42 Fat Grafting to the Perioral Region

Rod J. Rohrich and Raja Mohan

Abstract

One major adjunct in facial rejuvenation is autologous fat transfer or facial fat grafting to various facial fat compartments of the face. An important region to consider is the perioral region where deep and fine perioral rhytides are visible. Autologous fat grafting to this region adds volume to areas that are hollow or have become deflated secondary to aging and skin laxity.

Fat grafting – perioral rejuvenation – facial aging – fat transfer

42 Fat Grafting to the Perioral Region

Key Points

Fat grafting to the perioral region is a useful adjunct in facial rejuvenation.
Autologous fat grafting to the superficial fat compartments of the perioral region (Fig. 42.1) is meant to address volume deflation and deep rhytides that cannot be addressed with a facelift.
Other modalities such as chemical peels, microdermabrasion, and laser resurfacing induce dermal regeneration but do not add volume to the perioral region.
Fat injections are not recommended for the white roll. Injections into the white roll are unpredictable and asymmetric secondary to movement.

**Fig. 42.1** Superficial fat compartments of the perioral region.

42.1 Preoperative Steps

42.1.1 Analysis

A thorough preoperative analysis of the lower third of the face to identify areas of volume deflation and tissue laxity is performed.
Areas of volume deflation as well as deep rhytides are marked preoperatively in the perioral region to determine areas requiring volumization.
The lips become thin with age and subcutaneous fat atrophies. In addition, the nasolabial folds and marionette lines become more prominent with deflation and descent of fat.

42.2 Operative Steps

See Video 42.1 and Video 42.2.

42.2.1 General Technique of Autologous Fat Harvest and Transfer

Adipose tissue is harvested from the medial thighs using a 10-mL syringe with a 14-gauge (3 mm multihole) cannula.
No wetting or infiltration solution is used for the harvest.
The harvested lipoaspirate is centrifuged at 2,250 rpm for 1 minute followed by removal of the infranatant and supernatant to isolate the fat meant for transfer.
The harvested fat is collected in 1-mL syringes.
For any facial fat compartment, the 1-mL syringe with the harvested fat is connected to a blunt cannula and injected at a low pressure with anterograde and retrograde motions.