Goals/Purpose:
Loss of soft-tissue volume in the face contributes to the appearance of facial aging in certain areas.  Currently, methods of facial rejuvenation are being refined through better understanding of the subcutaneous fat compartments of the face.  However, no large study has been published regarding specific volumes of fat to be removed or injected for each area of subcutaneous fat in the face.  The goal of this study was to develop a comprehensive approach to facial rejuvenation employing volumetric augmentation of key areas.   We describe the senior author’s approach to rejuvenation of the aging face with regard to the recently described subcutaneous fat compartments in the face.
Methods/Techniques:
A retrospective review was conducted of the senior author’s experience with 282 female patients who had undergone facial rejuvenation using fat grafting from 1999 to 2004 with Coleman instrumentation, combined rhytidectomy with an extended-SMAS contouring technique, and liposuction with fine liposuction catheters.  Other procedures including endoscopic browlift, eyelid, and periorbital rejuvenation were sometimes performed concurrently.  Pre- and postoperative images were examined, and charts reviewed in regard to locations and volume of fat injected or aspirated.  Open contouring of fat could not be well quantified, but was confined to the following areas: pre and subplatysmal fat deposits and subobicularis oculi compartments in the upper and lower lids.
Results:
A total of 282 female patients were included in this study, with a mean age of 55.8 yrs (range 33-79 yrs). Areas of fat grafting that were evaluated included the nasolabial creases, the labiomental groove, the anterior and inferior surfaces of the chin, oral commissures, tear troughs, the glabellae, upper and lower lips, philtral ridges and bases, and the area of the corrugators.  Average volumes injected were calculated in cubic centimeters for each area.  These volumes were: nasolabial creases (1.65 each), the labiomental groove (1.14), the area of the chin (2.53), oral commissures (0.71 each), tear troughs (0.48 each), the glabellae (0.39 each), upper (1.04 each side) and lower lips (0.95 each side), philtral ridges (0.48) and tubercle (0.49 each), and the area of the corrugators (0.45 each side).  The abdomen was the donor site for 274 of these patients, while fat was harvested from the buttock in 3 patients, the neck in 2 patients, the medial knees in 2 patients, and the hip in one patient. 
Complications:  There were no infections or areas of cellulitis in this series.
Conclusions:
Amount and distribution of volume of the soft-tissues in the face play a significant role in the appearance of aging.  We detail the senior author’s approach to these areas, and the selective release, redraping, fine canula aspiration, and lipoinjection to achieve harmonious and artistically pleasing results in facial rejuvenation.  This is the first series to focus on specific volumes to rejuvenate the aging face with autologous fat.  However, more study into the process of facial aging is needed to elucidate the mechanisms involved.