ORIGINAL ARTICLE The Evolution of Midface Rejuvenation Combining the Midface-lift and Fat Transfer

Allison T. Pontius, MD; Edwin F. Williams III, MD

Objective: To evaluate the aesthetic results in our ini- marked improvement). The 2 groups were compared tial group of patients treated with a combination of a mid- with 4 ␹2 tests of independence. face-lift and fat transfer compared with a randomly se- ␹2 lected group of patients who underwent a midface-lift Results: Four tests of independence were conducted without concurrent fat transfer by one of us. to compare the findings between group 1 and group 2. One hundred twenty ratings were conducted; group 1 con- Methods: The setting was a private, ambulatory, sur- sisted of 90 total ratings on 30 patients and group 2 con- ␹2 gical center. The design was a comparative study sisted of 30 total ratings on 10 patients. The first (tear between patients who did or did not receive fat trans- trough/infraorbital rim) test revealed a significant differ- ␹2 Ͻ fer in addition to a midface-lift to determine if the ence on tear trough ratings by group ( 2=73.59, P .01). ␹2 addition of fat transfer to the midface-lift resulted in The second test (malar eminence) did not reveal a sig- an improved aesthetic outcome. A total of 40 patients nificant difference on malar eminence ratings by group ␹2 ␹2 with complete photographic and medical records and ( 2=3.10, P=.21). The third test (submalar region) failed a minimum of 6 months of follow-up were included in to reveal a significant difference on submalar region by group ␹2 ␹2 the study. Group 1 consisted of 30 patients randomly ( 2=4.01, P=.13). The final test (nasolabial crease) re- selected (from Ͼ650 potential patients) who under- vealed a significant difference on nasolabial ratings by group ␹2 Ͻ went a midface-lift without fat transfer to serve as a ( 2=14.28, P .01). control group. Group 2 consisted of our initial 10 Conclusions: Our findings revealed a statistically signifi- patients who underwent fat transfer in addition to a cant difference between group 1 (no fat transfer) and group midface-lift at the same setting. The degree of aesthetic 2 (fat transfer) in the tear trough region (PϽ.01) and the improvement in 4 facial zones was assessed by 3 inde- nasolabial crease (PϽ.01). The fat transfer technique in com- pendent blinded evaluators. Zone 1 represents the tear bination with a midface-lift is a safe and effective means to trough/infraorbital rim; zone 2, the malar eminence; provide more complete facial rejuvenation, especially in the zone 3, the submalar region; and zone 4, the nasola- regions of the tear trough and nasolabial crease. bial crease. Each zone was given a rating from 0 to 2 (0 for no improvement; 1, mild improvement; and 2, Arch Facial Plast Surg. 2006;8:300-305

HE AGED FACE IS THE CON- ever, despite repositioning of the ptotic soft sequence of several concur- tissues of the midface, facial rejuvenation rent factors, including skin may remain incomplete because of the per- laxity, soft tissue ptosis, and sistent loss of volume seen in these pa- volume loss. Improving the tients. Despite excellent surgical results ob- conditionT of the skin is most commonly tained from the midface-lift, we found that obtained with resurfacing procedures, la- our rejuvenation procedures needed to ser and light therapy, daily skin care, and evolve to include the correction of facial vol- UV protection. Correction of soft tissue ume loss. In 2004, we began introducing ptosis is usually surgically treated with a fat transfer to patients undergoing a mid- brow-lift, midface-lift, and lower face rhyti- face-lift to improve our aesthetic results. We Author Affiliations: Plastic dectomy. Correction of volume loss can specifically used fat transfer in patients un- Surgery Associates of New York, be obtained with injectable facial fillers, dergoing a midface-lift because the key areas New York, NY (Dr Pontius); most notably by autogenous fat transfer of volume l