Malar 3d Lipotopography: Relating Fat Grafting To The Cheek And Topographical Surface Changes
Carrie S. Stern, MD1, Jillian Schreiber, BA1, Jeremy Nikfarjam, MD1, Matthew Doscher, MD1, Evan S. Garfein, MD1, Elizabeth B. Jelks, MD2, Glenn W. Jelks, MD2, Oren M. Tepper, MD1.
1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA, 2NYU Langone Medical Center, New York, NY, USA.
Purpose: While distinct facial fat compartments have been identified, the dynamic changes that occur with fat transfer(FT) has not been well-elucidated. This study introduces facial lipotopography, a three-dimensional(3D) approach to analyzing surface changes in response FT.
Methods: Medial(MC) and lateral-cheek(LC) compartments of cadavers(n=12) were injected with 1 ml aliquots, up to 4 ml. Zone of augmentation(ZOA) was analyzed with 3D photographs (set at 0.1mm change from baseline).
Results: Topographical changes in MC: surface area(SA) increased from 10.3±0cm2 to 14.4±3cm2, 16.0±2cm2, and 17.9±2cm2(p<0.05). The perimeter initially increased with 2ml(187.3±2mm vs 158.6±10mm;p<0.05), but did not change thereafter (199.7±30mm,214.8±30mm,p>0.05). Anterior-posterior(AP) projection steadily increased; 2.5±0.5mm to 3.5±0.4mm, 4.5±0.6mm, and 4.9±0.6mm(p<0.05). ZOA remained spherical in shape(maximum vertical-horizontal distance was 33.9mmx34.6mm at 1ml versus 41.5x44.8mm at 4ml,p<0.05).
LC injections changed SA from 12.2±3cm2 to 15.6±3cm2, 19.3±4cm2, and 22.2±6cm2(p<0.05). The perimeter initially increased (167.0±20mm), but not thereafter (192.0±30mm,208.0±20mm,p>0.05). AP projection gradually increased (3.5±0.8mm to 3.7±0.9mm, 4.6±0.9mm, and 5.3±1mm,p=.03). ZOA changed in an elliptical fashion; maximum vertical distance was unchanged (31.4mm,33.6mm, 36.9mm, and 38.5mm, p<.05) versus horizontal distance which increased(43.7mm, 51.3mm,54.9mm, and 57.8mm, p<0.05). In all cases, the superior border of the ZOA was located at the nasojugal groove.
Conclusion: FT to MC and LC augment distinct zones that behave in a sigmoidal pattern. A ‘compartment-threshold’ is reached in which the borders of ZOA is maximized, and further FT only augments AP projection.
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