Malar Fat Pad Repositioning in Facelifting: A Simple Technique of Suspension and Fixation

Abstract

Aging in the malar fat pad is mainly caused by ptosis of the fibroadipose layer. In the lower level of the face, atrophy or osseous rotation may contribute to the signs and symptoms of facial aging. The senior author (CYC) describes his simple technique of suspension and fixation of the malar fat pad and the jowl during facial rejuvenation surgery. Ten patients underwent facial rejuvenation, the technique of which consists of sustaining and elevating the ptotic malar tissue and the jowl with four slings of monofilament nylon suture. The sutures are fixed medially in an artificial orifice dissected on the frontal process of the maxilla, above the alar groove. The sutures are distributed evenly on the face, directly supporting the jowl, the malar fat pad, and the periorbital tissue. Laterally, the loops are fixed under tension on the temporal fascia and the periosteum of the lateral orbital rim. The vector of tissue displacement is upward and concentric, opposing the vector of the aging process, and the fixation is consistent. Postoperative complications included moderate and transitory pain; patients reported no major complications or recidivisms during the follow-up period of two years. Results showed aesthetic improvement for all patients. The present technique has proven simple and effective in a small cohort over two years. A longer follow-up period with more patients would be valuable in further documenting the procedure.