Question: My cheeks seem to travel right down into my neck. I have lost the definition of a jawline. What type of surgery would you recommend for this problem, a facelift or a necklift?

Answer: Well first of all most facelifts that are performed actually do also treat the neck and can be considered a necklift but there are certain forms of necklifts that do not treat the face.  If you have significant jowling I would recommend a form of facelift, whether that be a minilift in the office setting or an extended SMAS deep plane facelift, or other more sophisticated technique that would be performed in an operating room setting.  If you are relatively young and only have laxity under the neck then a true necklift might be a solution for you.  This is performed through an incision under the chin and the excess muscle and fat deep to the muscle can be resected.  The muscle can then be put back together in a rather sophisticated way to give a very nice improvement in the neckline.  Ultimately, a consultation would be appropriate so that your specific anatomy can be appreciated and a customized treatment plan can then be created. 

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Question: I would like a cheek implant, chin implant, and fat transfer to my face. How long does this surgery take? What type of material is the implant? Is the fat transfer permanent?

Answer: If you desire cheek and chin implants and fat transfer you are looking at a procedure that typically would take about 2 to 2 1/2 hours to perform.  I personally use firm silicone implants for the cheek and chin.  These implants come in a variety of shapes and sizes and I customize which implant is inserted by the patient’s specific physical anatomy so that we can end up getting the best result possible.  Regarding fat transfer, it is a permanent procedure but the amount of fat that is permanent is the unreliable portion of the technique due to the fact that we know a significant volume of the fat, somewhere between 1/2 and 2/3 is going to be resorbed over the first 6 to 12 months.  We therefore tend to place more fat than we desire in that location since we expect a rather significant amount not to be present a year later.  All of these procedures are highly customized for each individual and I think it is therefore quite important that you seek out an experienced facial plastic surgeon for these rather advanced techniques.

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Question: My face seems almost 2 dimensional. I have absolutely no cheekbones. I am interested in getting some facial definition and I think that cheek implants might do this. What kind of implants do you use? Is this preferred for cheek augmentation over fat transfer?

Answer: By what you describe you certainly appear to be a good candidate for cheek implants but a consultation and physical evaluation would be required before I could absolutely say this.  Nonetheless, if you do require more volume in your cheek areas then cheek implants are certainly an excellent way to accomplish this as they are extraordinarily reliable and extremely safe and are much more consistent than fat transfer due to the fact that 100% of the implant is going to be there for the rest of your life, whereas fat transfer can lose up to 2/3 of the fat over the first 6 to 12 months.  So in patients that require a significant amount of volume in the actual cheek area as opposed to the area under the eye I always recommend consideration of cheek implants due to the fact that you are going to have a very reliable result that is permanent.

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Question: I am interested in fat grafting. From everything I have read it has wonderful benefits. I would like to fill out my eyes and fix my jawline and cheeks. Can this be done in 1 session? How much time does the procedure take? Where do you harvest the fat cells from?

Answer: We can definitely fill in area around the eyes and along the jawline and into the cheeks to improve the overall appearance of a patient’s facial features.  This can definitely be performed in a single session and this typically takes about an hour, but is dependent on how much fat is required.  I typically harvest the fat from the lower abdomen, but will occasionally use the inside of the knees or outer thigh or hip area.  Patients typically look a bit over-inflated for the first week or 2, but things settle down quickly after that.  The ultimate result can take 6 to 12 months before all of the non-viable fat is resorbed by the body and then what is left over is going to be permanent in my opinion. 

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Question: I would like plastic surgery on my cheeks, they have gotten very thin. I am interested in fat transfer for this. Where do you get the fat from on my body? How much do you remove and is it treated before it is put into my cheeks? Is it injected into the cheeks?

Answer: By what you are describing you seem like a good candidate for consideration of fat grafting if you have very thin cheeks and need more facial volume.  Fat is typically harvested from either the abdomen or inner knee, occasionally from the hips or inner thigh and this fat is then processed and then placed into 1 mL syringes and then reinjected through small needle sites in various areas of the face.  The injection cannulas are about the size of a medium-sized needle and can therefore be placed through the skin without leaving a visible scar.  Most people typically over augment the area where they are performing fat augmentation due to the fact that a significant portion of the fat is going to ultimately be resorbed by the body and not survive long-term.  If a patient needs a significant amount of volume replacement then I will usually tell them that they are going to need to perform fat grafting in 2 separate sessions and I typically space these 6 to 12 months apart.  Ultimately we can get very nice results that are essentially permanent in the far majority of patients. 

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