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Sydney Coleman, José Guerrerosantos, P. Craig Hobar, Edward O. Terino, Volumetric Considerations in Facial Augmentation, Aesthetic Surgery Journal, Volume 23, Issue 1, January 2003, Pages 45–51, https://doi.org/10.1016/S1090-820X(03)90024-0
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Dr. Coleman: The first patient is a 33-year-old woman with acne scarring of her cheeks. She complains that her face is too skeletal after a lower lid blepharoplasty (Figure 1). She may have had her buccal fat pads removed, and she is most bothered by the ice-pick scars and hollowing of her buccal cheeks. She believes her tear trough is a little bit more noticeable since her blepharoplasty. Dr. Hobar, how would you approach treating this patient?
Dr. Hobar: She does have a very chiseled look. To fill out the cheek, I would use autologous fat injection. The deeply pitted acne scars could be excised individually. She could also possibly be a candidate for laser, depending on her skin type.
Dr. Coleman: Dr. Terino, how would you approach treating the patient?
Dr. Terino: An implant could be used to extend the fullness below the lower border of malar bone down into the submalar region probably 2 to 2.5 cm. That would give the impression that the fullness of her midface extends almost down to the lateral commissure of the mouth, at least on the anterior view. Around the commissure, fat injections might be appropriate. Or I might use fat in the buccal space, which may be a more favorable recipient site for fat than the subcutaneous plane. I have injected autologous fat directly into the buccal space, and even into the masseter muscle from inside the mouth. The sub-orbital problem the patient complains about is not very apparent on the photographs. However, a suborbital implant in the area of the tear trough, and maybe a midface suspension would improve that region. I have recently seen evidence that an implant we have used in the junction between the orbit and suborbital region may be more effective than fat transposition.
