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Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume: The Midface

Wang, Wenjin M.D., Ph.D.; Xie, Yun M.D., Ph.D.; Huang, Ru-Lin M.D., Ph.D.; Zhou, Jia M.D., Ph.D.; Tanja, Herrler M.D., Ph.D.; Zhao, Peijuan M.D., Ph.D.; Cheng, Chen M.D., Ph.D.; Zhou, Sizheng M.D., Ph.D.; Pu, Lee L. Q. M.D., Ph.D.; Li, Qingfeng M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 563–572
doi: 10.1097/PRS.0000000000003160
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Background: Recent anatomical findings have suggested that facial fat distribution is complex and changes with age. Here, the authors developed a grafting technique based on the physiologic distribution and volume changes of facial fat compartments to achieve a youthful and natural-appearing face.

Methods: Forty cadaveric hemifaces were used for the dissection of fat compartments and neurovascular structures in the midface area. Seventy-eight patients were treated for cheek atrophy using the authors’ targeted restoration of midface fat compartment volume. The outcome was evaluated by a two-dimensional assessment, malar lipoatrophy assessment, and a satisfaction survey.

Results: The medial and lateral parts of the deep medial cheek fat compartment were separated by a septum arising from the lateral border of the levator anguli oris muscle. The angular vein traveled between the deep medial cheek fat compartment and the buccal fat pad, 12 mm from the maxilla. A total volume of 29.3 ml of fat was grafted per cheek for each patient. A 12-month follow-up revealed an average volume augmentation rate of 27.1 percent. Pleasing and elevated anterior projection of the cheek and ameliorated nasolabial groove were still obvious by 12 months after the procedure. In total, 95.2 percent of the patients were satisfied with their results.

Conclusions: The present study provides the anatomical and clinical basis for the concept of compartmentally based fat grafting. It allows for the restoration of facial fat volume close to the physiologic state. With this procedure, a natural and youthful facial contour could be rebuilt with a high satisfaction rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Supplemental Digital Content is available in the text.This and Related “Classic“ Articles Appear on Prsjournal.Com for Journal Club Discussions.

Shanghai, People’s Republic of China; Sacramento, Calif; and Munich, Germany

From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; the Division of Plastic Surgery, University of California, Davis; and the Department of General, Trauma, Hand, and Plastic Surgery, Ludwig-Maximillians-Universität München.

Received for publication July 3, 2016; accepted August 15, 2016.

Dr. Wang and Dr. Xie should be considered co–first authors.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Qingfeng Li, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Shanghai 200011, People’s Republic of China, dr.liqingfeng@yahoo.com

©2017American Society of Plastic Surgeons