Article by Dr. Shane Palmer

Recent observations and the application of new techniques have demonstrated the fallacy of the antiquated “skin-only” approach to the aging face.  In this older paradigm, the aging face was considered to be the result of sagging skin and muscle and was treated with a facelift.  Unfortunately, this only addresses the loose skin and muscle and ignores the more dramatic source of aging, volume loss.   Because the loss of volume is ignored, many facelifts leave patients with a gaunt and, often, over stretched appearance with obvious signs of having “gone under the knife”.  In addition, the taught skin initially obtained is often short lived, with sagging skin returning in only a few short years following a facelift, depending on the technique.


In retrospect, it is surprising that it has taken so long for cosmetic surgeons to recognize that volume loss is such an important component in the aging process, arguably contributing more to an aged look than loss of skin and muscle tone.  Re-positioning fat to compensate for the volume loss has been attempted with variable results, however it seems clear now that the best approach is to transfer fat to the face from other parts of the body.  This is known as fat grafting and can confer an astounding transformation when performed correctly.  In fact, when volume is replaced in the face, we often see that skin no longer sags and a facelift may be avoided altogether.  Consider how a sack, such as a balloon, distends when filled.  In a similar manner, wrinkles on the face are erased as the skin is stretched by the additional volume.  Another potential benefit of fat grafting to the face is the direct rejuvenating effects awarded the skin from the stem cells present in the fat.

If significant skin laxity is present despite fat grafting, then a more conservative facelift can augment the volume replacement.  Mild skin laxity can often be addressed with less invasive procedures, such as Thermitight or non-invasively with Thermismooth.  These are radio frequency devices that use heat to cause the skin to contract, leading to tightening.

Skinfinity Victoria Texas

To complete the facial rejuvenation, resurfacing the face to remove damaged skin and to efface lines around the eyes and mouth can be added to the process.  I prefer the CO2 laser for resurfacing the face because of its versatility and unparalleled efficacy.  To enhance the incorporation of the new fat and to speed the recovery of the resurfaced skin, I routinely use platelet rich plasma mixed with the fat as well as directly incorporated into the skin via concurrent micro-needling.78cc9f3a-c0e7-4c9d-a36a-efad31d4d1b0 (2) (1)

Other complimentary procedures can be added as needed, such as eyelid lifting and brow lifting.  These are considered on an individual basis.

To sum up, the modern approach to the aging face includes volume replacement with fat grafting, skin resurfacing with CO2 laser or similar, and skin tightening with invasive or noninvasive technique.  To learn more, please call to schedule a consultation and I’ll be happy to discuss the components of this facial rejuvenation process further and determine if any of these are right for you.  Package pricing is available for global facial rejuvenation which incorporates all three modalities.