Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Malar 3D Lipotopography: Relating Fat Grafting To The Cheek And Topographical Surface Changes
Carrie Stern, MD1, Jillian E. Schreiber, BA1, Matthew E. Doscher, MD1, Jeremy S. Nikfarjam, 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
Fat grafting is an essential part of aesthetic plastic surgery. Although studies have demonstrated the existence of distinct facial fat compartments, the dynamic changes that occur with fat transfer (FT) have not been well-elucidated. The following study introduces the novel concept of facial lipotopography, a three-dimensional (3D) approach to analyzing surface changes in response to targeted facial lipostructure.
Methods
Contralateral medial-cheek (MC) and lateral-cheek (LC) compartments of fresh cadavers (n=6) were injected with 0.5 ml aliquots of fat analogue up to a total volume of 4 ml. 3D photographs were taken at baseline and at each interval and were used for analysis. Variables analyzed included surface area (SA), perimeter, anterior-posterior (AP) projection, and maximum vertical and horizontal distances. Surface changes were set at lower limit of 0.1mm change from baseline.
Results
Topographical changes in the MC for injections volumes of 0.5cc, 1cc, 2cc, 3cc and 4cc were analyzed. The total surface area of augmented regions increased from 2.95±1.5cm2 to 13.5± 1.34, which corresponded a perimeter distance increase from 76.1±20mm to 171.8±3.4mm. The most significant changes in perimeter and surface area were noted at the interval of 2-3cc of injection (102±14.5mm to 143±9.5mm, and 5.05±1.3cm2 to 8.68±0.94cm2, respectively) (p<0.05). Anterior-posterior projection steadily increased as well (1.87±0.5mm to 2.58±0.5mm, 3.4±0.5mm, 4.47±0.6mm and 4.98± 0.8mm) with a significant change occurring between 3cc and 4cc injection volumes. The zone of augmentation (ZOA) remained spherical in shape (mean maximum vertical-horizontal distance was 25.3mmx21.4mm at 1ml versus 37.2x37.8mm at 4ml. (Figure 1)
Topographical changes in the in the LC were distinct from those of the MC. SA increased from 4.68±1.1cm2 (0.5cc injection) to 16.3±1.8cm2 (4cc injection, with the most significant change at 2-3 cc (6.6±0.6cm2 vs. 10.2±1.2cm2. The most significant change in perimeter distance was at 3cc and 4 cc intervals (3.75±0.7 vs 4.5±1.2, p<0.05). Unlike the spherical pattern of the MC, the ZOA changed in an elliptical fashion for the LC injection; maximum vertical distance was unchanged from 1cc to 4cc (p>.05) versus horizontal distance which increased (31.2mm to 48mm, p<0.05 ). In all cases, the superior border of the ZOA was located at the nasojugal groove.
Conclusion
Fat transfer to medial and lateral cheek leads to distinct dose-dependent changes at the surface. This relationship exhibits a sigmoidal pattern, as each compartment shows substantial changes until a ‘compartment threshold’ is reached. Studies are
underway to better define lipotopography at smaller aliquots, as well as its relationship to age and body mass index.


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