| 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. |
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
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
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).