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Progressive Improvement in Midfacial Volume 18 to 24 Months After Simultaneous Fat Grafting and Face

Although many facelift techniques incorporate fat grafting with tissue repositioning and removal, the intermediate and long-term changes in facial volume after these techniques is unknown. While fillers for facial volume have predictable life spans, little is known about the facial volume changes following fat grafting with facelift surgery.

This week, IFAAS faculty, Dr. Steven Cohen, shares his findings on Progressive Improvement in Midfacial Volume 18 to 24 Months After Simultaneous Fat Grafting and Facelift: An Insight to Fat Graft Remodelling.


To track the short-term and long-term effects on midfacial volume change.


Evaluated a subset of patients who were followed by 3-dimensional (3D) photometric imaging 18 to 24 months after facelift with fat grafting to the deep midfacial fat compartments and buccal fat pads. Volume changes were measured preoperatively and postoperatively every 1, 3, 6, 12, 18, and 24 months using the 3D photometry.


Injectable tissue replacement is used to replace lost fat in the appropriate size and anatomic structure to the compartment(s) that demonstrate fat loss.

  1. The harvested fat is sifted to remove extra fluids and tissue and is being divided three different sizes: Milifat - provides structure to the face and renews tissue; Microfat- smoothes and reforms; Nanofat - stimulates rapid cell production.

  2. The fat grafting procedure allows surgeons to modify or retrieve individually sized adipose parcels to treat the same range of facial aging concerns that are presently addressed with cosmetic fillers

  3. Injection was then performed into the deep fat compartments, preperiosteal in the pyriform aperture and prezygomatic and premaxillary areas, the medial and lateral sub-orbicularis oculi fat (SOOF), and into the deep medial cheek


At the 1- to 2-month follow-up period, average facial volume was 49.60% of the initial fat injected. At the 18- to 24-month follow-up period, average facial volume was 73.64% of the initial fat injected, indicating an increase in midfacial volume. Upon graphing available photometric data, dynamic changes in facial volume were observed. In 5 midfacial zones, facial volume appeared to initially decline (average decline, 49.0% of original fat injection), troughing at 10 months (range, 2-15 months), but later inclined (average increase in volume, 95.9% of original fat injection), peaking around 16 months (range, 4-24 months)

Patient A: In Depth Analysis

This 63-year-old woman underwent a facelift with high SMAS approach, septoplasty, bilateral upper and lower blepharoplasties, and facial fat grafting. Of the 34 mL of fat injected into the face, 2 mL of fat was injected into each midfacial zone, totaling 4 mL.

(A) Preoperative,

(B) 1-month postoperative

(C) 18-month postoperative photographs.

(D) 3-Dimensional imaging at baseline.

(E) 3-Dimensional imaging at the 1-month postoperative period, showing 0.4867 mL (24.34%) of fat retained upon overlay of preoperative photo.

(F) 3-Dimensional imaging at 18-month postoperative period, showing 1.7528 mL (87.64%) of fat retained upon overlay of preoperative photo.

Patient B: Dr. Cohen’s patient’s before and after photos

“I am now nine days post surgery and I am really pleased with the results. The area where I had liposuction are still sore and I still have some bruising under my eyes but I can easily cover them. My face looks rejuvenated and plump which is exactly what I wanted. I am very satisfied” said Dr Cohen’s patient.


Progressive improvement in midfacial volume in part may be explained by the graft replacement theory of Suga and Yoshimura, which suggests that grafted adipose tissue immediately dies after transplantation and is replaced by adipose-derived stem or progenitor cells. “This is not just about making a decent living — it’s about figuring out things that are going to help others age intelligently.” said Dr. Steven R. Cohen.


Learn more about advanced cutting-edge techniques in Biofilling and Biocontouring through Dr Cohen's Mini Fellowship in his own Operation Room:

IFAAS Mini Fellowship (Observation)

San Diego - Dr. Steve Cohen's Injectable Tissue Replacement and Regeneration & ABC Face Lift

June 28-29, 2019: San Diego, CA, United States

Last 1 spot

Register Now!

More upcoming Aesthetic Trainings happening globally:

Non-Surgical Face Lifting | Apr 7-8: Nice, FR


Non-Surgical Face Lifting | Apr 27-28: Texas, USA


Non-Surgical Face Lifting | May 4-5: Sydney, AU


Rhinoplasty, Facial Rejuvenation & Fat Grafting | Jun 7-8: Verona, IT


Non-Surgical Face Lifting | Jun 8-9: London, UK


Tissue Replacement & Regeneration | Jun 28-29: San Diego, CA, USA


Korean Non-Surgical Face Lifting | Jun 29-30: Vancouver, CA


Advanced Facial Aesthetic Surgeries | Jul 15-17: Seoul, SK


Liposuction under Local Anaesthesia | Jul 16-17: Seoul, SK


Non-surgical Facial Lifting | Jul 18-20: Seoul, SK


PRP Therapy for Facial & Neck Rejuvenation | Jul 27: Sydney, AU


Non-Surgical Total Eye Rejuvenation | Jul 28: Sydney, AU


Global Event Calendar

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