This is a very special chapter on liposuction, which has already been mentioned in the context of rhytidectomy, since it has strongly endorsed the validity of what is called “re-juvenescence” plastic surgery.

For a better explanation: traditional facial “plasty” (molding or grafting), consisted basically of skin traction (or techniques to keep stretched muscles in place), as well as excess skin removal. This technique has largely improved in the last years with a deep musculature treatment, etc., but always followed by traction of the skin that will ensure it remains more stretched, with less wrinkles, and covering the deep tissues.

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He systematized the delicate liposuction of these areas, and the fat grafting of the wilting regions, such as the malar region and the lips.

It happens that the deep tissues, the “content” (the deep tissues are called “content” and the skin that covers it is called “continent”), alter with the passing of years. This occurs due to fat accumulation in specific areas, conveying to the face contours characteristic to old age. These areas are the sub-mental (3) where the undesirable “turkey’s neck” is established, the lateral borders of the jaw (2), where pouches resembling bull-dog jowls appear (1), the naso-genian wrinkles (4 and 5), known as “Chinese moustache”, and the pre-auricular area(6), etc.

There exists an emptying of other regions such as the cheekbones, the lower eyelids, and a generalized sensation that the face “wilts” with age.

Now, if we use traction of the skin that is the outer coverage of the face, the “continent”, without working on the “content”, will produce a younger looking skin with fewer wrinkles, but within an aged facial contour.

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In 1988 Daher described the 6 regions of the face that create atypical fat accumulations.

At this stage, facial liposuction comes into use, which is performed with a very delicate canulla or thin tube as soon as the facial operation begins. This allows us to work on the excess of fat in undesirable areas (the double chin, the bulldog pouches, the “Chinese mustache”), rescuing and redefining a younger contour to the face. After this, we can traction the skin that, with fewer wrinkles, will settle harmoniously over this sculptured content.

Similarly, as there is an accumulation of fat located in the face with aging signs, there are also areas in which age creates an “empty/shriveled” look. This is the case for cheekbones, lower eyelids where the fat moves away from the bone border, producing deep eyes and dark circles, and the wrinkles around the mouth and the lips themselves become too thin.

Just as we remove the excessive and poorly distributed fat, we are now fully aware that this re-composition of the facial contours and excessive volume, inevitably involves fat grafting.  For this reason, we have developed techniques that collect fat, solely for its preparation and its injection.

The grafted fat on the face is absorbed in parts – in percentages that vary from individual to individual. Our recent work shows that about 43% of injected fat remains. Hence a schedule for successive grafts, with intervals from 6 up to 9 months, or even longer should be considered, so that with cumulative effects the patient has more lasting results.

In addition to filling in certain wrinkles (Chinese mustache, wrinkles of the corners of the mouth, etc.), the injection with overcorrection of the lips is very good, as it provides a general vigor to the tissues of the region, as well as improves the quality of the skin. In this way, at times, we graft fat under the entire skin of the face, which we call a pan-facial fat graft, to have beneficial effects on the texture of the skin.

THE LIPOSCULPTURE OF THE FACE

There are patients who have contours of an aged face, but are not old. For example, young or middle-aged people who have double chin (dewlap), or even gravity bags (the fat balls at the edge of the jaw), next to the chin as the bulldog’s jowls. These cases can be treated with facial liposculpture which is different from facial plastic surgery, as long as the skin presents turgor and some capacity of retraction. However, the patient should understand that if there is no expected skin retraction, there may be increased sagging in return for withdrawal of undesirable volumes. I have very much pointed out this treatment in very young patients with a round, larger faces and in some borderline young patients.

Liposculpture of the face undoubtedly revolutionized and supported great progress to the treatment of facial rejuvenation, modifying the traditional face plastic surgery, making it less invasive and much more efficient and natural.