Fran Lowry

October 08, 2010

October 8, 2010 (Toronto, Canada) — Restoring malar volume with autologous fat injection offers a safe, lasting, and natural alternative to the use of commercial fillers or implants for patients undergoing face rejuvenation, according to a study presented here at Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery and the Canadian Society of Aesthetic Plastic Surgery.

"Restoration of cheek volume is now recognized as a critical part of facial rejuvenation. Even movie stars and other celebrities are augmenting their cheeks in an attempt to turn back the clock, with some being criticized for adding too much volume," said Eric Swanson, MD, a plastic surgeon with the Swanson Center in Leawood, Kansas. "However, there have been no studies to determine whether any soft tissue technique is effective at achieving long-lasting results for volumizing cheeks."

Dr. Swanson used magnetic resonance imaging (MRI) to noninvasively assess change in malar volume in 5 patients who had undergone deep plane facelifts with autologous fat injection to plump up their cheeks. In all cases, the fat that was injected was harvested from the abdomen.

The volume of fat ranged from 4 to 12 cc (mean, 9.1 cc) in the right cheek and from 4 to 11.5 cc (mean, 8.5 cc) in the left cheek.

The MRI scans were done before surgery and at intervals after surgery up to 6 months in 4 patients, and up to 12 months in 1 patient.

Dr. Swanson reported that in all cases, malar thickness showed significant increases at the time of the 1-month follow-up appointment (P < .01), and that these increases were maintained at subsequent follow-up appointments (P < .01) up to 1 year.

"The MRI showed that the increase was due to tissue with fat density, not fluid. The average amount of increased cheek augmentation was 0.66 cm for the right cheek and 0.60 cm for the left cheek," he said.

"The take-home message is that this study has validated fat injection as a way to increase cheek volume at the time of face lift surgery," Dr. Swanson told Medscape Medical News.

Fat injection is the gold standard among fillers, he added. "Compared to other commercial fillers that you get off the shelf, fat is your own tissue, and there's virtually always a donor site that we can use. We can also use greater volumes and be confident that although some of the fat gets absorbed, most of it stays. That's the beauty of fat compared to other fillers, like Restylane [HA North American Sales AB] and Juvéderm [Allergan]," he said.

The study also confirmed that fat injection at the time of a face lift is safe to do, he said.

"We really didn't know. If you do a face lift at the same time as fat injection, perhaps this might interfere with the take of the fat, because we are elevating tissue planes. But the fat is actually put in a plane that is not dissected," Dr. Swanson explained. "I do a deeper plane lift and I put the fat more superficially, so that it's within a vascularised plane and therefore has a better chance of taking and not getting absorbed."

Doing a face lift without doing fat injection is like robbing Peter to pay Paul, he added. "You're just repositioning the tissue. We don't want to just lift things. We want to restore volume to the face, and this is the only way to actually give a net increase to the fullness of the face."

Injecting the patient's own fat is also much more cost-effective for them, he added. "Injecting a couple of syringes of commercial fillers costs a thousand dollars. In my series, I averaged 30 ccs per treatment. I'm injecting a lot more volume, so the patients are getting a lot more bang for the buck."

Moderator of the session, Joseph P. Hunstad, MD, from the University of North Carolina, Chapel Hill, and president of the Hunstad Center for Cosmetic Plastic Surgery in Chapel Hill, said that malar augmentation with fat grafting practiced by Dr. Swanson was consistent with techniques that have been proposed by others.

"But he was the first to really quantify this and demonstrate longevity with the MRI," he told Medscape Medical News. "The longevity and reliability of the fat grafting in the malar region was consistent and impressive."

The study has important clinical implications for surgeons who do face rejuvenation, Dr. Hunstad added. "It is well-known that fat restoration to the aging face has very powerful rejuvenation characteristics. Now we have documentation of the long-term viability and efficacy. An excellent paper."

Dr. Swanson and Dr. Hunstad have disclosed no relevant financial relationships.

Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery and the Canadian Society of Aesthetic Plastic Surgery: Malar Augmentation Assessed by Magnetic Resonance Imaging in Patients After Facelift and Fat Injection. Presented October 3, 2010.