Lift and Fill Facelift: Integrating the Fat Compartments.
- 11Chairman and Professor-Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 2Assistant Clinical Professor -David Geffen UCLA School of Medicine-Department of Surgery-Division of Plastic Surgery; Private Practice, Beverly Hills, CA. 3Resident Surgeons-Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 4Assistant Professor, Department of Plastic Surgery, University of Lyon, France.
Abstract
BACKGROUND::
Improvements in facelift outcomes are largely based on sound anatomical knowledge and principles. Recent discovery of the numerous fat compartments of the face has improved our ability to more precisely restore facial volume while rejuvenating it through differential SMAS treatment. Incorporation of selective fat compartment volume restoration along with SMAS manipulation allows for improved control in re-contouring while addressing one of the key problems in facial aging, volume deflation. This theory was evaluated by assessing the contour changes from simultaneous face "lifting" and "filling" through fat compartment-guided facial fat transfer.
METHODS::
A review of 100 facelift patients was performed. All patients had an individualized component facelift with fat grafting to the nasolabial fold, deep malar and high/lateral malar fat compartment locations. Photographic analysis using a computer program was conducted on oblique facial views, pre and post-operatively, to obtain the most projected malar contour point. Two independent observers visually evaluated the malar prominence and nasolabial fold improvements based on standardized photographs in the ¾ oblique view. The nasolabial fold depth was and malar improvement were scored as a 0 to 3, with 3 representing the deepest NLF and the greatest degree of malar contour improvement.
RESULTS::
Nasolabial fold improved by at least one grade in 81%, and by over 1 grade in 11%. Through, objective computer evaluation, malar prominence average projection increase was 11.26% while the average amount of lift was 7.85%. The malar prominence score improved by at least 1 grade in 62% of the post op pts and 9% had a greater than 1 improvement. 28% of the patients had a convex malar prominence post operatively versus 6% preoperatively. Malar prominence improved by at least 1 grade in 63%, and by over 1 grade in 10%.
CONCLUSION::
The lift and fill facelift merges two key concepts in facial rejuvenation: 1) effective tissue manipulation via lifting and tightening in differential vectors according to original facial asymmetry and shape; and 2) selective fat compartment filling of deep malar and high malar locations as well as nasolabial fold fat grafting to precisely control facial contouring. This was shown with objective numerical grading as well as through observer assessment.
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