eyebrow shape. Women tend to have higher set eyebrows that sit above the brow ridge (also known as the supraorbital ridge), the brow bone located above the eye sockets, as well as a more arched shape. While there are surgical facial feminization surgeries, such as an [endoscopic brow lift](https://aedit.com/procedure/endoscopic-brow-lift), Botox® is a good non-surgical option to create a more feminine arch. Additionally, patients can opt for an ultrasound to tighten the skin around the eye, thread lifts to give a cat-eye look, or filler under the eye to lift the brow.

## **The Takeaway**
While most features can be feminized through Botox® and filler, there are some features that would require surgery. A lip lift, for example, requires a plastic surgeon to remove a section of skin in between the tip of the nose and upper lip. Additionally, an Adam’s apple reduction would include a surgical tracheal shave (also known as a thyroid cartilage reduction or TCR). 

As always, it is crucial that patients carefully vet providers and, in this case, choose a surgeon or doctor who specializes in FFS. Achieving the softer, feminine face you have always dreamed of is an empowering and life-changing moment. Experimenting with dermal fillers, Botox®, and PDO threads is a great non-permanent start. 