The Clinical Importance of the Fat Compartments in Midfacial Aging

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Abstract

Summary:

The recent identification of the facial fat compartments has greatly affected our understanding of midfacial aging. This article chronicles the discovery of these fat compartments including the shift of attention from a purely gravitational to a volumetric approach to facial aging and the series of methodologies attempted to ultimately define the anatomy of these compartments. The revived interest in volumetric facial rejuvenation including compartment-guided augmentation techniques is discussed. Lastly, the article discusses interesting distributional patterns noted in these fat compartments likely related to the different mechanical and biologic environments of the deep and superficial facial fat pads.

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Most cited references 34

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The fat compartments of the face: anatomy and clinical implications for cosmetic surgery.

Rod J Rohrich, Joel E Pessa (2007)

Observation suggests that the subcutaneous fat of the face is partitioned as distinct anatomical compartments. Thirty hemifacial cadaver dissections were performed after methylene blue had been injected into specified regions. Initial work focused on the nasolabial fat. Dye was allowed to set for a minimum of 24 hours to achieve consistent diffusion. Dissection was performed in the cadaver laboratory using microscopic and loupe magnification. The subcutaneous fat of the face is partitioned into multiple, independent anatomical compartments. The nasolabial fold is a discrete unit with distinct anatomical boundaries. What has been referred to as malar fat is composed of three separate compartments: medial, middle, and lateral temporal-cheek fat. The forehead is similarly composed of three anatomical units including central, middle, and lateral temporal-cheek fat. Orbital fat is noted in three compartments determined by septal borders. Jowl fat is the most inferior of the subcutaneous fat compartments. Some of the structures referred to as "retaining ligaments" are formed simply by fusion points of abutting septal barriers of these compartments. The subcutaneous fat of the face is partitioned into discrete anatomic compartments. Facial aging is, in part, characterized by how these compartments change with age. The concept of separate compartments of fat suggests that the face does not age as a confluent or composite mass. Shearing between adjacent compartments may be an additional factor in the etiology of soft-tissue malposition. Knowledge of this anatomy will lead to better understanding and greater precision in the preoperative analysis and surgical treatment of the aging face.

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Observations on periorbital and midface aging.

V S Lambros (2007)

Many of the anatomical changes of facial aging are still poorly understood. This study looked at the aging process in individuals linearly over time, focusing on aspects of periorbital aging and the upper midface. The author compared photographs of patients' friends and relatives taken 10 to 50 years before with closely matched recent follow-up pictures. The best-matching old and recent pictures were equally sized and superimposed in the computer. The images were then assembled into GIF animations, which automate the fading of one image into the other and back again indefinitely. The following findings were new to the author: (1) the border of the pigmented lid skin and thicker cheek skin (the lid-cheek junction) is remarkably stable in position over time, becoming more visible by contrast, not by vertical descent as is commonly assumed. (2) Orbicularis wrinkles on the cheek and moles and other markers on the upper midface were also stable over decades. (3) With aging, there can be a distinct change in the shape of the upper eyelid. The young upper lid frequently has a medially biased peak. The upper lid peak becomes more central in the older lid. This article addresses these three issues. No evidence was seen here for descent of the globe in the orbit. There seems to be very little ptosis (inferior descent) of the lid-cheek junction or of the upper midface. These findings suggest that vertical descent of skin, and by association, subcutaneous tissue, is not necessarily a major component of aging in those areas. In addition, the arc of the upper lid changes shape in a characteristic way in some patients. Other known changes of the periorbital area are visualized.

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The youthful cheek and the deep medial fat compartment.

Rod J Rohrich, Joel E Pessa, Brunno Ristow (2008)

This article introduces the concept of pseudoptosis as a mechanism of midfacial aging: diminished volume of a specific deep fat compartment leads to an excess skin envelope and the illusion of a more prominent nasolabial fold. Tha anatomy of this deep fat compartment, and of two others, is described.

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Author and article information

Journal

Journal ID (nlm-ta): Plast Reconstr Surg Glob Open

Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open

Journal ID (publisher-id): GOX

Title: Plastic and Reconstructive Surgery Global Open

Publisher: Wolters Kluwer Health

ISSN (Electronic): 2169-7574

Publication date Collection: December 2013

Publication date (Electronic): 06 January 2014

Volume: 1

Issue: 9

Electronic Location Identifier: e92

Affiliations

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.

Author notes

Kathryn Davis, PhD Department of Plastic Surgery University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard F4.310A Dallas, TX 75390–8560 E-mail: kathryn.davis@ 123456utsouthwestern.edu

Article

Accession ID: 00004

DOI: 10.1097/GOX.0000000000000035

PMC ID: 4174112

PubMed ID: 25289286

SO-VID: 5a2c0052-2466-4a22-88d7-c67f2735dadd

Copyright © Copyright © 2013 The Authors. Published by Lippincott Williams & Wilkins on behalf of The American Society of Plastic Surgeons. PRS Global Open is a publication of the American Society of Plastic Surgeons.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

History

Date received : 19 June 2013

Date accepted : 12 November 2013

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