title: Periorbital rejuvenation to improve the negative vector with blepharoplasty and fat grafting in the malar area.
abstract: OBJECTIVE
  Periorbital rejuvenation is not achieved by upper and lower blepharoplasty alone; the presence of malar atrophy and the excessive length of the lower eyelid may change the face's oval shape, with the progressive formation of the negative vector. We describe our technique combining blepharoplasty and malar fat grafting to reverse the negative vector.
  
  
  METHODS
  After thorough anamnesis, we perform the blepharoplasty and canthopexy if necessary. In the upper blepharoplasty, we do not extirpate muscle, and in the lower blepharoplasty, we extirpate the fat pads via the transconjunctival route. In the case of excess skin, we prefer to perform skin pinching without resecting muscle, followed by a canthopexy. We then perform malar fat grafting by using fat obtained with low to moderate-pressure aspiration and centrifugation, injected with criss-cross tunnels in the malar region with a volume of 7 to 12 cm3 of fat on each side.
  
  
  RESULTS
  Between 2006 and 2010, we operated on 142 female patients (age range, 45-74 years). The follow-up period was 2 years. In patients with "good fat quality" (n = 129), the results at 24 months were "excellent" in 93.79% of cases, "good" in 3.8%, and "fair" in 2.32%. The medical team's ratings were "excellent" in 97.6% of cases and "good" in 2.3%. In patients with "poor fat quality" (n = 13) at 12 months, a high percentage of the injected fat had been reabsorbed. The application of high-density hyaluronic acid was recommended (16).
  
  
  CONCLUSIONS
  Periorbital rejuvenation is a part of integral facial rejuvenation and is achieved only if, in addition to the blepharoplasty, the negative vector is also corrected. With the technique of malar fat grafting, we achieve very good remodeling of the oval face shape, correct the negative vector, and shorten the height of the eyelid; the preadipocytes improve the tissue quality, especially in the skin.
authors.affiliation: Institute of Aesthetic and Plastic Surgery Dr. Serra-Renom, Hospital Quiron Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain. serrarenom@gmail.com
authors.forename: Jose M
authors.initials: JM
authors.lastname: Serra-Renom
authors.forename: Jose M
authors.initials: JM
authors.lastname: Serra-Mestre
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging; D015050:Zygoma / Q000601:surgery*