Elevation of the Malar Fat Pad with a Percutaneous Technique（3）
RESULTS
At 3 months after surgery, all patients had significant elevations of their malar fat pads, with the exception of 2 early patients, who underwent revision surgery, with satisfactory results. The elevation was of an extremely natural appearance. Excellent volume replacement of the cheek region was obtained. Results, in the senior author's opinion, were improved over those seen in deep-plane face-lifting with malar fat pad fixation. The average malar pad elevation before creation of the temporal pocket was 2 to 3 mm. After the surgical procedure incorporated the creation of the temporal pocket, 4 to 5 mm of elevation was uniformly achieved.
Temporary asymmetries were seen in 8 patients, but resolved within the 3-month period. Temporary unilateral pain complaints were expressed by 3 patients, but also resolved within the 3-month period. Two patients, as mentioned above, underwent revision surgery to remove the palpable temple polytef bolster used in the early subcutaneous fixation technique.
All patients at 1 year after surgery (excluding the exceptions mentioned above) have maintained their malar elevation. These results are in contrast to those seen with deep plane face-lifting, after which the senior author has seen a regression of malar fat pad elevation in some of his (and other surgeons') patients. In fact, the technique provides an easy, minimally invasive "tune-up" in the malar area for rejuvenation of patients with previous face-lifts (Figure 5, Figure 6, and Figure 7).
Figure 5.
A, Preoperative photograph of 42-year-old patient with mild malar ptosis.
B, Postoperative photograph taken 1 year after closed technique.
Figure 6.
A, Preoperative photograph of 50-year-old patient with more-pronounced malar ptosis.
B, Postoperative photograph taken 1 year after closed technique.
Figure 7.
A, Preoperative photograph of 49-year-old patient before surgery of the midface, jowls, and neck.
B, Postoperative photograph taken after open technique (face-lift) and tip rhinoplasty.
C, Preoperative oblique view.
D, Postoperative oblique view.
No facial nerve problems, no excessive pulling, and no muscle fixation problems were noticed. There were spots of bruising in many patients, but they could generally be covered with makeup after about 72 hours. Four patients had prolonged infraorbital edema that required 2 weeks to resolve.
COMMENT
A simplified method of malar fat pad elevation is described. This method allows for elevation of the malar fat pad without extensive dissection. Complications were minor with this procedure when compared with endoscopic midface-lifting and complex deep-plane face-lifting procedures.
The procedure may be performed in conjunction with a face-lift (open technique), allowing for a more conservative face-lift technique than is customarily used to elevate the malar pad. It may also be performed without a face-lift to allow minimally invasive rejuvenation of the midface in the younger patient, in the older patient who has previously had a face-lift, or in the older patient whose aging is confined to the middle third of the face.
ARTICLE INFORMATION
Accepted for publication November 7, 2001.
This study was presented at the American Academy of Facial Plastic and Reconstructive Surgery Spring Meeting, Palm Desert, Calif, May 13, 2001.
Corresponding author and reprints: Gregory S. Keller, MD, 222 W Pueblo St, Santa Barbara, CA 93105 (e-mail: faclft@aol.com).
REFERENCES
1、Millard DR JrYuan RTDevine JW Jr
A challenge to the undefeated nasolabial folds
Plast Reconstr Surg. 1987;8037- 46
2、Ivy EJLorenc ZPAston SJ
Is there a difference ? a prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies
Plast Reconstr Surg. 1996;981135- 1143
3、Keller GSCray J
Suprafibromuscular facelifting with periosteal suspension of the superficial musculoaponeurotic system and fat pad of Bichat rotation : tightening the net
Arch Otolaryngol Head Neck Surg. 1996;122377- 384
4、Hamra S
The deep-plane rhytidectomy
Plast Reconstr Surg. 1990;8653- 61
5、Psillakis J
Face lift without preauricular scars
Plast Reconstr Surg. 1994;941093- 1094
6、Owsley JQ
Lifting the malar fat pad for correction of prominent nasolabial folds
Plast Reconstr Surg. 1993;91463- 476
7、Bosse JP Papillon J
Surgical anatomy of the SMAS at the malar region
Transactions of the Ninth International Congress of Plastic and Reconstructive Surgery. New York, NY McGraw-Hill Co1987;348- 349
8、Quatela VC Sabini P
Techniques in deep plane face lifting
Facial Plast Surg Clin North Am. 2000;8193- 209
9、Anderson RD Lo MW
Endoscopic malar/midface suspension procedure
Plast Reconstr Surg. 1998;1022196- 2208
10、Isse NG
Endoscopic facial rejuvenation
Clin Plast Surg. 1997;24213- 231
11、Freeman MS
Endoscopic malar pad lift and subperiosteal midface lift
Keller G Sed Endoscopic Facial Plastic Surgery. St Louis, Mo Mosby–Year Book Inc1997;109- 136
12、Hester TR JrCodner MAMcCord CDNahai FGiannopoulos
A Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging : maximizing results and minimizing complications in a 5-year experience
Plast Reconstr Surg. 2000;105393- 406discussion407- 408
13、Edelstein CBalch KShorr NGoldberg RA
The transeyelid subperiosteal midface-lift in the unhappy postblepharoplasty patient
Semin Ophthalmol. 1998;13107- 114
14、Su NN
Closed suspension mini–cheek lift to reduce the nasolabial fold : a preliminary report
Am J Cosmetic Surg. 1995;1231- 34
15、Sasaki G
Percutaneous suture elevation of malar fat pads
Paper presented at: Annual Meeting of the American Society for Plastic Surgery May 4, 2001 New York, NY Course 206
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