Autologous fat grafting for midface rejuvenation

The authors have been performing autologous fat grafting for facial rejuvenation for 15 years and the procedure has evolved significantly during this time. In the beginning, the authors were primarily transferring to nasolabial folds, lips, and cheeks and found that the only patients who were satisfied with the procedure were cheek patients. To this day, the authors maintain that for isolated filling of lips and nasolabial folds, off the- shelf fillers are a better alternative. The authors treat these areas, however, as part of a current philosophy of smaller volumes over larger areas. In the early 2000s, the understanding of the volumetric nature of the aging process began to gain traction and global volumetric treatment became the authors' standard therapy. During that time, the authors developed a technique that led to an algorithmic approach to the surgery that allowed standard reproducible results for all surgeons. With the greater adoption of volumetric rejuvenation, an era of "more volume is better" has been entered, which is producing unnatural results. The authors' theory of facial shadow patterns explains more precisely why volume leads to facial rejuvenation and the understanding necessary to produce subtle more natural results. Currently, the authors are interested in quantitatively documenting results and evolving autologous fat transfer to a more predictable procedure.