Composite Face Lifting: The Combination of Stromal Enriched Lipograft With Face Minilift and Upper and Lower Blepharoplasty: A Review of 210 Cases.

BACKGROUND Face rejuvenation is increasingly challenging because patients request minimally invasive surgery; rapid surgical course and recovery; and fast, tangible, and long-term results. Rejuvenation of face often requires surgery to multiple areas, that is, the lateral face, the midface, the neck, and periorbital areas, in addition to the emerging procedures of face volumizing and biostimulation through fat injection. At our institution, a systematic approach comprising all of these procedures has been developed, with consistent results. OBJECTIVE The aim of this study was to describe the combination of blepharoplasty, minilift, and Stromal Enriched Lipograft (SEL) for thorough rejuvenation of face and neck regions. METHODS A prospective study was performed to evaluate outcomes and patient satisfaction with composite face lifting, comprising upper and lower blepharoplasties, minilift, and SEL in 210 patients between 2009 and 2018. Overall improvement after the procedure was rated on a scale of 1 to 5, where 1 is "poor," 2 is "fair," 3 is "good," 4 is "very good," and 5 is "excellent." The evaluation was expressed at 6 months postoperatively by the patient. RESULTS The amount of SEL transplanted varied from 22 to 56 mL per side (mean, 41). There were no cases of liponecrosis, infection of the grafted area, or pulmonary embolism. More than 85% of patients expressed a very good to excellent evaluation of the result obtained. No one expressed a degree of satisfaction less than good. CONCLUSIONS Composite face lifting seems as a safe and effective combined procedure for the rejuvenation of face. Face harmony not only depends on redraping tissues toward a more natural, tense, and young conformation, but also on restoring volumes and improving the quality of the redraped tissues. More research is necessary, but the preliminary encouraging impression is that the composite face lifting is capable of addressing all issues, the necessity of correcting laxity, filling volumes, and improving the quality of cutaneous tissues.