Curette Fat Sculpture in Rhytidectomy: Improving the Nasolabial and Labiomandibular Folds

Ellenbogen, Richard G.; Wethe, James; Jankauskas, Saulius; Collini, Francis J.

doi:10.1097/00006534-199109000-00009

Cited by 25 publications

(5 citation statements)

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“…Early on, Millard et al recommended direct lipectomy by resecting the NLF fat from superficially through a subdermal dissection, whereas Ellenbogen et al used curettage of the NLF fat from deep through a deep subcutaneous dissection. 22 , 38 Direct liposuction of the NLF fat was described by McKinney and Cook in 1989. 39 On the other side of the spectrum, augmentation of the NLC was utilized by volumizing the soft tissues or the bone ( Figure 10 ).…”

Section: Discussionmentioning

confidence: 99%

Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

Minelli¹,

Brown

Warren

et al. 2023

Aesthetic Surgery Journal

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Background A limitation of current facelift techniques is the early postoperative reappearance of anterior midcheek laxity associated with recurrence of the nasolabial fold (NLF). Objectives This study was undertaken to examine the regional anatomy of the anterior midcheek and NLF with a focus on explaining the early recurrence phenomenon and to explore the possibility of alternative surgical methods that prolong NLF correction. Methods Fifty cadaver heads were studied (16 embalmed, 34 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT. Mechanical testing of the melo fat pad (MFP) and skin was performed to gain insight on which structure is responsible for transmission of the lifting tension in a composite facelift procedure. Results Anatomical dissections, sheet plastination and micro-CT demonstrated the three-dimensional architecture and borders of the MFP. Histology of a lifted midcheek demonstrated that a composite MFP lift causes a change in connective tissue organization from a hanging-down pattern into a pulled upward pattern suggesting traction on the skin. Mechanical testing confirmed that, in a composite lift, despite the sutures being placed directly into the deep aspect of the MFP, the lifting tension distal to the suture is transmitted through the skin and not through the MFP. Conclusions As a composite midcheek lift is usually performed, it is the skin and not the MFP itself, that bears the load of the non-dissected tissues distal to the lifting suture. For this reason, early recurrence of the NLF occurs following skin relaxation in the postoperative period. Accordingly, specific surgical procedures for remodeling the MFP should be explored, possibly in combination with volume restoration of the fat and bone, for more lasting improvement of the NLF.

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Section: Discussionmentioning

confidence: 99%

Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

Minelli¹,

Brown

Warren

et al. 2023

Aesthetic Surgery Journal

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“…14 Ellenbogen y cols. (1989) 15 proclaman que las curetas son superiores a la succión grasa. Nosotros describimos una técnica usando gubias óseas para esculpir la almohadilla grasa.…”

Section: Discussionunclassified

La gubia ósea como instrumento escultor del pliegue nasolabial: Nota técnica

Mommaerts

Médina

2008

Rev Esp Cirug Oral y Maxilofac

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Los pliegues nasolabiales prominentes son uno de los aspectos que más preocupan a los pacientes candidatos a un lifting facial, y han sido descritas muchas técnicas que intentan atenuar este signo distintivo del envejecimiento. Las sustancias de relleno tienen limitaciones inherentes. Las disecciones amplias del SMAS y su posterior suspensión no tienen efecto después de transcurridas 24 horas. La suspensión de la almohadilla grasa malar tiene un efecto que se extiende como máximo a los dos años de duración. La extirpación directa de la grasa lateralmente al surco nasolabial, aunque debe hacerse con mucha cautela, es la única técnica que proporciona resultados permanentes. Técnicamente, esta resección grasa se ha descrito realizada valiéndose de pinzas y tijeras, con cánulas de liposucción o con curetas. Este procedimiento requiere un control muy preciso, táctil y visual, de la localización y profundidad de la extirpación, control que puede mejorarse usando una gubia ósea con una mano para extirpar la grasa a eliminar de la dermis, mientras la otra mano maneja el colgajo cutáneo de la mejilla, para un control alternativo interno y externo del efecto escultural de la extirpación y para permitir una guía táctil externa.

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“…3 Such limitations with rhytidectomy have prompted numerous modifications and adjunctive procedures to address the deep nasolabial crease. Direct excision of the redundant skin and subcutaneous tissue, 6,7 suctionassisted liposuction, [8][9][10][11] fat curettage, 12 and tissue advancement at the alar-facial groove 13 have all been described. Rhytidectomy modifications such as direct cheek fat excision, 14 sutured-in-place fat grafts, 15 extended sub-SMAS dissection, 5 deep-plane release of the ligamentous structures associated with the zygomaticus muscle, 16,17 resuspension of the malar fat pad, 18 and repositioning the midface musculature by the subperiosteal approach have all been promoted.…”

Section: Commentmentioning

confidence: 99%

Expanded Polytetrafluoroethylene (Gore-Tex) Augmentation of Deep Nasolabial Creases

Robertson

Dyer²

1999

Arch Otolaryngol Head Neck Surg

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Curette Fat Sculpture in Rhytidectomy: Improving the Nasolabial and Labiomandibular Folds

Cited by 25 publications

References 0 publications

Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

La gubia ósea como instrumento escultor del pliegue nasolabial: Nota técnica

Expanded Polytetrafluoroethylene (Gore-Tex) Augmentation of Deep Nasolabial Creases

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