Photographic Comparison of Malar Projection in 100 Facelift Patients Treated with and without Fat Injection

Facelifts are frequently combined with fat injection to restore volume. However, the efficacy of simultaneous fat grafting has not been objectively evaluated in a large number of patients that includes a control group. This study was undertaken to fill this gap in our knowledge base.

A retrospective comparative cohort study was undertaken among 100 patients who underwent a subsuperficial musculoaponeurotic system facelift with (n = 61) or without (n = 39) simultaneous malar fat injection. Rigorously standardized photographs were obtained 1, 3, and 6 months after surgery, including oblique photographs with the nasion aligned with the far inner canthus. Malar projection and area were measured with the assistance of a computer imaging software.

Fat injection produced a significant (P < 0.001) increase in right and left malar projection. The mean increase in projection was 3 mm, significantly greater than control patients, who also demonstrated a significant (P < 0.001) but more modest (<1 mm) increase. Malar projection was significantly correlated with the fat injection volume (P ≤ 0.001). The increase was sustained at follow-up times up to 6 months, and 1 year in a smaller patient cohort (n = 44), with no evidence of a decline or rebound. The calculated fat retention was 34%.

Fat injection at the time of a facelift effectively adds malar volume, and this increase is sustained at time points up to 1 year after surgery, consistent with the cell survival theory.