Rejuvenation of the midface using lipostructure may in our opinion obtain results that are equivalent to those of more aggressive techniques of reshaping those same areas .
If volume is restored, the face appears rounded, healthy, attractive and younger. We also believe in the importance of cheek sculpture in the younger patient searching for a fuller malar eminence (Fig. 64.12).
The structures we can improve by fat injections are the lips and perioral area, the periorbital area, the chin, jowls, cheeks, glabellar area and nose. The lips and the lid-cheek junction are the two most difficult regions for lipofilling. Lipostructuring these sites is occasionally fraught with significant postoperative swelling, visible grafts and irregularities, and all too often unpredictable survival of the grafted fat particles.
Owing to different soft-tissue properties, motion and underlying structures, a different survival rate in different anatomical areas of the face is observed, and the incidence of secondary surgery and touch-ups varies with recipient site.
It has been our personal experience that only 60% of the patients having lipofilling of the lips are satisfied with one procedure, while 20% require a second procedure, 18% a third, and 2% need more than three interventions to achieve a satisfactory and stable result.
The second most difficult area to graft fat in is the cheek-eyelid junction. In this thin and delicate soft-tissue area, 80% of the patients are satisfied with one procedure, 10% with two, 8% with three, and 2% with more than three interventions. The main problem in this area is hiding the fat "parcels" under the thin coverage.
Other areas such as the malar, submalar, glabelar, perorbital, frontal, mental and mandibular regions are more favorable. In those areas, when injecting directly over the bone, 95% of the patients are satisfied with one procedure, and 5% with two.
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