With aging we observe ptosis of soft tissues, such as fat pads migrations in the face, particularly in the lower cheek. As you can see in the picture below, it is very important to distinguish between malar fat (in red) and jowl fat (in green). With aging, malar fat decreases and goes down, creating hollowing of the temple, the lateral cheek and the central cheek. In elderly patients, both fat pads become closer between each other, which makes more difficult to apply the enzymes where they should be applied. In these elderly patients we need to be extra careful, because it is crucial to specifically delimit just the lower third in order to reduce jowl fat without reducing malar fat, which is not our target. If the lipase degraded malar fat, we would be enhancing the hollowing even more, causing a facial depression, so malar fat shouldn’t be touched.