Direct fixation of the malar pad

In most patients, the upper portion of the subcutaneous fatty mass--the malar pad--is modest in size and only moderately displaced inferiorly. Mobilization of the malar pad together with the ovelying skin flap achieves a pleasing result in these cases. Occasionally a patient will present with very prominent and ptotic malar fat pads and deep nasolabial folds that cannot be adequately addressed by existing methods. This article describes a technique of malar pad suspension by direct suturing that preserves the blood supply to the pad while placing it in a higher, more aesthetic position.