Does a Deep Plane Facelift Restore Malar Volume Without Simultaneous Fat Injection?
Jacono et al1 conclude that a vertical deep plane facelift "may obviate the need for other volumization procedures such as autologous fat grafting in selected cases." The advantages of a deep plane dissection2 4 and vertical vector4,5 to correct the descent of facial tissues are well known. Elevation of the malar fat2 6 or buccal fat pad7 may be accomplished either using direct tissue approximation2 4 or suspension sutures.1,5 7 Beginning in the late 1990s, many surgeons started adopting fat injection as part of their strategy to replace lost volume.8 10 Magnetic resonance imaging has demonstrated its efficacy.10 Is it time to reconsider the role of fat injection? Some weaknesses of the authors' study design merit comment. To compare facial topography, before and after photographs must be exactly matched for size and orientation (Figure 1) Variations in focal distance (the after photographs being larger) chin elevation, and head rotation preclude accurate comparisons. The authors' Figures 4G and H and 5G and H demonstrate all three inconsistencies in the same patients. To avoid error from dissimilar rotation, one must accurately line up the nasion with the inner canthus of the far eye (Figure 1).10
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