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Ramirez. Plast Aesthet Res 2020;7:25 I http://dx.doi.org/10.20517/2347-9264.2019.78 Page 5 of 21

Figure 3. The SOOF suspension lifts the entire cheek and effaces the tear trough deformity. The addition of the Bichat’s fat pad
accentuates the Ogee line of the face. SOOF: sub-orbicularis oculi fat; DTF: deep temporal fascia

Figure 4. The Ogee line is the curvilinear line of beauty and youth

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fisherman’s knot . This suture controls the proper tension for volume control and desired elevation. A
2 mm butterfly drain is placed in the midface and fixated to the temporal scalp. The temporoparietal fascia
is lifted and anchored to the temporal fascia with 3-0 PDS sutures. This provides additional remodeling of
the upper cheek and periorbital region. The intraoral incision is closed with 4-0 chromic catgut sutures.
The frontal scalp is suspended with two self-stabilizing Ramirez endoforehead screws (Dupuy Synthes.
Warsaw, Indiana). These were applied percutaneously in the frontal scalp away from the access incisions.