Commentary on: External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique.

Abstract

The human face is composed of multiple fat layers and compartments. Each fat layer or fat compartment has a different histomorphologic structure, different biomechanical properties, is subject to different external and internal stimuli, and ages differently. Fat layers and compartments also experience differential rates of atrophy or hypertrophy. The superficial subcutaneous “compact” fat layer is relatively resistant to hormonal changes and weight fluctuations, but is quite sensitive to internal and external stressors such as ultraviolet radiation, stress, smoking, and iatrogenic thermal damage. This layer undergoes slow, constant atrophy even when the patient gains weight. Conversely, the subcutaneous “lobular” fat layer of the cheek and neck is sensitive to hormonal changes and weight fluctutions. Although it has been proven that the human face progressively loses volume with aging, this layer holds a lifetime potential for expansion in proportion to bodyweight. Bichat’s deep fat system, the orbital retroseptal fat pads, and the...