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Press release from The American Society of Plastic Surgeons (November 2001)

ORLANDO, Fla. - - - Looking refreshed, younger and more attractive are goals often cited by facelift patients. At the 70th Annual Scientific Meeting of the American Society of Plastic Surgeons (ASPS), four studies will be presented that detail facelift innovations and enhancements offering such benefits as more natural and pleasing results, increased patient safety and ease of the procedure for the surgeon.

Traditionally, facelifts focused on tightening the skin in the neck and jawline. Recently, significant attention and debate has focused on the central portion of the face, often called the midface. Not every candidate needs the midface addressed and every surgical plan should be individualized to the patient.

Three papers presented at the meeting will specifically address techniques to rejuvenate the midface through manipulation of the malar fat pad, the cushiony area overlying the cheek bone. As a person ages, the malar fat pad can droop or settle, contributing to the hollowing under the eyes and deep creases running from the nose to the corner of the mouth.

The first study describes a technique to elevate the malar fat pad (cheek fat) through a incision routinely used for lower eyelid surgery. Once the fat pad is freed from its attachments, it is lifted vertically and slightly diagonally and then it is suspended in a higher position along with the circular muscle below the eye.

"This approach is an efficient, safe, and reproducible way for surgeons to re-elevate the malar fat pad and create a youthful look around the eyes," said Grady B. Core, MD, FACS of Birmingham, Alabama. " I initially began this approach endoscopically (surgery aided by a camera-like instrument) in 1993 but soon developed this much easier approach through the lower eyelid incision I had always used."

The technique described in the study is not as aggressive as those that go deeper under the facial muscles and, therefore, it is an option which may reduce the potential for damage to underlying muscles and nerves, according to Dr. Core.

The second study incorporates elevation of the malar fat pad as part of a facelift that works on three levels - 1) traditional removal and tightening of loose skin, 2) SMAS (the support layer of the face composed of muscle and connective tissue) lifting to reduce jowls and 3) elevation of the mid face.

For the third level, the surgeon frees the malar fat pad from the underlying bone. Once it is free, a suture is placed through the fat pad surface and run underneath a nerve bridge supplying muscle function to the forehead and upper eyelid, thereby reducing the chance of nerve damage. The suture is then pulled at a direct 45 degree angle to the temple area where tension to elevate the fat pad is adjusted.

"This technique is simple and safe," said Mark Wigod, MD, co-author of the study and associate of Idaho Plastic Surgeons in Boise, Idaho. "The patient gets fuller cheeks as well as diminished jowls and lower eye hollowing. The result is a more youthful appearance. The surgeon can include the midface by adding only a short amount of operative time."

The third study looks at elevating the malar fat pad in 97 patients who previously had a traditional facelift, but now desire a procedure focused on the midface.

"With this procedure, we can address the structures underneath the skin," said Jorge de la Torre, MD, co-author and assistant professor in the division of plastic surgery at the University of Alabama in Birmingham. "Not only did the elevation of the malar fat pad give patients the more youthful look they desired, we were able to correct some of the negative effects of traditional facelifts such as the 'wind tunnel' pull and the tethering back of the ears."

The study concluded that elevating the malar fat pad in patients who had undergone previous facelifts brought about impressive results, safely and with a low complication rate.

Another facelift study, looks at taking the facelift beyond age minimization to restoring a more feminine or attractive look in the older patient.