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Plastic and Reconstructive Surgeon, San Francisco, CA Dr. Brunno Ristow, American Society for Aesthetic Plastic Surgery
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Contact Dr. Ristow by phone 415.202.1507, San Francisco, CA
Dr. Brunno Ristow, renown Plastic Surgeon
 
Aesthetic Plastic Surgeon Dr. Brunno Ristow, San Francisco, California Diplomate of the American Board of Plastic Surgery
 
Ristow's Space has been augmented on the patient's right side. On the left, Ristow's Space is so sunken that almost all of the patient's upper lip is visible.

Ristow’s Space

Among Dr. Ristow's major contributions to the field of facial rejuvenation is "Ristow's Space." At the base of the nose, where the alae meet the cheek, a youthful appearance is created by underlying bone and, crucially, fat. Dr. Ristow was aware of bone resorption as part of the aging process, but he observed that the overlying fat disappeared almost completely from the compartment as well.

In the 1990s Dr. Ristow began to relocate small amounts of the patient's own fat, harvested from excess facial tissue removed during the rejuvenation procedure, back into the compartment with a canula. The compartment into which the fat was injected has become known as "Ristow's Space” after one of Dr. Ristow’s colleagues, Joel E. Pessa, M.D., observed Dr. Ristow volumizing the compartment during an office visit in 1998. Dr. Pessa, Dr. Rod Rohrich and Dr. Ristow penned an influential article for The Journal of the American Society of Plastic Surgeons that established Ristow’s Space as one of the most important loci for facial rejuvenation. 1

“Ristow's Space" is bounded medially by the pyriform ligament of the nasal base, superiorly by the ORL, and lies just deep to the orbicularis oculi muscle. In addition to supporting facial rejuvenation, volumizing "Ristow's Space" has become an important practice in the treatment of tear trough deformity. 2



Footnotes:
1 Rod Rohrich, M.D., Joel E. Pessa, M.D., Brunno Ristow, M.D. (June 2008). "The Youthful Cheek and the Deep Medial Fat Compartment". Plastic and Reconstructive Surgery: The Journal of the American Society of Plastic Surgeons 121 (6).
2 Einan-Lifshitz, Adi M.D.; Holds, John B. M.D.; Wulc, Allan E. M.D.; Hartstein, Morris E. M.D. (November/December 2013). "Volumetric Rejuvenation of the Tear Trough With Repo and Ristow". Ophthalmic Plastic & Reconstructive Surgery (Lippincott, Williams & Wilkins).