Evolution of Technology

Autologous Fat Transfer

Various filler materials exist, and are catered to cosmetic outcome, as well as patient goals for longevity. Filler material can broadly be separated into permanent and temporary, however most various types exist on a spectrum from months to years. There are permanent and temporary filler materials. Fat from our own body (autologous fat) is permanent filler, although it does undergo resorption to a certain degree (about half is resorbed). Another benefit in facial cosmetics is that it acts as a natural feeling substance (vs. implants and other filler material).  Some side effects of fat grafting include clumping if improperly placed, as well as rare granuloma formation. Autologous fat also cannot be broken down if the cosmetic result is undesirable. This is opposed to hyaluronic acid fillers, which can be broken down with injection of hyaluronidase to reverse the cosmetic result.

Evolution of Procedure

Noninvasive Lip and Cheek Augmentation

  1. In facial plastic surgery, the ideal lips are believed to exist in a height ratio of 1/3 upper lip to 2/3 bottom lip. A symmetric and well-defined cupids bow and philtrum are also important. The lips should be the same width as a line dropped straight down from the medial canthus, or the most medial part of the white of our eyes as it meets the skin.  
  2. The augmentation of the cheekbones is typically tapered gradually along their course, with the most volume more laterally, and tapered off at both ends. This method will give the appearance of a shadow below the cheekbone. The same principles are used in makeup contouring to create the appearance of a defined cheek. The description of a patient having a “heart shaped face” refers to the cosmetically appealing cheekbones that are sought after with augmentation.
Evolution of Diagnosis

Lip/Cheekbone Volume Loss

The facial subunits and their relative proportions/symmetry encompass much of what defines subjective ideas of beauty throughout modern cultures. There are certain ideal ratios that define the cosmetically appealing lips and cheekbones (aka zygomatic arches). The cheekbones act to give the appearance of a lifted and elevated midface. Adding volume to the cheekbones gives the appearance of more defined and sculpted cheek (buccal) area below them. Cheekbone angulation can also play a part in the appearance of a lifted and defined cheekbone. The size, angle, and shape of the cheekbones and lips are parameters that we are born with, but also change with age.  Over time, patients tend to lose volume in these areas.