Sequential autologous fat injection techniques for volumetric face lifting in young Korean females

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Background: Various fat grafting techniques have been preferentially performed to restore facial volume deficiency. However, no reports have focused on simultaneous volume deficiency and sagging appearance improvements, barring the sequential autologous fat injection (SAFI) technique. Objective: This study aimed to show real evidence of volumetric lifting using the SAFI technique. Methods: From 2007 to 2009, we performed the SAFI technique on 10 patients in their 20s. Fat was purified using Coleman’s method and sequentially injected into each defective region from the superolateral to the anteroinferior direction. The fat was placed subsequently in the supra-periosteal, deep, and superficial layers (approximately 60%, 30%, and 10% of the injected volume, respectively) of each region to increase the skeletal support for the soft tissue. Morphological changes were evaluated by comparing pre- and postoperative photographs. The effects were monitored from 3 months to 1.5 years. Results: We included 10 patients with an average age of 25.4±2.56 years, having relatively small and flat malar bones with negative globe-to-skeletal rim relations; moreover, they were injected averagely with 38.8±4.89 ml of fat. In most of the cases, the facial contour changed from a rectangular to an oval shape. Furthermore, the appearance was lifted through great volume restoration in the midface and volume reduction in the deep nasolabial folds (NLFs) and jowls. The wrinkle severity rating scale (WSRS) grade decreased in 7 patients (3 on both sides and 4 on either side) and increased in 3 patients. The WSRS improvement was not statistically significant; however, NLFs showed a younger, more natural, and lifted look in all cases. Patient satisfaction was relatively high (4.4±0.5). Conclusion: The results indicated that the SAFI technique could be used for both volume deficiency and sagging appearance improvements because it preferentially focused on both skeletal deformity and soft tissue defect corrections.