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de la Torre et al. Plast Aesthet Res 2020;7:11 I http://dx.doi.org/10.20517/2347-9264.2019.54 Page 3 of 6

A B

C D

Figure 2. Technical details. A: The blunt passing instrument is introduced by stab incision up through the fixation incision. The Vicryl
suture is passed through the eye of the passing instrument; B: The passing instrument is withdrawn, pulling the suture through the malar
fat pad; C: The suture is engaged in the malar fat pad and then the tip of the passing instrument is passed up through the fixation incision;
D: The suture is drawn out of the passing instrument. The passing instrument is removed through the naso-labial stab incision and the
suture can then be secured to the temporal fascia

overlying skin or the underlying facial muscles. A 3-0 Vicryl, PDS absorbable suture, or 4-0 nylon clear
permanent suture is threaded through the eye of the instrument and the suture needle is held in a needle
diver. The instrument is then partially withdrawn through the stab incision [Figure 2A and B]. A mark
on the instrument demarcates how close the tip of the instrument is to the puncture site so that the tip is
not fully withdrawn. The passing instrument is re-advanced taking care to engage the malar fat pad tissue.
The insertion path of the needle is in a slightly different path within the malar fat pad [Figure 2C and D].
The tip of the passing instrument exits the fixation incision and the suture is then withdrawn from the
instrument leaving the two ends. The needle of the suture can then be used to attach the suture to the deep
temporal fascia. Tension is placed on the suture to elevate the malar fat pad to the desired level. The suture
is then secured to the deep temporal fascia. The temporal incision is closed using deep dermal sutures and
subcutaneous sutures, and the stab incision is closed using 5-0 subcutaneous chromic suture.

Patients
An institutional review board-approved retrospective review was performed to identify all patients who
underwent a MIMS procedure between 2008 and 2018. Preoperative and postoperative photographs were
reviewed as was the electronic medical record. There were a total of 71 patients, 59 females and 12 males
with an average age of 59 years.

RESULTS
A representative case is illustrated and described in Figure 3. There have been no major complications in
any of the patients. No revision or re-elevation was necessary. Long-term results were assessed subjectively
by patient report and surgeon examination. They were found to have been very satisfactory and lasting.

DISCUSSION
Various techniques have been described to correct malar fat pad ptosis, including open surgical approaches
and closed procedures [1-3,8,10,11,13-17] . In terms of minimal access procedures, endoscopic techniques with