The volumetric face lift

Many face lift techniques that manipulate the superficial musculoaponeurotic system (SMAS) in order to correct a perceived descent of deeper facial structures have been presented. However, such procedures can result in insufficient volume restoration, which may be correctable only by actual fat replacement.

We describe a face lift technique that combines volume restoration by fat grafting and results in removal of descended fat below the mandible as well as conservative skin redraping.

A short-scar incision was utilized and limited flap dissection was performed in the subcutaneous plane. Direct defatting of the fat superficial to the platysma and inferior to the mandibular border was performed. Submental fat near the midline that could not be excised was removed by lipoplasty under direct vision. The platysma was treated only if prominent banding was present preoperatively. The skin was redraped utilizing a suspension suture between the flap and the cartilaginous canal of the ear, and excess skin was excised. Fat grafting was performed into volume-deficient areas using a blunt-tipped cannula. The SMAS and other deeper layers were not manipulated.

A retrospective review of 83 consecutive patients revealed high patient satisfaction and an overall complication rate of 6% after a mean follow-up of 12 months.

The described procedure represents an evolution to a simpler and effective technique that produces a natural, youthful appearance with minimal morbidity and downtime.