What the research shows
Why surgeons add fat. Adding fat to a facelift improved facial volume and aesthetic ratings and was safe (Molina-Burbano 2021). Most US plastic surgeons surveyed graft fat during face lifts, most often into the deep cheek, the junction of the lower lid and cheek, and the folds beside the mouth (Sinno 2015). In a randomized trial of midface lifts, patients who also had fat rated their results higher in every area measured, kept their result, and needed fewer later procedures (Barone 2021). Fat added most under the eye and at the fold beside the nose; the cheekbone looked the same with or without it (Pontius 2006).
How much fat stays. About a third of the fat placed in the midface remained after more than a year, with variation between patients, and about 1 patient in 4 had a touch-up (Meier 2009). Filtered fat kept about 4 parts in 10; younger patients kept more, and patients who had a facelift at the same time kept less (Gerth 2014). In another practice, midface volume after facelift with deep fat grafting dipped in the first months and then rose again by 18 to 24 months (Cohen 2020), so the final look can take more than a year to settle.
What fades. Fat injected on its own into the folds beside the mouth looked good at three to four months but faded in most patients within about a year, and fat in the frown lines between the brows was lost within months (Eremia 2000). A strip of deeper skin with its fat, placed under the fold beside the nose during a facelift, kept the fold softer at one year (Zhi 2024).
Additives. Platelet-rich plasma mixed into the fat shortened recovery but did not improve skin elasticity, fold volume or satisfaction in a double-blind trial (Willemsen 2018). In facelift patients who chose them, platelet or stem cell additives kept more midface volume at a year (Sasaki 2015).
Risks. Fat injected under pressure can enter a vessel and travel to the eye or brain; one report advises injecting slowly with little force and avoiding tissue already disturbed by surgery (Feinendegen 1998). Firm lumps in the eyelid can appear months or years after fat in the forehead or between the brows; most cleared with a steroid injection and a few on their own (Park 2016), while some needed surgery (Sa 2011).
Where surgeons disagree
- Fat or the patient's own lifted tissue. Most plastic surgeons surveyed in 2015 add fat (Sinno 2015); most facial plastic surgeons surveyed in 2026 perform deep plane lifts and have not widely adopted fat grafting (Pak 2026). A rotated deep plane flap added volume at the angle of the jaw, which its author offers as a substitute for fat there (Jacono 2019).
- Grafting at the time of the lift. One group found fat survived less when a facelift was done at the same time (Gerth 2014); another found volume grew over two years after combined surgery (Cohen 2020).
What is new
- Fat placed into the buccal fat pad through a small cheek incision smoothed the curve of the midface in women with hollow cheeks (Zhu 2024).
- A forehead overfilled with fat can be reduced by MRI-guided microliposuction, with temporary lid swelling afterward (Huang 2026).
- Dermal fat grafts give surgeons a way to treat deep folds beside the nose during the lift itself (Zhi 2024).
What is still unknown
- The best way to take, prepare and place fat with a lift; methods still vary from surgeon to surgeon (Molina-Burbano 2021).
- Why grafted volume can rise late, which may reflect fat cells being replaced by new ones from stem cells (Cohen 2020).
Key papers
- Eremia 2000: fat alone in lines and folds fades within months to a year.
- Pontius 2006: fat with a midface lift improved the tear trough and the fold beside the nose.
- Meier 2009: an early measurement of how much midface fat survives.
- Gerth 2014: age and a same-day facelift change fat survival.
- Sinno 2015: how US plastic surgeons graft fat at facelift.
- Jacono 2019: a deep plane flap that adds jawline volume without fat.
- Cohen 2020: midface volume kept improving up to two years.
- Barone 2021: in a randomized trial, lift and fill satisfied patients more than lift alone.
- Molina-Burbano 2021: review of facelift with fat grafting.