PURPOSE: Malar fat pad ptosis together with prominent nasolabial folds is a common feature of the aging face. Several midface rejuvenation techniques to correct malar fat pad ptosis have been suggested; however, no one method has proved to be better than the other. The purpose of this paper is to present a simple and safe technique which provides a three-dimensional elevation of the ptotic malar fat pad.

METHOD: Preoperative markings include one dot within the nasolabial fold, one centimeter from the nasal ala. A second dot is marked one centimeter distal to the first while continuing down the nasolabial fold. A 2-centimeter incision one centimeter posterior to the temporal hairline is made. Through the first dot, the blunt end of a six-inch mortician’s needle is inserted through the malar fat pad while it is held between index finger and thumb towards and through the temporal incision. At this time, a 2-0 Supramid (B.Braun Surgical S.A., Spain) suture is threaded through the needle, and the needle is once again brought through the malar fat pad towards the first dot. Prior to delivering the blunt end of the needle through the skin, it is redirected towards the second dot, catching approximately one centimeter of malar fat pad between the two strands. The needle is then delivered through the temporal incision and sutured to the temporoparietal fascia. This technique can also be performed during open rhytidectomy. General anesthesia is not necessary. 

RESULTS: Over the last 6 years, approximately 150 patients underwent trans-malar fat pad elevation. No facial nerve injuries or muscle weakness occurred. No infections using this technique occurred. Patients were pleased with the results. 

CONCLUSION: This simple and safe trans-malar-fat-pad suture provides a three-dimensional improvement to the malar area, resulting in a more full and youthful malar appearance.