For what deflated, not what fell.

Look at a photograph of yourself from fifteen years ago and the difference is rarely just that things have moved. The temples are flatter. The cheek is less full over the bone. The area beneath the eye has gone from a smooth transition to a shadow.

None of that is descent. It is loss of fat, and to some extent of the bone underneath it. Lifting a deflated face pulls an empty structure tighter, which is a specific and recognizable kind of wrong.

Lifting restores position. Only volume restores volume.

Fat is not a product with a duration printed on it. The proportion that establishes a blood supply in its new location becomes living tissue and stays. That is the meaningful difference from filler, and it is why fat is usually the answer when the volume deficit is substantial or when the goal is a durable structural change rather than a seasonal correction.

It comes with an honest caveat: not all of it takes. Some proportion is reabsorbed in the first months, which is why the assessment at settling matters more than the appearance in the first weeks.

Most faces past a certain age are some of both problems, in a ratio unique to that face. Repositioning the descended tissue and restoring the lost volume are complementary operations, and doing one while ignoring the other is the most common way a technically sound facelift still fails to look right.

The donor site is your abdomen, thigh, or hip. I liposuction the fat and then process it through a centrifuge, handling it as gently as the technique allows. Fat cells are fragile, and how roughly they are treated between coming out and going in has a great deal to do with how much of the graft survives.

It goes back in through a small cannula, placed where the face has deflated: around the eyes, the temples, the cheeks, the nasolabial folds, and on occasion the lips and marionette lines.

Those last three come with a caveat I give every patient. They are areas of constant motion, and moving tissue holds onto grafted fat less reliably than still tissue does. I will treat them, and I will not promise you permanence there.

Nobody can tell you in advance how much of a graft will take. In some patients it is eighty or ninety percent. In others it is twenty or thirty. The same technique, the same surgeon, a different face.

The old habit was to overfill, on the theory that you are compensating for the loss. My practice now is to correct to visible improvement and stop there. When the take turns out to be ninety percent, an overfilled face means going back in to take fat out, and that is a worse problem to have than adding a little more later.

I would far rather do a second, smaller session than talk you through why your cheeks are too full.

There is a second version of this. If the fat is processed much further, breaking down the larger cells, what remains is a preparation of smaller cells, growth factors and stem cells. That is nanofat, and it does a different job.

It is not for volume. I use it for the quality of the skin itself: fine lines, tone, and texture. It also behaves differently in recovery, without the prolonged swelling that structural grafting can bring.

Grafted areas hold swelling, and minimally processed fat holds it longest. Some patients are still swollen at six weeks. Most start looking like themselves again at three to four weeks.

This matters when fat transfer is added to another operation, because it can extend the recovery you were planning for. It is worth knowing before you book the time off.

Contour irregularity is the main one, and it is the reason I place conservatively and avoid overcorrection.

The graft not taking is the other. If too little survives to give the result we discussed, we can do a further session, usually about six months later once everything has settled.

Infection is uncommon and covered with a short course of antibiotics.