Goals/Purpose:
Recent discovery of the numerous facial fat compartments has improved our ability to contour the face while surgically rejuvenating it. Incorporation of selective fat compartment volume restoration along with SMAS manipulation affords 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."
Methods/Technique:
A review of 100 consecutive individualized component facelifts was performed. All patients underwent fat grafting to the nasolabial fold, deep malar, and high malar fat compartment locations. Trained observers (FCC and JU) examined preoperative and post-operative photographs from each case and graded the nasolabial fold and malar prominence on a predetermined scale. The nasolabial fold scale is; 0, no visible fold; 1, minimal fold; 2, moderately deep fold; and 3, very deep fold. Malar prominence scores were scored on a 1-3-point scale; 1, concave malar projection; 2, neutral; and 3, convex malar projection.
Results/Complications:
With 100 patients, the average nasolabial fold score for the 0 grade improved from 1.5% pre-operatively to 21.5% post-operatively. Average malar prominence convexity improved from 6% pre-operatively to 28% post-operatively. Nasolabial fold improved by at least one grade in 81%, and by over 1 grade in 11%. Malar prominence improved by at least 1 grade in 62%, and by over 1 grade in 9%. Average follow up was 8 months.
Conclusion:
The individualized component facelift allows for effective tissue manipulation via lifting and tightening in vectors according to facial symmetry and shape. The addition of selective fat compartment filling of deep and high malar locations along with nasolabial fold injections improve control of facial contouring. This was shown with objective numerical grading. As we improve our understanding and control of fat grafting, more precise filling of numerous facial fat compartments can augment our facelift results.
