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Various fat grafting techniques are commonly performed to restore the facial volume deficiency in the soft tissue. Generally, the purified fat is evenly injected into the whole layer in the volume deficit area. The sequential autologous fat injection (SAFI) technique is known to have a volumetric lifting effect. In patients with small and flat malar bones, the soft tissue foundation becomes weak; hence, the soft tissue overlying the bone easily sags even in young patients. Therefore, the author tried to apply the SAFI technique to correct the sagging face. The fat was harvested and purified by the Coleman’s method, and sequentially injected into each defective region in the superolateral to anteroinferior direction. Furthermore, the fat was injected consequently in the deep, middle, and superficial layers to increase the skeletal support for the soft tissue using the SAFI technique. An increase in the volume in the malar and sub-malar areas and decrease in the volume in the deep nasolabial folds and jowls were simultaneously observed. Moreover, the facial contour changed from square to inverted triangle type with shallow nasolabial folds and lifted appearance of the jowls in these 3 cases. The results indicated that the SAFI technique could be used for volumetric face lifting, because it focuses on the correction of the skeletal deformity in order to improve the soft tissue foundation.

Lifting effect of sequential autologous fat injection (SAFI) in three patients with small and flat malar bones