At Virginia Institute of Plastic Surgery (VIPS) in Richmond, Drs. Burton Sundin and Reps Sundin routinely combine facial fat grafting with facelift surgery. Here's why volume restoration effectively changes the outcome of aging and gravity.
Facelifts Can’t Replace What Is Lost
When patients come to the Virginia Institute of Plastic Surgery asking about a facelift, one of the first things Dr. Burton Sundin and Dr. Reps Sundin discuss is what lifting alone will and will not accomplish. The answer shapes everything that follows.
A facelift repositions tissue. It tightens skin, lifts the jawline, addresses jowling, and restores definition. What it does not do is replace what has been lost. And for most patients seeking facial rejuvenation, volume loss is as significant a contributor to an aged appearance as sagging tissue. That is why the Sundins make facial fat grafting a routine part of every full facelift they perform at their Richmond practice.
Why Aging Is Both a Gravity Problem and a Volume Problem
Aging Facial Changes
As we age, the face loses fat in predictable areas: the temples, the midface, beneath the eyes, the lips, and along the jawline. Bone structure also changes over time, with the underlying skeleton gradually receding in ways that reduce the foundation on which the overlying tissue rests. The result is a face that does not just sag downward but hollows out.
The Problem With Only Lifting
A facelift that only lifts without addressing this hollowing can produce an outcome that looks tight rather than young. The skin may be repositioned, but the face still lacks the full, three-dimensional quality that characterizes a youthful appearance. Patients sometimes describe this as looking pulled rather than refreshed.
Volume Restoration
Volume restoration changes the equation. When fat is strategically placed in areas that have deflated, the face regains structure, softness, and proportion. Combined with a lift, the result is a face that looks genuinely rejuvenated rather than surgically altered.
How Fat Transfer Works at VIPS
Facial fat grafting begins with harvesting fat from another area of the patient's body, typically the abdomen, flanks, or inner thighs, using gentle liposuction. That fat is then processed and purified before being carefully injected into targeted areas of the face in small, precise deposits.
Because the transferred fat is the patient's own tissue, there is no risk of allergic reaction or rejection. A portion of the transferred fat will be reabsorbed by the body in the months following surgery, which is why Drs. Sundin typically transfers slightly more than the final desired volume. Once the fat has established a blood supply and stabilized, the surviving portion becomes a permanent part of the facial tissue.
Experience Matters
The technique requires experience and a refined aesthetic eye. Too little fat produces minimal improvement. Too much can make the face look overfilled or unnatural. Placement matters enormously. Fat deposited in the wrong plane or wrong location produces a different result than fat placed precisely where volume was lost.
At VIPS, Drs. Burton and Reps Sundin bring more than 30 years of combined experience to facial surgery, with a particular focus on results that look balanced and natural rather than operated upon.
Which Areas Benefit Most from Fat Transfer During Facelift
The specific areas where fat is placed will vary by patient, but the most common sites for volume restoration during a facelift at VIPS include:
- Temples: One of the earliest areas to hollow with age, temple deflation gives the face a gaunt, skeletal appearance that a lift alone will not correct.
- Midface and cheeks: Volume loss in the midface flattens the face and deepens the nasolabial folds. Restoring cheek volume lifts the entire appearance of the midface.
- Undereye area: The junction between the lower eyelid and cheek, known as the tear trough, deepens as volume is lost. Fat grafting here softens the shadow that makes patients look perpetually tired.
- Lips and perioral area: The lips thin with age, and the surrounding tissue loses fullness. Fat transfer restores a natural youthfulness without the artificial look that overfilled dermal fillers can produce.
- Jawline: Small deposits along the jawline can help define and sharpen contours that have softened over time.
Fat Transfer vs. Fillers: How to Think About the Decision
Many patients considering a facelift have already had experience with dermal fillers such as Juvederm Voluma or Sculptra for volume restoration. It is a reasonable question to ask: if fillers have been working, why switch to fat transfer at the time of facelift? The answer comes down to permanence, volume, and integration.
Permanence
Hyaluronic acid fillers like Voluma are gradually metabolized by the body, typically lasting one to two years before maintenance is required. Sculptra stimulates collagen production and lasts somewhat longer, but it too requires repeat treatments over time. Fat grafting, once the transferred fat has survived the initial reabsorption phase, is permanent. The fat that establishes a blood supply and integrates into the facial tissue becomes a lasting part of the face's structure.
Volume Capacity
Fillers are well-suited for targeted, relatively modest volume additions. When a patient needs more comprehensive restoration across multiple facial zones simultaneously, the volume of filler required becomes significant in both cost and the number of syringes involved. Fat grafting allows Drs. Sundin to restore volume across the temples, midface, tear troughs, lips, and jawline in a single procedure using the patient's own harvested fat, without the per-syringe cost of filler.
Integration
Fat is living tissue. It does not just sit in the face the way a filler does. Transferred fat integrates biologically into the surrounding tissue, taking on the characteristics of native facial fat over time. The result tends to look and feel more natural than filler, particularly in the context of a facelift where the goal is comprehensive rejuvenation rather than targeted augmentation.
For patients who are not undergoing a facelift, fillers remain an excellent non-surgical option for volume restoration. But at the time of a full facelift, the Sundins consider fat grafting the more complete and lasting solution.
What Patients Should Expect
Combining fat grafting with a facelift does not dramatically extend recovery compared to a facelift alone, but there are some specific things to anticipate at each stage of healing.
Week 1: Rest and Early Swelling
The first week involves the most visible swelling and bruising, both from the facelift and from the areas where fat was harvested. The face will appear fuller than the final result due to swelling in the grafted areas. This is expected and does not reflect the eventual outcome. Most patients remain at home during this period, with head elevation, cold compresses, and prescribed pain management supporting comfort.
Weeks 2 to 3: Swelling Begins to Resolve
Bruising fades significantly during this window, and most patients feel comfortable resuming light activity. The face may still appear slightly uneven or fuller in some areas as the transferred fat settles. Patients who work in non-physical roles often return to work during this period, though sun exposure and strenuous activity remain restricted.
Weeks 4 to 6: Early Results Emerge
The facelift results become more visible as residual swelling continues to resolve. The fat grafting results are still in transition during this phase as the body determines which transferred cells will survive and establish circulation. Some patients notice fluctuation in facial fullness during this period, which is a normal part of the process.
Months 3 to 6: Final Results
This is when most patients at VIPS see the outcome they came for. The surviving fat has fully integrated, swelling from both the lift and the grafting has resolved completely, and the face reflects the balanced, three-dimensional result that combining both procedures is designed to achieve. Final scar maturation continues beyond this window, but is typically well underway.
The fat that survives long-term does so permanently. Unlike dermal fillers, which require ongoing maintenance, the volume restoration achieved through fat transfer is a one-time investment in the structure of the face.
Is Fat Transfer Right for Every Facelift Patient?
Drs. Sundin evaluate every patient individually, and fat grafting may not be the right choice in every case. Patients with minimal volume loss, very thin skin, or other anatomical considerations may benefit from a different approach to facial restoration.
During your consultation at the Virginia Institute of Plastic Surgery in Richmond, the Sundins will assess your facial anatomy, review your goals, and walk you through exactly what combination of techniques will produce the best outcome for your specific face.
If you have been considering a facelift in Richmond and want to understand what a truly comprehensive approach to facial rejuvenation looks like, schedule a consultation with Drs. Burton and Reps Sundin today.
