One very important area or facial zone that makes a major play in imparting this shape is the lateral facial triangle. Positioned between the bony points of the cheek bone, chin and jaw angle, the lateral facial triangle is comprised of soft tissue only. There is no underlying bony support of any significance.
In some people the lateral facial triangle has a thicker soft tissue thickness, imparting a more round facial shape. In other patients the lateral facial triangle has much less soft tissue thickness. When this area contracts inward, the face appears more triangular in shape which some call a gaunt appearance. The influence of this soft tissue zone on facial appearance is well illustrated in patients with facial lipoatrophy. While some have it naturally, an extreme example is what happens in certain medical conditions such as AIDS. (facial HIV lipoatrophy)
Filling in the lateral facial triangle with fat injections is the only surgical approach for augmentation of this zone. Because it is not supported by any underlying bone, traditional facial implants will not help. In fact, augmenting the cheeks or jaw angles will only make this appearance worse. Injecting this zone with fat, filling it up at least to the level of a plane that touches all three points, will change the facial shape. This can soften a long more angular facial look by adding width or improve a gaunt facial shape by filling out the concave shape to the lateral facial triangle.
When considering facial fat grafting, there are several important considerations that patients need to know. Even though injectable fat grafting is fairly simple (no open incisions), it is not fool proof and outcomes can be variable. Fat grafting can only be done using your own fat. No other person’s fat will be accepted by your body. The amount of fat to fill in the lateral facial triangle can be anywhere from five to fifteen ccs. Even in a thin person, you can usually still get enough from the abdomen using the inside the umbilicus as the harvest entrance site. Concentration is the key after harvest to eliminate injecting as many impurities as possible. Adding PRP extract (platelet-rich plasma) may have a positive effect on fat survival, particularly in small-volume fat injections, but this has yet to be scientifically proven. Injection technique is important so multiple passes from different injection angles is necessary. One ball of injected fat will likely lead to complete resorption.
The only risk of this surgery is the unpredictability of fat survival. Complete fat retention can not be guaranteed which is why I, in my Indianapolis plastic surgery practice, always overfill it somewhat. A patient can expect to look a little too full for several weeks after surgery until the fat and swelling settles. What is retained in the lateral facial triangle after three months can be expected to be retained.
Dr. Barry Eppley
Indianapolis, Indiana