Combined approach for facial contour restoration: Treatment of malar and cheek areas during rhytidectomy

Background: One of the main objectives in facial lifting is to achieve an adequate facial contour, to enhance facial characteristics. Sometimes, facial areas are more or less accentuated, resulting in an unbalanced or inharmonious facial contour; this can be resolved in the context of a face lift. In the middle third of the face, two anatomical regions define the facial silhouette: the malar contour, with its bone support and superficial structures and, at the cheek level, intimately associated with the mastication system and the facial nerve, the buccal fat pad or Bichat fat pad. Methods: The authors describe their experience since 1998 using the double approach to malar atrophy and buccal fat pad hypertrophy in 194 patients with facial aging signs undergoing a face lift. All patients were offered a face lift with partial resection of the fat pad through facial incisions and a stronger malar projection using an inverse superficial musculoaponeurotic system flap. Results: The main complications observed regarding this surgical technique, in order of appearance, were light asymmetry, caused by a persistent hematoma or swelling; paresthesia of the buccal and zygomatic branches, which resolved spontaneously; and a light sinking of the cheek caused by excessive resection. One patient underwent correction with a fat injection. Conclusions: The superior superficial musculoaponeurotic system flap and buccal fat pad resection provided excellent aesthetic results for a more harmonic and proportioned facial contour during rhytidectomy. Particularly in patients with round faces, the authors were able to obtain permanent malar symmetry and projection in addition to diminishing the cheek fullness.