The Shift in Aesthetics: From Fillers to Fat Grafting and Facelifts

Dr. Doft thinks it’s partly a natural ebb and flow—aesthetics change. (Just look at the generational divide over winged liner and hair that’s parted to the side.) And it’s partly a reexamining of what’s youthful and, by extension, desirable for many patients. "That fleshier look is associated with youth—I mean, when you look at children, they have full cheeks," says Dr. Doft. But she also thinks that the more we see sunken faces, the more we’re forced to confront how aging that can be—and it’s not a coincidence that this self-reflection is coming on the heels of so much GLP-1-induced weight loss. "Ozempic face is a really hollow face—we know that it looks drawn, it looks sad, it looks sickly, and so we’re trying to combat that," posits Dr. Doft. "Could this be our natural reaction, pushing back?"

The Rise of Fat Grafting

Instead of taking fat out of the cheeks (buccal fat removal) or injecting filler to create more sculptural cheekbones, more and more patients are putting fat into their faces. It can be used to plump areas that lose fat with age, like the temples, tear troughs, and cheeks. "Many of my patients love fat grafting. When I perform liposuction I often repurpose the fat in the face—or the chest to increase cleavage," says Dr. Doft. Facial fat grafting can be done as an adjunct to liposuction (when the fat is being removed anyway) or as a standalone procedure (a small amount of fat is obtained, via lipo, from areas like the thighs or abdomen). The fat is injected into the face, where only about 50 to 75 percent of it lasts, but what sticks around is permanent—it attaches to surrounding tissues and forms a new blood supply.

The Attraction of Permanent Results

"I personally like fat a lot, because it’s natural, it’s well-tolerated. The downside is that it’s permanent—the upside is that it’s permanent," says Marc Mofid, MD, FACS, a board-certified facial plastic surgeon in San Diego and Beverly Hills and clinical assistant professor of plastic surgery at the Johns Hopkins School of Medicine. For a lot of people that certainly is a plus—"the concept of not needing maintenance, that’s very attractive," says Dr. Williams. "I think for Botox, people kind of tolerate needing to come back over and over again, but I don’t think [they do] as much for filler."

The Drawbacks of Fat Grafting

However, it’s important to acknowledge that, with its permanent nature, fat grafting is not the end-all-be-all filler alternative for every single patient. Once it’s in your body, it does what fat does: "If you put fat in someone’s lips and they wind up gaining 30 or 40 pounds, their lips are going to be massive," says Dr. Mofid. "So in general, I think that we ought to tread carefully."

Fillers Will Give Way to Scalpels Along the Jawline

Maybe you’ve already heard of mewing, but for the uninitiated: It’s a new selfie trick—kind of like pinching your cheeks for a quick flush, but it’s for your jawline. You put the top of your tongue against the top of your mouth and swallow, and you’re supposed to get a more defined jawline. Jury’s out on whether it works, but one thing is clear—there’s "tons of focus on the jaw," says Dr. Doft. Why? We’ve maybe—just maybe—been hypersensitized to critiquing our softening jawlines. (For the record, anatomically speaking, this is a totally normal and expected change that happens with age.) There are so many energy devices that promise to tighten the area and injectors who want to "lift" it with filler, that jaws and jowls are more in the conversation than ever. But a lot of said devices don’t give the dramatic results patients hope for, and attempting to correct jowls with filler can require so much filler that it winds up looking off. "People are getting frustrated with the noninvasive stuff, like Thermage or Ultherapy," says Dr. Doft. "And they’re finding that filler’s expensive, it’s bulky looking, and there’s a huge fear now of fillers lasting too long [in your skin] and not going away [after they’ve been injected], and distorting your skin forever." It has a lot of people questioning whether they want to continue down the path with filler. "Many people are kind of saying that surgery is going to be their ultimate end goal, so why am I spending all of this other money?" says Dr. Doft. And that brings us to more patients asking about facelifts for tightening their jawlines. Many of them are relatively young—in the mid-40s and early 50s.

Conclusion

The shift in aesthetics is clear: from fillers to fat grafting and facelifts. As Dr. Doft puts it, "Instead of wanting to create shadows and more angularity, we’re looking for that fresh, youthful, less defined face." For many patients, the allure of permanent results with fat grafting is a major draw. However, it’s essential to weigh the pros and cons and consider individual circumstances before making a decision.

FAQs

Q: What is fat grafting?
A: Fat grafting is a procedure that involves injecting fat into the face to plump and rejuvenate the skin.

Q: Is fat grafting permanent?
A: Yes, fat grafting is a permanent procedure, but only about 50-75% of the fat lasts, and what remains becomes a permanent part of the surrounding tissues.

Q: What are the potential drawbacks of fat grafting?
A: The potential drawbacks include the risk of the fat gaining weight and becoming distended, and the need for careful consideration before undergoing the procedure.

Q: What is mewing?
A: Mewing is a new selfie trick that involves putting the top of the tongue against the top of the mouth and swallowing to achieve a more defined jawline.

Q: Why is there a focus on the jawline?
A: There is a focus on the jawline because of the perceived importance of a strong, defined jawline in beauty standards, and the desire to counteract the natural signs of aging.