Objectives: 1. Discuss the rationale for anatomic and regenerative facial fat grafting
2. Demonstrate the technique
3. Present 19 month prospective outcome data

Introduction: A standardized technique for facial fat grafting, Injectable Tissue Replacement and Regeneration (ITR2), was developed to address both anatomic volume losses in superficial and deep fat compartments as well as skin aging, incorporating newer regenerative approaches.

Materials / method: Twenty-nine female patients with a mean age of 52.9 years and mean BMI of 22.5 kg/ m2 were analyzed for mid-facial volume changes after autologous fat transfer with ITR2. Estimates of volume change over the course of 19 months were evaluated using the Vectra XT 3D Imaging System to calculate volume differences between a predefined, 3-dimensional mid-facial zone measured preoperatively and serially after fat grafting with novel approach using varying fat parcel sizes and using an overlaid postoperative 3D image.

Results: Patient data was analyzed collectively as well as separately by age (< and> 55 years). Collective analysis revealed a trend of initial volume loss within the first 1-7 months followed by an increase in facial volume within 8–19-month range, averaging 56.6% postoperative gain within the first 1-3 months and ending at an average of 52.3% gain in mid-facial volume by 14-19 months. A similar trend was observed for patients <55 years of age, but to a greater extent. Patients above 55 years of age demonstrated a gradual volume loss to around 30% improvement at 19 months after treatment.

Conclusion: Preliminary evidence shows a dynamic change in facial volume, with an initial decrease in facial volume followed by a rebound effect that demonstrated improvement of facial volume regardless of patient weight change or amount of fat injected 19 months after treatment. Volume improvement occurred to a greater extent in patients under 55 years old, whereas in patients older than 55 volume gradually decreased. To our knowledge, this study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment.

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Objectives: To undertand the anantomy and the concept of skeletal augmenation in Facial rejuvenation surgery and to safely implement jawline augmenation with implants or fat grafting into your face lifting techiques.

Introduction: The outcome of any suspension / lifting technique in facial rejuvenation depends strongly of the anatomy of teh underlying bony framework and the distribution of supporting facial soft tissue and fat pads. The ageing process resulting in bone loss and / or soft tissue loss and anatomical variations of this framework will contribute significantly towards premature ageing ad loss of facial definition.

Materials / method: We wil show an anatomy based approach towards the modifciation of the jawline during facial rejuvenation. The use of fat and osseo-integrative implants will be explained and their relevance ilustrated with clinical cases.

Conclusion: The use of facial implants and fat grafting in facial rejuvenation surgery / facelifts is still not widely implemented, though the correction of the bony framework and attributes significantly to the surgical outcome of any lifting techniques. The isolated or combined use of thses techniques is safe, reproducable and leads to better neck / jawline definition and overall better rejuvenation outcomes in any surgical facelift.

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Objectives: The purpose of this article is to solve the problem of the unnatural looking of the marionette line accompanied by the classic mouth corner lift surgery by using a more stable Three-layer smile lip lift surgery approach.

Introduction: Mouth corner lift surgery is an effective procedure to bring a patient a warm smile. However, if not done carefully, the previous marionette line is still dropping down while the mouth corner is being lifted up, the patient may feel unnatural due to this bifurcation between the dropping marionette line and mouth corner.

Materials / method: In order to solve this problem, I invent the modified “three layers smile lip lift surgery.” It handles three layers of mouth corner tissue separately:
1. Skin: transitional mouth corner lift surgery
2. Fat flap transfer: preserve the original subcutaneous fat flap that is supposed to be removed in the traditional way and roll to the side beneath the newly formed mouth corner. This step can minimize the marionette line and lessen the feeling of bifurcation between marionette line and mouth corner.
3. Muscle: the roll of the mouth layer and fixation can shift the tension from skin to mus

Results: The three layer smile lip surgery can significantly improve the outcomes of mouth corner lift surgery. The unnatural looking of the bifurcation between marionette line and mouth corner is reduced due to the fat flap transfer step and the stability is reinforced by the roll of the mouth layer.

Conclusion: The three layer smile lip surgery can be suggest for surgeons as well as patients who are concerned about a more natural and stable results for mouth corner lifting.

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