injury. The frontal branch lies along the line drawn from infra-tragal notch to 1.5 cm above the lateral eyebrow. The zygomatic branch runs along zygomatic arch. The buccal branch runs along parotid duct. The mandibular (or marginal) division lies along the body of the mandible (80%) or within 1–2 cm below (20%). The marginal branch lies deep to the platysma along most of its course. Approximately, 2 cm lateral to oral commissure it becomes more superficial and ends on the under surface of the muscles. Injury to the marginal branch results in paralysis of the muscles that depress the corner of the mouth. The cervical branch supplies platysma and runs behind the posterior border of mandibular ramus. These nerves are likely to get injured when the fat graft is placed below the muscle or above periosteum.

23.3 Clinical Applications

There are six areas that are the best areas for fat transfer in the face (Table 23.1; Fig. 23.3).

Table 23.1 Areas that need fat

1.Trough area

2.Nasolabial

3.Marionette lines

4.Cheeks

5.Brows

6.Chin area

23.3.1 Harvesting the Fat

Under twilight anesthesia the area is marked from which fat would be taken. The commonest areas are:

1.Submental area during facelift.

2.Abdomen, upper and lower. The author prefers the upper abdominal area.

3.Outer or inner thighs.

4.Inner knee.

5.Sacral area.

The area is marked in black, the entry site in red, and the highest point of the fat in red.

Local infiltration is done using lignocaine with 1:200,000 adrenaline at the point of entry. Inject the area with tumescent infiltration about 20–30 ml depending on the amount of fat required to be removed. You will only need to aspirate 20–30 ml of fat (Fig. 23.4). With a sharp 15 blade make a puncture wound using a 10 ml syringe and a small aspiration cannula 2–3 mm (Fig. 23.5). Insert 1 ml of saline in the syringe and cannula to act as a buffer and remove

a

b