Goals/Purpose:
As facial volumes change with age, the upper facial width decreases and the lower facial width increases. The rectangular face of aging can be rejuvenated by an additive/reductive liposculpture technique that adds volume with autologous fat to the upper face while subtracting volume from the lower face.
Methods/Technique:
Patients are marked preoperatively delineating regions requiring volume addition or subtraction. Low pressure lipoaspiration of the jowl and neck is done via 2 submental crease stab incisions. Coleman technique is used to prepare fat harvested from face, neck and other donor sites. Oral commissure stab incisions allow injection of fat into the mid and upper face in 1 ml aliquots. Refined fat is injected in multiplanar passes. Change in facial contour is apparent immediately. Other adjunctive procedures are done after fat addition/reduction. A facial compression garment is applied to facial subtraction sites.
Results/Complications:
Twenty-two patients ranging in age from 42 to 71 years underwent additive/reductive facial liposculpture between 2005-2010. Four had this as their only procedure, 18 had concomitant procedures. Follow up time ranged from 6 months to 5 years. The net shift of facial fat redistribution performed varied from 10-52 mL (mean 33 mL). A single post-operative complication was submental hematoma attributed to concomitant platysmaplasty. Patient acceptance has been excellent.
Conclusion:
The additive/reductive principle is a powerful tool for changing facial volume and can be used as a stand alone or adjunctive procedure in facial rejuvenation. Avoidance of incisions and sharp dissection minimizes post-operative complications. Addition of fat to the midface has the effect of restoring malar volume, causing skin to passively lift, lessening the nasolabial lines and jowls. This effect is further enhanced by subtraction of volume in the jowl and neck, allowing the skin to assume a cleaner contour along the mandibular border.
Pre-Operative:
Markings:
Post-Operative:
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