Midfacial Fat Compartments Research Articles

The mobility of the superficial and deep midfacial fat compartments: An ultrasound-based investigation.

Understanding the mobility of the midface and the separate contributions of the superficial and deep fat compartments is essential for natural esthetic outcomes following soft tissue filler or fat grafting procedures. A study was designed that used ultrasound imaging to demonstrate in vivo visualization and quantification of distances and movements in the midface. A total of 48midfaces of 24healthy Caucasian volunteers, all naïve of esthetic procedures, (22 females; 46.85 (9.8) years; 22.83 (3.1) kg/m2 ) were scanned using 18MHz ultrasound imaging. Distances between bony landmarks (inferior orbital rim, infraorbital foramen) were used as markers to measure the cranial movement of the superficial (superficial nasolabial and superficial medial cheek fat compartment) and the deep (deep pyriform space, deep medial check fat compartment, deep lateral cheek fat compartment) midfacial fat compartments between resting and smiling facial position. The superficial midfacial fat compartment moved, on average, 3.7mm (p<0.001) cranially, whereas the deep midfacial fat compartments moved, on average, 0.1mm (p>0.05) during smiling. No gender differences in mobility were identified (p>0.05). The results obtained are in line with previous cadaveric investigations and revealed, in a highly statistically significant fashion, that the superficial midfacial fat compartments move in cranial direction whereas the deep fat compartment did not display similar positional changes. These results help to guide facial injectable treatments and to understand why, in the midface, a deep supraperiosteal approach should be favored when augmenting the deep midfacial fat compartments.

Can smiling influence the blood flow in the facial vein?-An experimental study.

The understanding of functional facial anatomy and the interplay between facial structures is crucial for safe and effective minimally invasive and cosmetic surgical procedures. In this experimental study, we investigate the hypothesis that smiling can alter the blood flow in the angular/facial vein. Twenty-six observations from 15 healthy volunteers (6 men, 9 women) with a mean age of 50.53±13.27 (range: 24-66) were obtained. Doppler ultrasound imaging of the infraorbital segment of the angular vein (cranial to the zygomaticus major muscle) was performed and the venous flow was measured in a smiling and a resting, nonsmiling facial position. A statistically significant change in venous blood flow was detected upon smiling: a reduction in flow from 6.12±3.0cm/s to 0.52±1.3cm/s (P=.001). After three seconds, 80.8% of the observations had a blood flow of 0.0cm/s. Increasing age was significantly correlated with a persistent blood flow during smiling (rp =.469; P=.016). No differences between gender and sides of the face were observed. The results of this experimental study reveal that smiling can significantly reduce the venous flow in the angular/facial vein. Contraction of the zygomaticus major muscle compresses the vein against the underlying maxilla. Both minimally invasive and surgical procedures that alter the SMAS, the periocular musculature or the deep midfacial fat compartments might affect angular/facial venous flow.

Anatomy Behind the Facial Overfilled Syndrome: The Transverse Facial Septum.

The midface is an area of high demand for minimally invasive cosmetic procedures, that is, soft-tissue filler injections. To investigate the functional anatomy behind the facial overfilled syndrome observed after soft-tissue filler injections. The clinical part of the study enrolled 25 volunteers (12 men and 13 women, Caucasians); the anatomical part included 72 fresh frozen cephalic specimens obtained from 32 male and 40 female body donors. 3D surface scanning procedures were applied to calculate the maximal anterior projection of the midface. Upon smiling, the point of maximal anterior projection shifted cranially in men by 12.43 ± 8.8 mm (difference between resting and smiling; p < .001) and by 8.75 ± 4.1 mm in women (p < .001). Cadaveric dissections identified a septum originated from the underside of the zygomaticus major muscle forming a transversely running boundary between the buccal space and the deep midfacial fat compartments. Facial overfilled syndrome can potentially be explained by the presence of the transverse facial septum. Dynamic filling-injecting small amounts of filler and asking the patient to smile repeatedly during the procedure-seems to be a viable way to avoid this adverse event during soft-tissue filler injection.

