title: The evolution of midface rejuvenation: combining the midface-lift and fat transfer.
abstract: OBJECTIVE
  To evaluate the aesthetic results in our initial group of patients treated with a combination of a midface-lift and fat transfer compared with a randomly selected group of patients who underwent a midface-lift without concurrent fat transfer by one of us.
  
  
  METHODS
  The setting was a private, ambulatory, surgical center. The design was a comparative study between patients who did or did not receive fat transfer in addition to a midface-lift to determine if the addition of fat transfer to the midface-lift resulted in an improved aesthetic outcome. A total of 40 patients with complete photographic and medical records and a minimum of 6 months of follow-up were included in the study. Group 1 consisted of 30 patients randomly selected (from >650 potential patients) who underwent a midface-lift without fat transfer to serve as a control group. Group 2 consisted of our initial 10 patients who underwent fat transfer in addition to a midface-lift at the same setting. The degree of aesthetic improvement in 4 facial zones was assessed by 3 independent blinded evaluators. Zone 1 represents the tear trough/infraorbital rim; zone 2, the malar eminence; zone 3, the submalar region; and zone 4, the nasolabial crease. Each zone was given a rating from 0 to 2 (0 for no improvement; 1, mild improvement; and 2, marked improvement). The 2 groups were compared with 4 chi(2) tests of independence.
  
  
  RESULTS
  Four chi(2) tests of independence were conducted to compare the findings between group 1 and group 2. One hundred twenty ratings were conducted; group 1 consisted of 90 total ratings on 30 patients and group 2 consisted of 30 total ratings on 10 patients. The first chi(2) (tear trough/infraorbital rim) test revealed a significant difference on tear trough ratings by group (chi(2)(2) = 73.59, P<.01). The second chi(2) test (malar eminence) did not reveal a significant difference on malar eminence ratings by group (chi(2)(2) = 3.10, P = .21). The third chi(2) test (submalar region) failed to reveal a significant difference on submalar region by group (chi(2)(2) = 4.01, P = .13). The final chi(2) test (nasolabial crease) revealed a significant difference on nasolabial ratings by group (chi(2)(2) = 14.28, P<.01).
  
  
  CONCLUSIONS
  Our findings revealed a statistically significant difference between group 1 (no fat transfer) and group 2 (fat transfer) in the tear trough region (P<.01) and the nasolabial crease (P<.01). The fat transfer technique in combination with a midface-lift is a safe and effective means to provide more complete facial rejuvenation, especially in the regions of the tear trough and nasolabial crease.
authors.affiliation: Plastic Surgery Associates of New York, 59 East 79th Street, New York, NY 10021, USA. allisonpontius@yahoo.com
authors.forename: Allison T
authors.initials: AT
authors.lastname: Pontius
authors.forename: Edwin F
authors.initials: EF
authors.lastname: Williams
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D017060:Patient Satisfaction; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome