Deep Plane Facelift with Facial Fat Grafting, Lower Blepharoplasty and Fractional CO2 Laser ResurfacingRestoring Lift and Lost Fullness at 61Before and After

For this 61-year-old patient, Beverly Hills plastic surgeon Suzanne A. Trott, M.D., F.A.C.S. combined an upper, mid and lower facelift with transconjunctival lower blepharoplasty to remove lower eyelid fat, microfat grafting to the nasolabial folds, marionette lines, jaw, temples and under eyes, and fractional CO2 laser resurfacing of the skin. Each procedure has a specific responsibility. The facelift addresses tissue position and facial contours. Microfat grafting, a form of facial fat transfer, uses the patient’s own fat to replenish selected areas of volume loss.

Together, they address both the descent and the depletion associated with aging. The fractional CO2 laser resurfacing addresses the skin itself, improving its texture and quality: changes no lifting procedure can achieve on its own. Fat grafting was mapped to specific areas rather than spread evenly. Small amounts went into the nasolabial folds and the marionette lines, where deepening creases pull the lower face down.

The jaw and the temples were treated for lost definition and the hollowing at the side of the head, and the under eyes were filled to take the shadow out from beneath the lower eyelid. The lower eyelid work does two things at once. Fat is removed through an incision placed inside the lower eyelid, so no scar shows on the outside skin. Fat grafting is then placed into the under eyes to correct the hollowness that makes someone look tired.

Taking the puffiness down and filling the hollow in the same operation is what makes the eye area look rested rather than operated on. With these facelift before-and-after photographs side by side, look beyond the outline of the face. Examine the lower eyelids, the cheeks and the relationship between fullness and definition. That is the thinking behind Dr. Trott’s approach to this case.

The planning extends beyond how much to lift. It considers where fullness belongs and how the individual corrections will work together. The procedures are separate. The face is not.