Superior Sulcus Volumetric Rejuvenation Utilizing Dermis Fat Grafting.

Abstract

Reversal of facial aging has been a quest of cosmetic surgeons throughout time. To further this goal, mechanisms of aging are continually under investigation. While various theories have been proposed, facial aging is likely a multifactorial phenomenon. Bone loss, muscle atrophy, and subcutaneous fat loss and/or redistribution have been suggested as the main variables in facial alteration due to aging.1-8 Recent reports on facial rejuvenation focus on replacement of facial volume loss, sometimes referred to as the “third dimension.” There is no consensus as to one universally applicable method of volume replacement. Current en vogue techniques include autologous fat grafting (facial fat rebalancing, liposculpture, fat autograft muscle injection), alloplastic implants, and injectable tissue fillers.9-11 Each method has advantages and disadvantages. Autologous fat is biocompatible with existing tissues, but there is no definitive evidence of fat longevity, and fat reabsorption can be asymmetric.10-12 Alloplastic implants are relatively permanent and allow for control of volume distribution, but require surgical placement with risks of infection, exposure, and inflammatory reaction. Further, alloplastic implants do not adapt to the continued progress of facial aging changes. Injectable tissue fillers require a minor procedure for placement, but duration of effect is variable and limited. It has been suggested that optimal facial rejuvenation requires a combination of surgical techniques and volumizing modalities.13 Aging changes of the superior sulcus require unique considerations for rejuvenation. The superior sulcus is in close proximity to the globe and orbital structures, and therefore modifications present challenges that are not encountered elsewhere on the face. Muscles of the eye and lid and their associated nerves pass in close proximity or directly within the superior sulcus. The superior sulcus is also the location of the lacrimal gland and the superior ophthalmic vein. Disruption of these …