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      A New Approach in the Correction of the Midcheek Groove: The Liquid Malar-lift Technique

      case-report
      , MD 1 ,
      Plastic and Reconstructive Surgery Global Open
      Wolters Kluwer Health

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          Summary:

          The liquid malar-lift technique describes an approach to correct the midcheek groove by injecting monophasic cross-linked hyaluronic acid into the deep medial cheek fat, deep lateral cheek fat, and the superficial fat compartments, that is the superficial medial cheek fat and superficial middle cheek fat, respectively. The selective volume loss in the deep fat compartments of the face with aging is restored with the liquid malar-lift technique, and the midcheek groove is corrected in harmony with the patient’s unique facial anatomy.

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          Most cited references7

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          The youthful cheek and the deep medial fat compartment.

          This article introduces the concept of pseudoptosis as a mechanism of midfacial aging: diminished volume of a specific deep fat compartment leads to an excess skin envelope and the illusion of a more prominent nasolabial fold. Tha anatomy of this deep fat compartment, and of two others, is described.
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            Aging changes of the midfacial fat compartments: a computed tomographic study.

            The restoration of a natural volume distribution is a major goal in facial rejuvenation. The aims of this study were to establish a radiographic method enabling effective measurements of the midfacial fat compartments and to compare the anatomy between human cadavers of younger versus older age. Data from computed tomographic scans of 12 nonfixed cadaver heads, divided into two age groups (group 1, 54 to 75 years, n = 6; and group 2, 75 to 104 years, n = 6), were analyzed. For evaluation of the volume distribution within a specific compartment, the sagittal diameter of the upper, middle, and lower thirds of each compartment was determined. For evaluation of a "sagging" of the compartments, the distance between the cephalad border and the infraorbital rim was determined. Computed tomography enables a reproducible depiction of the facial fat compartments and reveals aging changes. The distance between the fat compartments and the infraorbital rim was higher in group 2 compared with group 1. The sagittal diameter of the lower third of the compartments was higher, and the sagittal diameter of the upper third was smaller in group 2 compared with group 1. The buccal extension of the buccal fat pad was shown to be an independent, separate compartment. This study demonstrates an inferior migration of the midfacial fat compartments and an inferior volume shift within the compartments during aging. Additional distinct compartment-specific changes (e.g., volume loss of the deep medial cheek fat and buccal extension of the buccal fat pad) contribute to the appearance of the aged face.
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              The Clinical Importance of the Fat Compartments in Midfacial Aging

              Summary: The recent identification of the facial fat compartments has greatly affected our understanding of midfacial aging. This article chronicles the discovery of these fat compartments including the shift of attention from a purely gravitational to a volumetric approach to facial aging and the series of methodologies attempted to ultimately define the anatomy of these compartments. The revived interest in volumetric facial rejuvenation including compartment-guided augmentation techniques is discussed. Lastly, the article discusses interesting distributional patterns noted in these fat compartments likely related to the different mechanical and biologic environments of the deep and superficial facial fat pads.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                June 2020
                25 June 2020
                : 8
                : 6
                : e2876
                Affiliations
                [1]From the Department of Dermatology, Cosmopolitan Clinic, Istanbul, Turkey.
                Author notes
                Bulent Bagci, MD, Cosmopolitan Clinic, Nispetiye Caddesi No. 40/1, Besiktas, Levent, Istanbul, Turkey, E-mail: estetikkozmetik@ 123456gmail.com
                Article
                00019
                10.1097/GOX.0000000000002876
                7339370
                98f56230-cc89-42e3-82f0-00b3a2a7fe19
                Copyright © 2020 The Author. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 17 February 2020
                : 9 April 2020
                Categories
                Cosmetic
                Case Report
                Custom metadata
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