title: [The middle third of the face in facial lift: lipopexy of the premalar fatty pad].
abstract: The technique proposed tries to resolve an irritating problem which has been incompletely and illogically resolved until now: the restoration of the natural relief of the middle third of the face. An anatomical study shows that the malar region is an eminence composed of a double structure, bony and fatty. The ptosis of what the authors propose to call "the premalar fatty pad" is probably the earliest sign of ageing in the face. It give a skeletal appearance and fills the canine fossa which become a heavy fold and increases the apparent depth of the naso genio labial sulcus. The aim of this technique is to restore a normal appearance by restoration of the true anatomical structures. The technique consists of extensive undermining behind the ptotic fatty pad, in front of the malar bone and SMAS as fas as the orbital rim which allow displacement upwards and backwards. Resorbable sutures and an accurate skin tension ensure the new premalar position of the fatty pad. Posterior fibrosis, in the undermining, will be the essential means of late fixation. 70 such operations with sufficient follow up have been carried out. The result is stable in 58 of them and insufficient but appreciable in all of the others. Fatty faces give poor results due to the poor quality of the skin.
  
  
  CONCLUSIONS
  it is a simple, logical and efficient procedure, more often performed in association with the treatment of frontal and cervicofacial level of the face. No complications related to this procedure have been observed.
authors.affiliation: Service de Chirurgie Plastique, Hôpital Saint-Antoine, Paris.
authors.forename: C
authors.initials: C
authors.lastname: Nicoletis
authors.forename: E
authors.initials: E
authors.lastname: Sitbon
authors.forename: B
authors.initials: B
authors.lastname: Cadot
authors.forename: K
authors.initials: K
authors.lastname: Marsot-Dupuch
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology / Q000601:surgery; D002610:Cheek / Q000033:anatomy & histology; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging
vernacular_title: L'étage moyen de la face dans le lifting: lipopexie du coussinet adipeux pré-malaire.