Fat injection for aesthetic facial rejuvenation

Abstract

Val Lambros, MD, Santa Ana, CA , is a board-certified plastic surgeon. I believe that early facial aging is manifested by ptosis secondary to volume loss. Moreover, this volume loss creates changes in facial shape that conventional skin tightening procedures either do not address or make worse. Definition is achieved largely at the expense of soft tissue fill. For example, the eyebrows of young persons typically lie low and flat. The soft tissue over the entire superior third of the face is full. This fullness, with its large radius of anterior curvature, generates a reflective convexity. As make-up artists know, brighter features appear larger or closer and dark features appear smaller or receding. In youth, these shape and reflective characteristics give the impression of high-sitting eyebrows. In photographic images, the younger face appears to have a larger circumference at brow level than it does later in life. This feature contributes significantly to the top-heavy or heart-shaped configuration of the younger face. As the brow “deflates,” the skin settles against the upper lids and the eyebrow becomes foreshortened as it wraps around a smaller circumference. The brow lift elevates the brows by traction, but no corresponding changes in width occur. When the operative plane traverses temporal fat, frequently the result is local fat atrophy and narrowing of the face. Whereas some patients desire a youthful appearance, others also desire improvement in the aesthetics of their facial features. Facial implants can and have been used to improve both aging and developmental characteristics. However, the effects of these prostheses are localized, and size and shape options are limited. These devices are also associated with problems common …