Microinvasive Mid-Lower Facial Rejuvenation: Soft Tissue Reposition Grounded in Fat Compartments Gliding Theory

Descent and separation of the fat compartments, including the superficial medial cheek fat compartment (SMC), nasolabial fat compartment (NLF), deep fat compartment (DFC), and jowl fat, can lead to deepening of the nasolabial fold with reduced malar highlight and growing marionette lines involving the midface and lower face. Based on the fat compartments gliding theory, microinvasive reposition surgery is introduced in this article. In total, 14 patients, including 3 men and 11 women, underwent microinvasive reposition surgery from April 2021 to January 2024. With 4 tiny incisions on half of the face, the sagging tissue, including superficial tissues (SMC and NLF) and deep tissue (DFC), is fully parcelled up and repositioned depending on different trajectory layers and trajectory pathways with nonabsorbable thread guided by a graduated double-ended flexional needle. Preoperative and postoperative photographs at 6, 12, and 24 months were taken. The patients' ages ranged from 34 to 63 years, with a mean of 49 years. Follow-up time ranged from 9 to 29 months, with a mean of 17 months. No major complications (obvious bruising and swelling, hematoma, infection, permanent pit and unnatural appearance, thread exposure, scar complaint, temporary sensory or motor decreases) were observed. A palpable thread node at the external canthus was found in 1 patient, which was removed after 3 months, and reoperation was performed. As an alternative method grounded in fat compartment gliding theory, microinvasive reposition surgery can primarily meet the needs of minimum downtime, lasting and natural results, with the least scars for patients seeking mid-lower facial rejuvenation.