The Outcome of 3 Various Reconstructive Procedures After Permanent Filler Removal and Deep Plane Face Lift

Background: Deep plane face lift in patients with previous permanent filler injections is a formidable reconstructive and aesthetic procedure. Various reconstructive techniques have been previously described in the literature to address the defects after removal of permanent fillers. However, no comparative study in the literature has been conducted to demonstrate the effectiveness and complications of these reconstructive procedures in the pursuit of achieving aesthetically favorable results with safe techniques. The study aimed to describe the effectiveness and complications of 3 reconstructive techniques: micro–fat grafting, dermal fat grafting, and pedicled flap reconstruction. Methods: A multiarm, randomized, parallel study was conducted among patients who had undergone permanent filler injections between 2014 and 2022. Patients were divided randomly into 3 groups, each comprising 160 individuals; all patients were managed by removal of the permanent fillers, deep plane face lift, and reconstruction of the defects as a consequence of the filler removal. Participants were randomly assigned to 3 groups. This allocation was based on the defect reconstruction method, including dermofat grafting (group A), fat grafting (group B), and a pedicled buccal fat pad flap (group C). The minimum follow-up was 6 months. Results: The most prevalent complications detected were contour irregularity. Fat graft surgery was associated with the highest rates of complications. Conclusions: The pedicled flap technique had the fewest postoperative complications and was superior to fat and dermal fat graft techniques. The results could guide surgeons in optimizing patient selection and surgical techniques to improve patient outcomes.