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

BACKGROUND: Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, there exists significant procedural variation between providers. OBJECTIVE: The primary purpose of this systematic review is to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. METHODS: A systematic review of the Cochrane Library and MEDLINE databases as completed to identify all clinical reports of fat grafting combined with facelift surgery using the following key terms: ('fat grafting' OR 'lipotransfer' OR 'lipofilling' OR 'fat transfer') AND ('facelift' OR 'rhytidectomy' OR 'SMASectomy' OR 'facial rejuvenation'). Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS: The systematic review was performed in April 2017. 248 articles were identified for review. After application of exclusion criteria, a total of 15 primary studies were included in this review. Various facelift techniques were used, including deep-plane or sub-SMAS facelift, SMAS facelift, modified MACS lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvement in facial volume and aesthetic assessments. CONCLUSIONS: Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities.