Back to 2014 Annual Meeting Abstracts

Rhinoplasty is the most common procedure seen in the teenage population. Many of these patients have issues of facial balance both recognized and unrecognized by individual and family. Most often it involves relative microgenia, but can also include a flattened maxilla.
In many situations when the discussion involves the possibility of additional surgery, such as an alloplastic chin implant or a surgical osteotomy the conversation halts; as the patient and family feel the process has become too much and they refuse or seek a “simpler” surgery elsewhere.
Autologous fat transfer to the face has been widely spoken of for volume restoration in the aging patient. Yet this useful adjunct has little written about it as a tool to aid in the achievement of facial balance in chin and cheek in the teen population. It offers an easy and minimally invasive way to maximize a rhinoplasty result with little additional surgical time or risk.
Computer imaging allows for a visual representation of the problem of facial balance and enables the clinician to design a proposed treatment plan for both the nose, chin, and cheek deficiencies.
We have successfully employed this approach in 8 patients with a greater than 3 year follow-up. Following the imaged plan, fat was harvested from the abdomen or flanks using the hand Coleman technique. Forty cc of fat was processed to yield 25 cc of injectable material. On average, 7-9cc of fat was required for chin augmentation and 2-3cc of fat was needed for the midface. This amount allowed for successful contouring.
In all 8 patients, there has been no resorbtion of grafted fat to date, and the individuals report a high degree of satisfaction with their facial asesthetics. Ultimately, the patients were happy that they were able to achieve the facial balance, but admit that they would have not gone forward with more invasive procedures. Figures 1 and 2 are demonstrative pre- and post-operative images.
The combination of rhinoplasty and autologous fat transfer to the chin to correct relative microgenia and to the mid-face for maxillary deficiency when needed has become critical in my practice to achieve optimization in many rhinoplasty situations and should be considered as an option in achieving facial harmony.