Update: Lifting the Malar Fat Pad for Correction of Prominent Nasolabial Folds

Abstract

The malar fat pad suspension technique is a safe and effective method for rejuvenation of the aging midface. When combined with the SMAS-platysma rotation flap face-lift as a multi-vector technique, most of the changes that occur with aging are addressed and corrected in an anatomic fashion, resulting in an aesthetically pleasing result. Careful attention to the tension and position of the suspension suture enhances the improvement of the infraorbital flattening as well as correcting the excessive prominence of the nasolabial fold.

Understanding the Finger-Assisted Malar Elevation Technique in Face Lift

“…16 Flaccidity makes skin and malar fat pads slide and accumulate in this region and, together with other factors, such as laxity of the retaining ligaments and specific individual characteristics of each person, contributes to the apparent increase in depth of this fold. 10,13,14 Considering that the anatomical alterations stated above are the main cause of marked nasolabial folds and malar flattening observed with aging, lifting of only the SMAS does not modify the nasolabial fold that extends from the nasal alar cheek junction to the corner of the mouth, as previously noticed by Owsley 1993. 13 We also agree with Hoefflin 26 and Saylan's 27 observations in that "pulling on the SMAS is like repositioning a living room sofa by pulling on the carpet.…”

“…Regarding fixation sutures, Owsley 13,14 described fixation of the malar fat pad to the subcutaneous fascia at a point over the lateral body of the zygoma that is medial to the frontal branch and cephalad to the zygomatic branch of the facial nerve, respectively. The authors believed that the suspension suture enhanced correction of the nasolabial fold and helped to produce a rounded cheek.…”

Some Anatomical Observations on Midface Aging and Long-Term Results of Surgical Treatment

“…10 In contrast, if downward migration of a normal volume of cheek fat has occurred, surgical repositioning of the malar fat pad can predictably accomplish an effective long-term cheek and infraorbital rejuvenation. 11,12 The significant difference between the two methods of midface rejuvenation regards the pre- Plastic and Reconstructive Surgery • January 2008 dictability of the result and the potential longevity of the improvement. These distinctions are important because of the widespread and intensive marketing by nonsurgical cosmetic specialists in the public media about the benefits of fat or other injectables as a noninvasive alternative to surgical treatment.…”

Suture Suspension Malarplasty with SMAS Plication and Modified SMASectomy: A Simplified Approach to Midface Lifting

“…Owsley popularized this concept by undermining beneath the fat pad and separating it from the SMAS, keeping the fat pad attached to the skin, and repositioning the fat pad by attaching it to the SMAS. [15][16][17] This contribution demonstrated the effectiveness of nasolabial fold improvement by Volume 117, Number 3 • Suture Suspension Malarplasty elevating the composite of malar fat and its attachments to the skin. However, similar to the deep plane dissections, Owsley's technique required a dissection above the SMAS-invested levator muscles.…”