Malar Augmentation Assessed by Magnetic Resonance Imaging in Patients after Face Lift and Fat Injection

Abstract

Restoration of cheek volume is recognized as an important part of facial rejuvenation. However, there are no previous studies that have determined whether any soft-tissue technique is effective for achieving lasting malar augmentation. This study prospectively evaluated a subset of five patients who had deep-plane face lifts with fat injection, and other facial cosmetic procedures. The mean volumes of fat injected were 9.1 cc (range, 4 to 12 cc) into the right cheek and 8.5 cc (range, 4 to 11.5 cc) into the left cheek. Magnetic resonance imaging scans were obtained before surgery and at intervals after surgery up to 6 months (and 1 year in one patient) for a total of 22 studies. Axial, coronal, and sagittal images, T1- and T2-weighted, were obtained. Thickness of the malar fat pads was measured. Malar thicknesses showed significant increases at the time of the 1-month follow-up appointments (p < 0.01). This increase was maintained at the next follow-up appointment (p < 0.01). There was no significant difference in thickness between the first postoperative appointment and the second postoperative appointment. The T1- and T2-weighted images revealed that the increase was attributable to tissue with fat density, not fluid. The average increase in malar projection was 0.66 cm for the right cheek and 0.60 cm for the left cheek. Fat injection at the time of face-lift surgery produces an increase in malar volume that is still present up to 6 months after surgery. This study confirms the rationale for injecting fat at the time of face-lift surgery.