Lifting the malar fat pad for correction of prominent nasolabial folds.

The anatomic presence of a discrete malar fat pad has not been widely recognized. In his paper on the "deep plane rhytidectomy," Hamra describes the increased thickness of the subcutaneous fat over the anterior midface. Cadaver and clinical studies confirm the consistent presence of a localized subcutaneous malar fat pad overlying the body of the zygoma and maxilla. Downward displacement of the infraorbital skin and underlying malar fat pad causes an increased prominence of the nasolabial fold. The surgical dissection of the malar fat pad starts from the malar eminence at the plane of the orbicularis oculi muscle and superficial to the origin of the zygomaticus and levator muscles, which are invested by the SMAS. There is an easily dissected plane deep to the fat pad that extends to the nasolabial crease. Surgical correction of the prominent nasolabial fold is enhanced by undermining the malar fat pad and advancing it laterally by traction on the skin flap with additional upward fixation by sutures between the lateral edge of the fat pad and the subcutaneous fascia at the lateral malar eminence.