Stand in front of a mirror and use your fingers to pull the skin of your jawline back. You will see a sharper angle, yes. Jowls disappear and sagging skin tightens. But look closer at the midface, the cheeks, and the eyes. Does the face look youthful? Or does it simply look tight?
This is the friction point of nearly every consultation for facelift surgery. Patients understand gravity. Things fall, so we must lift them up. But they often overlook atrophy.
At our Beverly Hills practice, Dr. Gould operates on a fundamental truth: A facelift repositions the architecture, but it does not replace the foundation. To truly reset the clock and reclaim a youthful appearance, you can't just tighten the canvas. You have to pad the frame.
We tend to blame skin laxity for everything, but the real structural changes happen much deeper. As part of the natural aging process, the distinct facial fat pads that give the cheeks their high, youthful position begin to shrink and separate. Even collagen and elastin production slow down, compromising the structural integrity of the tissues.
When you combine age-related atrophy (the deterioration of cells that make up youthful tightness) with environmental factors like sun exposure or significant weight loss, the result is lost facial volume. The orbital rims widen, the jawbone recedes, and the face loses its hydraulic support.
If a surgeon performs a facelift procedure on a patient with significant volume loss without addressing that deflation, the result is often described as "skeletonized." The loose skin is smooth, but the face looks gaunt, flat, or severe. The character of the face has been tightened, but the vitality hasn't been restored.
Structure (the lift) and Substance (the volume) are two different operating systems. A deep plane facelift handles the descent of the lower face and neck. It puts the house back on its foundation. But restoring lost volume renovates the house itself.
So, how do we restore lost volume after plastic surgery? To address the sunken cheeks and hollows that surgery misses, Dr. Gould frequently integrates fat transfer directly into the surgical plan. Unlike synthetic dermal fillers, which are temporary guests in the face, autologous fat is a permanent resident.
We harvest excess fat from the body (typically the abdomen or thighs), purify it, and micro-inject it into the deep compartments of the face—the temples, the tear troughs, and the sub-malar hollows. This serves a dual purpose. Aesthetically, it helps restore volume to create the soft curves associated with youthful contours. Biologically, the fat brings with it stem cells and growth factors that often improve the overlying facial skin quality.
It's not about making the face "fat." It is about calibration. Fat grafting acts as a natural filler, creating the difference between a face that looks pulled and a face that looks naturally younger.
Structural repair is essential, but tissue vitality is the final polish. This is why Dr. Gould often incorporates Platelet-Rich Fibrin (PRF) into his comprehensive rejuvenation plans.
PRF represents the next evolution in regenerative aesthetics. By drawing a small sample of your blood and spinning it at a precise speed, we create a fibrin matrix teeming with platelets, white blood cells, and mesenchymal stem cells.
We don't just want the face to look lifted; we want it to behave like younger tissue. When applied during a facelift or combined with fat transfer, PRF acts as a biological supercharger. It accelerates the integration of grafted fat, significantly reduces inflammation for a faster recovery, and triggers a sustained release of growth factors.
This process stimulates new collagen and elastin production from the inside out. While the scalpel addresses the sagging skin, PRF rejuvenates the canvas itself, enhancing texture and luminosity. It serves as the bridge between surgical precision and biological regeneration, ensuring your natural results radiate health.
This isn't to say hyaluronic acid fillers are obsolete. They simply serve a different purpose.
Dermal fillers are excellent for precision work, highlighting the vermillion border of the lips, refining the chin projection, or managing early volume loss in younger patients. Hyaluronic acid is particularly effective for smoothing fine lines in the perioral area (around the mouth) or softening marionette lines and nasolabial folds.
However, when the facial volume loss is global (affecting the whole face), using hyaluronic acid to compensate leads to the dreaded "overfilled" or "pillow face" syndrome. When the structural deficit is significant, gel is a poor substitute for tissue. Dr. Gould’s approach is hierarchical: use plastic surgery to lift excess skin, fat transfer for volume restoration, and dermal fillers only for the final, surface-level polishing.
Ultimately, an elite result requires diagnosing which "system" of the face is failing. Dr. Gould views facial appearance through three distinct lenses. A facelift only cures the first issue. If you ignore the other two, the facial contours will never look fully harmonious.
The ligaments stretch, causing jowls and a heavy neck area.
The Fix: Deep Plane Facelift or Neck Lift.
Facial fat and bone recede, leading to loss of facial volume.
The Fix: Fat transfer to add volume.
The skin accumulates sun damage and develops deep wrinkles.
The Fix: Aesthetic dermatology treatments like lasers or peels.
There is a practical benefit to this multi-modal approach: longevity. A facelift supported by restored volume tends to age better. When the skin is draped over a robust, voluminous foundation, it maintains its position longer than skin draped over a hollow structure.
Fullness is not the enemy of definition. In fact, distinguishing between facial volume and fat redistribution is the secret to natural results.
While a healthy diet and skincare can slow the signs of aging, they cannot replicate the structural support of bone and fat. Ideal candidates for rejuvenation understand that addressing the double chin or sagging skin is only half the battle. Restoring the underlying shapes is what brings the face back to life.
Whether through hyaluronic acid, fat transfer, or a facelift, the aim is always a seamless restoration of the self you recognize.
No matter what brought you here, a visit with our doctors will bring out the best in you. Call us today to schedule your initial consultation, either in person or online.
465 North Roxbury Drive, Suite 1007, Beverly Hills, CA 90210
Hours of Operation
Mon-Fri: 9am – 5pm
Closed Weekends
