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This is a timely publication to address some of the contemporary issues we face in dealing with poor results, or remediating results of others. No one escapes dissatisfactory outcomes. Lower lid rejuvenation is no longer a surgical manipulation of the lid skin, muscle and orbital fat. Regardless of ones ‘cutting’ techniques, fat grafting has become a useful adjunct to address lower lid ageing. As our experience grows this paper provides timely guidance on how to avoid the stigmata of poor grafting technique, fat malposition and asymmetry. Moreover, stepwise methods to address these complications is well thought out, and unlike Some proponents of surgical revision, adheres to the maxim ‘KISS – keep it simple stupid’. As radiofrequency and other skin tightening devices enter the arena, it is likely this challenging area of rejuvenation will remain so, and dealing with complications of energy devices and fat grafting will continue as we build our experiences to lessen the ‘surgical’ aspect of rearranging aged anatomy. The article is clearly divided into under and over correction of the tear trough, and volumetric or contour related issues. This breakdown will equip the reader to consider the combination of issues to formulate a surgical plan. Whilst we hinge most things on evidence, empiricism from leaders in the field is useful, and as this particular area will become a standard in lower lid rejuvenation, appraisals such as these are welcomed. It would have been a bonus to see some discussion regarding what type of fat grafts may have a propensity for poorer outcomes, and what specific fat preparation methods the authors use to mitigate against adverse outcomes.

Revision facial plastic surgery: Correcting bad results in facial plastic surgery.  
Maamari RN, Massry GG, Holds JB.  
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Daniel B Saleh

Newcastle Hospitals, UK.

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