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As the face ages it undergoes a set of well known changes including loose skin and deeper tissues as well as loss of fat. Some of these changes have served as the basis for the historic facelift procedure. The recent understanding of the effects on aging by structural fat loss has led to fat grafting procedures done in conjunction with facelifting procedures or as an stand alone procedure.

The most common area of the aging face treated by volumetric addition is by cheek fat injections. The addition of volume to the midface can help reverse tissue descent and decrease the depth of certain facial wrinkles. Anatomic dissections of where these fat injections should be placed have shown that there are distinct superficial and deep compartments of which the deep midface fat compartment is what can best achieve a more youthful appearance.

In the April 2018 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘The Boomerang Lift: A Three-Step Compartment-Based Approach to the Youthful Cheek’. In this paper the authors describe a three-step approach to cheek augmentation using a deep three compartment (lateral suborbicular, medial suborbicular and deep medial cheek), calling it the Boomerang Lift. Comparison of 3D intraoperative before and after pictures showed a topographic contour change that resembled a boomerang shape. The short tail supports the medial eyelid and the long tail extending out towards the zygomatic arch. The deep medial compartment provided the maximal area of projection.

Rather than merely pumping fat into the face in an effort to just add fullness, this study provides an anatomic and thoughtful approach to cheek fat injections for facial rejuvenation purposes. Adding support to both the lower eyelid and the cheek provides a more harmonious and targeted lifting effect that is reproducible based on known fat compartment locations.

Dr. Barry Eppley

Indianapolis, Indiana

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