ORIGINAL PAPER Malar fat pad suspension through intraoral approach: a personal technique Pedro Vidal & Juan Enrique Berner & Pablo Castillo Received: 2 September 2013 /Accepted: 23 March 2014 /Published online: 16 April 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Background For decades, facelifting has been the gold stan- dard for facial rejuvenation. However, there is a current ten- dency towards new and less complex procedures. The reposi- tion of the malar fat pad plays a central role to restore a convex mid-face contour, and until now, it has been achieved mainly through large incisions or endoscopic techniques. Methods Authors present a minimum scar procedure using a 20-cm needle: a 45-min operation that lifts the ptotic malar fat to restore a youthful looking facialvolume. Nineteen conse- cutive patients were addressed using this technique with con- sistent satisfactory results between the years 2007 and 2012. Results Patients were mostly women (16), between 24 and 70 years of age. Six patients had this procedure as a single surgery, the rest in combination with other aesthetic proce- dures. All of them were satisfied with results at one year after the procedure operation. Conclusions The authors conclude that this is a reliable pro- cedure that obtains the desired results in mid-face rejuvenation by restoring a youthful contour, avoiding large visible incisions. Level of evidence: Level IV, therapeutic study Keywords Rhytidoplasty . Surgery . Plastic . Cheek . Malar Introduction For decades, the cornerstone for facial contouring and rejuve- nation has been the facelifting. However, there is a current tendency among patients who are now requesting less aggres- sive procedures. This is because of the inevitable long post- operative period following a facial lifting which usually im- pedes an earlier return to work [1]. Another fact why many patients turn down a facelift is the undesired stigmata, which is not uncommon. Proof of this is the clear increment of “lesser” procedures [2], including those called “lunch hour injections”. This request, added to the fact that many surgeons feel that the facelift is a long, tiring procedure, and sometimes followed by patient complaints, implies that we now see more filler and Botox injections, microdermabrasion and lasers as an alternative to larger surgeries. As an answer to this cultural change, some authors have published innovative techniques to comply with these re- quests. These authors prefer adding several small procedures in order to obtain a remarkable result [3, 4] comparable to a face lift. Many procedures have recently been designed to reposition the malar fat pad in order to restore a youthful-looking facial contour [5]. The malar fat pad is crucial for any rejuvenation procedure for two main reasons: when well-positioned, it is responsible for a convex mid-face silhouette; however, when ptotic, it contributes along with the buccal fat pad in exagger- ating the nasolabial folds [6]. Apart from cheek implants and autologous fat injections, there are numerous proposed techniques that involve transpo- sition of the ptotic malar fat pad and the buccal fat pad in order to restore an oval shaped mid-face [7–10]. Most of the published techniques imply superficial muscle aponeurotic system (SMAS) traction or flaps involving all the mentioned consequences: scars, long postoperative swelling P. Vidal (*) Department of Plastic Surgery, P. Universidad Católica de Chile, Santiago, Chile e-mail: pvidalg@mac.com P. Vidal : J. E. Berner : P. Castillo Hospital Clínico de la Fuerza Aérea, Santiago, Chile P. Vidal Cienmanos Foundation, Santiago, Chile Eur J Plast Surg (2014) 37:367–372 DOI 10.1007/s00238-014-0954-4