Analysis of age-related changes in midfacial fat compartments in Asian women using computed tomography

Volume restoration is no more a fresh theory for midfacial rejuvenation. However, lack of knowledge regarding the natural ageing process of fat compartments often leads to an insufficient or excessive clinical result. The aim of this study is to reveal the age-related changes in midfacial fat compartments and the correlation between midfacial grooves and the related fat compartments. This study included 60 Asian females in defined age-based categories. The thickness of the infraorbital fat compartment, the nasolabial fat compartment, and the cheek fat compartments were measured using computed tomography (CT) images. Analysis of correlations between midfacial grooves and the related fat compartments was performed using the SPSS software. A tendency of thickening in the infraorbital fat and nasolabial fat compartments with age was observed. The superficial layer of cheek fat compartments was found to be thinner, and a similar tendency was observed in the medial part of deep medial cheek fat. However, it was thicker in the lateral part of deep medial cheek fat. There was a negative correlation between the fat thickness of deep medial cheek fat and both the severity of tear trough deformity and the nasolabial fold. A positive correlation between the lower third of the nasolabial fat compartment and the severity of the nasolabial fold was found as well. Different midfacial fat compartments tended to undergo selective hypertrophy or atrophy with ageing. The findings of this study suggested that augmentation of the deflated fat compartment and liposuction of the hypertrophic fat compartment can provide a more natural effect in facial rejuvenation.

The Functional Anatomy of the Deep Facial Fat Compartments: A Detailed Imaging-Based Investigation.

Injection of soft-tissue fillers into the facial fat compartments is frequently performed to ameliorate the signs of facial aging. This study was designed to investigate the functional anatomy of the deep facial fat compartments and to provide information on the effects of injected material in relation to age and gender differences. Forty fresh frozen cephalic specimens of 17 male and 23 female Caucasian body donors (mean age, 76.9 ± 13.1 years; mean body mass index, 23.6 ± 5.3 kg/m(2)) were investigated. Computed tomographic and magnetic resonance imaging procedures were carried out using colored contrast-enhanced materials with rheologic properties similar to commercially available soft-tissue fillers. Anatomical dissections were performed to guide conclusions. No statistically significant influences of age or gender were detected in the investigated sample. Increased amounts of injected contrast agent did not correlate with inferior displacement of the material in any of the investigated compartments: deep pyriform, deep medial cheek, deep lateral cheek, deep nasolabial (located within the premaxillary space), and the medial and lateral sub-orbicularis oculi fat. Increasing volume in the deep midfacial fat compartments did not cause inferior displacement of the injected material. This underscores the role of deep soft-tissue filler injections (i.e., in contact with the bone) in providing support for overlying structures and resulting in anterior projection.

Progressive Improvement in Midfacial Volume 18 to 24 Months After Simultaneous Fat Grafting and Facelift: An Insight to Fat Graft Remodeling.

Although many facelift techniques incorporate fat grafting with tissue repositioning and removal, the intermediate and long-term changes in facial volume after these techniques is unknown. Whereas fillers for facial volume have predictable life spans, we know little about the facial volume changes following fat grafting with facelift surgery. The authors sought to track the short-term and long-term effects on midfacial volume change. We evaluated a subset of patients who were followed by 3-dimensional (3D) photometric imaging 18 to 24 months after facelift with fat grafting to the deep midfacial fat compartments and buccal fat pads. Volume changes were measured preoperatively and postoperatively every 1, 3, 6, 12, 18, and 24 months using the 3D photometry. At the 1- to 2-month follow-up period, average facial volume was 49.60% of the initial fat injected. At the 18- to 24-month follow-up period, average facial volume was 73.64% of the initial fat injected, indicating an increase in midfacial volume. Upon graphing available photometric data, dynamic changes in facial volume were observed. In 5 midfacial zones, facial volume appeared to initially decline (average decline, 49.0% of original fat injection), troughing at 10 months (range, 2-15 months), but later inclined (average increase in volume, 95.9% of original fat injection), peaking around 16 months (range, 4-24 months). Progressive improvement in midfacial volume in part may be explained by the graft replacement theory of Suga and Yoshimura, which suggests that grafted adipose tissue immediately dies after transplantation and is replaced by adipose-derived stem or progenitor cells.

Progress of midfacial fat compartments and related clinical applications

To review the research progress of midfacial fat compartments, and to thoroughly understand its current state of the anatomy and the aging morphologic characters of midfacial fat compartments, as well as the current status of clinical applications. The recent literature concerning the midfacial fat compartments and related clinical applications were extensively reviewed and analyzed. Midfacial fat layer has been considered as a fusion and a continuous layer, experiencing a global atrophy when aging. As more anatomical researches have done, recent studies have shown that midfacial fat layer is broadly divided into superficial and deep layers, which are both divided into different fat compartments by fascia, ligaments, or muscles. Midfacial fat compartments tend to atrophy with age, specifically in the deep fat compartments while hypertrophy in the superficial fat compartments. Clinical applications show that fat volumetric restoration with deep medial cheek fat and Ristow's space can restore the appearance of midface effectively. In recent years, the researches of midfacial fat compartments have achieved obvious progress, which will provide new ideas and basis for fat volumetric restoration. Corresponding treatments are selected based on different sites and different layers with different aging changes, reshaping a more youthful midface.

