A 59 year old lady troubled by loose, dimpled facial skin and volume loss following multiple filler complications (Bio Alcamid) underwent lower facelift and fat grafting. A High SMAS technique was selected to deliver a natural and long lasting result and allow access to remove as much filler as possible. Simultaneous fat injection was performed to restore lost volume and improve symmetry in the lips, cheek and suborbital region. An improvement in skin texture is also apparent following fat injection. Result at 6 months.