Facial Contour Rejuvenation by Reduction Malarplasty Combined With Second-Stage Fat Grafting

Background: With aging, the facial contour shows a double-concave deformity. Conventional facial contouring procedure, including face lifting and fat grafting, cannot yield a smooth facial contour line. This study was the first to propose a combination of reduction malarplasty and 2nd-stage autologous fat grafting so as to achieve the aesthetic goals of facial contour rejuvenation. Methods: The study group comprised patients seeking facial contour rejuvenation from January 2017 to May 2018 (28 patients: 28 females and 0 males) at the Department of Plastic Surgery, Tian Tan Pu Hua Hospital. All of the cases underwent bilateral malarplasty with 2nd-stage autologous facial fat grafting. Radiologic and photographic documentation was completed preoperatively. The mean follow-up period was 12 months. Patients’ pre-op photographs and 3 months follow-up pictures were blindly assessed. Results: Most of the patients were satisfied with their results after 1-time fat grafting. Eleven patients demanded re-injection after the 1st fat grafting in temporal area, and 6 patients demanded 3rd time fat grafting in temporal area. Eleven patients demanded re-injection insubmalar area, and 8 patients demanded 3rd time fat grafting in submalar area. Meanwhile, 9 of those patients underwent fat grafting in other sites other than temporal and submalar region. The amount of fat injected was also recorded in this study. The appearance of double-concave deformity was greatly improved in all cases. Complications included infection (3.6%), hematoma (7.1%), and malar prominence relapse (7.1%), and so on. Conclusion: Reduction malarplasty combined with several times of fat grafting could effectively overcome the malar prominence and soft tissue deflation. Complications were minimal after these procedures. Therefore, this technique is useful to restore the youthful facial contour in Asian patients with aging double-concave deformity.