Lipocontouring in Conjunction with the Minimal Incision Brow and Subperiosteal Midface Lift: The Next Dimension in Midface Rejuvenation
Srinivasan Krishna, M.D. and Edwin F. Williams, III, M.D., FACS
Aging of the midface is characterized by three essential processes that are progressive in nature. The first two, laxity of skin and soft tissues and inferomedial descent of the malar fat pad, are well recognized in the literature. The third, which is increasingly being recognized as a significant factor in aging, is loss of facial volume. Loss of volume that results from a combination of a reduction in the skeletal framework and atrophy of muscle and the subcutaneous fat layer, further accentuates skin and soft tissue laxity. Volume loss is especially evident in the periorbital and perioral areas, the cheeks, and along the mandible.
When used in conjunction with the minimally invasive brow and subperiosteal midface lift, autologous lipotransfer provides the next dimension in comprehensive midface rejuventation. Based on the senior author’s experience over the last 3 years, the added morbidity is minimal, and results are universally favorable to both surgeon and patient. Lipotransfer may be performed as an isolated procedure in patients who present with volume loss as a predominant feature of aging while their skin and soft tissue tone is well maintained. Additionally, it may be safely repeated in patients who have a need for additional rejuvenation and are reluctant to undergo a second lifting procedure. Although there is some controversy regarding the longevity, there is abundant evidence to show survival of the transferred fat at 3 to 5 years, particularly with the FAMI technique.
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