Branham head shot

Dr. Gregory Branham

It’s a new year; and if you’re wanting a new look, consider the new concept in facial rejuvenation: pan-facial volume augmentation.

“We used to simply fill in wrinkles and lines, plumping them up with facial fillers,” ex-plains Dr. Gregory Branham, division chief of facial plastic surgery with Washington University Physicians. “We were very focused on the symptoms, but not on the cause. Facial folds and lines are largely due to a lack of overall facial volume that occurs naturally with aging.”

Starting at about age 30, gradual bone loss begins. This ‘facial osteoporosis’ compromises the bony scaffolding that helps anchor fat deposits to the upper portion of the face. The result is the typical facial droop, a process Branham calls “descent and deflation,” in which fat redistributes and settles near the jowl, chin and neck. And simply injecting filler into lines and wrinkles won’t change the facial architecture, he notes.

“The newer concept we’re using addresses the deeper volume loss,” he says. “We now target the areas where the face needs additional structural support.” For example, nasolabial folds (lines from the nose to the corners of the mouth) are caused by a lack of supporting bone and fat volume in the cheekbone region. Correcting this issue involves adding volume to the mid-face, supporting and lifting the droopy skin that creates the fold. “By adding support to the area above the fold, we can lift it up and decrease the depth of the fold, while retaining a very natural appearance,” he says. “And if the fold is very deep, we can also target it with some local filler.”

The pan-facial approach reshapes facial contours, replacing the heavy, square-jawed appearance of jowls with a more youthful oval shape in which the upper portion of the face tapers to a more narrow jawline. Branham refers to the desired shape as an ‘inverted egg’ with the pointy end at the bottom and the wider end at the top.

To achieve this effect, Branham uses a combination of techniques. First, the lower portion of the face is contoured with gentle liposuction to carefully remove excess fat from the jawline and chin. A small volume of fat also is removed from the belly, again using techniques that create minimal cell disruption. Retaining the integrity of the harvested belly fat is important because these are the fat cells that will be used to recreate volume in the upper portion of the face.

Branham notes that harvesting fat from the belly or thigh is not done to contour those areas. Rather, the fat from these regions tends to be “a bit more stubborn,” and generally survives better when injected into the face. “We expect about 60 percent of the fat we inject to persist after injection,” he says.

Depending on the patient’s individual needs, additional augmentation with fillers, some type of lifting procedure and/or skin resurfacing may be needed to obtain the best overall results. “How long the results last depends on the individual’s own aging process, but we generally expect lifting and fat transfer procedures to last for five to 10 years. Fillers are absorbed by the body within a year or so,” he says.

The most important advice Branham offers those who are considering facial rejuvenation is to “have an open mind. You may have a set notion about what you need, but be willing to look at all the options.”

On the cover: Dr. Gregory Branham specializes in cosmetic procedures such as rhinoplasty, facelifts, browlifts and eyelid surgery. He also performs reconstructive facial surgery for patients who have had cancer removed with Mohs surgery. He sees patients in West St. Louis County at the Washington University Facial Plastic Surgery Center in Creve Coeur. For more information, call 996-3880 or visit

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