Panfacial volume restoration with fat

BACKGROUND. A careful look at the aging face shows it to consist of more than loose skin and rhytids. With aging, the face loses its anterior projection, with a resultant displacement of skin inferiorly. There is mimetic muscular accentuation and an abundance of deep grooves and shadows. In addition, fat redistributes in specific patterns in overweight versus lean individuals. OBJECTIVE. To restore the three-dimensional projection and overall shape of the face to more youthful contours and to eliminate shadowing and muscle to skin interactions. METHODS. Autologous fat is harvested with an open-tipped, blunt cannula under tumescent anesthesia. It is then transferred to 1 mL syringes for injection into the face under local anesthesia. Fat is woven into the deep tissues of the face using a small-bore blunt cannula. The entire face is addressed by filling one cosmetic unit at a time. Fat is anchored deep to the muscles, in the muscles, and subcutaneously depending on the anatomic site and desired result. RESULTS. Dramatic changes in contour are achieved with judicious placement of fat. Skin redraping and the interruption of muscle to skin interactions occur when autologous fat is infiltrated in small aliquots, with specific direction at appropriate tissue levels. Complications are rare and minor with this technique. CONCLUSIONS. Autologous fat is an excellent tool for replacing volume and restoring contour to the aging face.