Meloplication of the Malar Fat Pads by Percutaneous Cable-Suture Technique for Midface Rejuvenation: Outcome Study (392 Cases, 6 Years’ Experience)

Abstract

The aging anterior midface is restored by reversing the contour undulations produced by sagging of the malar fat pad complex toward the nasolabial line. The convex irregularities include the exposed bulges of the post-septal fat, the unveiled malar bag, and the prominent nasolabial fold. The depressed irregularities are represented by the cresent-shaped hollow at the lid-cheek junction, the accentuated nasojugal groove, and the deepening nasolabial line. Repositioning of the ptotic malar fat pad, among other elements of meloplasty, represents a key procedure. In this study, the malar fat pad has been defined as a fan-shaped structure by external anatomic landmarks that correlate closely to the findings in cadaveric dissections and clinical cases, confirmed by the findings of spiral computed tomographic scanning. A simple but powerful adjustable and long-lasting percutaneous suture elevation technique was developed over the past 6 years by the senior author (G.H.S.) to reposition the fat pad in a superolateral direction. Through a dot incision within the nasolabial line, a permanent CV-3 Gore-Tex (or 4-0 clear Prolene) suspension suture, looped through a Gore-Tex anchor graft, suspends the malar fat pad in a direction perpendicular to the nasolabial line. A second suspension system is identically passed through another lower dot incision to broaden the repositioning vectors on the malar fat pad. Tension on each of the paired suture ends elevates the malar fat pad by 1 to 3 mm as measured from the nasolabial dot incisions. The sutures are fixed to the deep temporal fascia through a Gore-Tex tab, effectively stabilizing the soft-tissue repositioning. This maneuver may be performed in younger patients who present with an isolated malar fat pad ptosis without excess facial skin. The procedure may also be incorporated into open rhytidectomies to address this recalcitrant area along with superficial musculoaponeurotic system tightening. A total of 392 patients since 1995 underwent suture elevation of the malar fat pads. An outcome study indicated that the usage of two permanent sutures with Gore-Tex anchor grafts since 1998 resulted in improvement in midface rejuvenation of over 82 percent. Early and late complication rates were small and temporary. Patient acceptance was excellent, indicative of the benefits of anatomic repositioning of the malar fat pad complex.

Deep-planes lift associated with free flap surgery for facial reanimation

“…Use of a deep-plane facial lift in association with other static suspension techniques may achieve symmetry of the midface (Rubin and Simpson, 1996;Sasaki and Cohen, 2002;Sasaki et al, 2003). The SMAS flap is also known as a technique used in primary postparotidectomy reconstruction for benign parotid tumours (Giannone et al, 2008), although a total conservative parotidectomy should be considered carefully in case of superficial adenomas because of the increased risk of facial nerve injury despite the same recurrence risk as superficial approaches (Zernial et al, 2007).…”

Temporary Suspension of Acute Facial Paralysis Using the S-S Cable Suture (Medical U&A, Tokyo, Japan)

“…Similar methods followed for lifting other ptotic lesions. 10 -12 The presented cable suture system with a small Gore-Tex graft was firstly reported by Sasaki et al 6,7 in 2002 for lifting the malar fat pad in unison with superficial musculoaponeurotic system (SMAS) lifting. The S-S Cable Suture suspension method in that report was also applied by Suzuki and Shirakabe using a different suture material for cosmetic improvement of ptotic regions.…”

“…The suture suspension method using a Gore-Tex suture material with a malar graft was first reported by Sasaki et al 6,7 for lifting the malar fat pad. Suzuki and Shirakabe,8,9 applied the similar method changing the suture material to a commercially available polypropylene thread (S-S Cable suture, Medical U&A, Tokyo, Japan) ( Fig.…”

The “Midface-Lift” as a Misnomer for Correctly Identifying Procedures Designed to Lift and Rejuvenate the Cheeks and Malar Regions of the Face

“…However, in many of the articles analyzing outcomes with midfacelifting, patients also underwent other procedures such as rhytidectomy via preauricular approach. 6,13 The present study does not seek to suggest that a temporal cheek-lift is the right operation for all patients; however, for patients without aging changes in the neck, it may be all that is required. One legitimate weakness of this study is that some patients underwent simultaneous neck-lifting.…”

“…6,13,19 Naturally, a wide variety of midface-lifting techniques have now been described. With different techniques come new risks to the patient.…”