The Differing Adipocyte Morphologies of Deep versus Superficial Midfacial Fat Compartments: A Cadaveric Study: Correction

The Differing Adipocyte Morphologies of Deep versus Superficial Midfacial Fat Compartments: A Cadaveric Study: Correction

The Differing Adipocyte Morphologies of Deep versus Superficial Midfacial Fat Compartments

Anatomical studies show that facial fat is partitioned into distinct compartments, with the nasolabial fat pad in a superficial compartment and the deep medial cheek fat in a deep compartment. Gross morphologic differences may exist between these fat depots, but this has never been established at the cellular level. Adipose tissue specimens from nasolabial fat and deep medial cheek fat pads were obtained from 63 cadaveric specimens (38 female and 25 male cadavers) aged 47 to 101 years (mean, 71 years). Thirty-seven cadavers had a normal body mass index (≤25 kg/m) and 26 cadavers had a high body mass index (>25 kg/m). Cross-sectional areas of individual adipocytes were calculated digitally and averaged from histologic sections of the adipose tissue samples. The average adipocyte size of nasolabial fat is significantly (p < 0.0001) larger than that of deep medial cheek fat. The average adipocyte size in both nasolabial and deep medial cheek fat is significantly (p < 0.0001) larger in subjects with high compared with low body mass index. Although the overall average adipocyte size is significantly (p < 0.0001) larger in female than in male subjects, this sexual dimorphism is lost in the nasolabial fat depots of overweight subjects and in the deep medial cheek depots of normal-weight subjects. The significantly smaller adipocyte size in deep medial cheek fat relative to nasolabial fat in elderly subjects supports the theory that deep and superficial facial fat pads are morphologically different. Future investigation of the metabolic and structural properties of these fat compartments will help us understand the different patterns of volumetric facial aging.

Computer-assisted midface reconstruction in Treacher Collins syndrome part 2: Soft tissue reconstruction

IntroductionTreacher Collins syndrome (TCS) midfacial involvement associate a skeletal hypoplasia centred on the zygoma to a hypoplasia of all surrounding soft tissues layers and an inferolateral lower lid pseudocoloboma. TCS soft tissue hypoplasia, which has not been well studied, continues to bring challenges in both the indication of surgical treatment and the prediction of their results. Material and methodFrom a standard magnetic resonance imaging (MRI) acquisition, we studied qualitatively and quantitatively the prezygomatic fat compartments and the buccal fat pad of two individuals with TCS whose age were 10 and 14 years. In parallel, we studied 20 controls at the same age to obtain a morphometric database of reference and compare our results. TCS soft tissue involvement was correlated to the results of our prior skeletal involvement study. ResultsThe midfacial fat compartments in TCS are severely hypoplastic, especially in the superficial and lateral compartments of the face (all P's < 0.001). No significant correlation existed between the soft tissue and the skeletal involvement. ConclusionsTo our knowledge, this is the first published study of TCS midfacial fat compartments. Their hypoplasia is an important part of the syndrome's facial deformity. The knowledge of their anatomy, organization and volumetric variation is essential. Their re-establishment is key in the early treatment phases of this syndrome. Using the preoperative data, the morphometric database of reference, and surgical simulation, an appropriate surgical technique, going from an autologous fat graft to a free flap, can then be chose.

CT Shows Age-Related Downward Shift of Midfacial Fat Compartments

With the goal of further understanding facial fat distribution and how it is affected by age-related changes, investigators used computed tomography in combination with injectable dyes to illustrate the location of the facial fat compartments of four male and eight female cadavers. The results were divided into two groups by age at death: …

Aging Changes of the Midfacial Fat Compartments

The restoration of a natural volume distribution is a major goal in facial rejuvenation. The aims of this study were to establish a radiographic method enabling effective measurements of the midfacial fat compartments and to compare the anatomy between human cadavers of younger versus older age. Data from computed tomographic scans of 12 nonfixed cadaver heads, divided into two age groups (group 1, 54 to 75 years, n = 6; and group 2, 75 to 104 years, n = 6), were analyzed. For evaluation of the volume distribution within a specific compartment, the sagittal diameter of the upper, middle, and lower thirds of each compartment was determined. For evaluation of a "sagging" of the compartments, the distance between the cephalad border and the infraorbital rim was determined. Computed tomography enables a reproducible depiction of the facial fat compartments and reveals aging changes. The distance between the fat compartments and the infraorbital rim was higher in group 2 compared with group 1. The sagittal diameter of the lower third of the compartments was higher, and the sagittal diameter of the upper third was smaller in group 2 compared with group 1. The buccal extension of the buccal fat pad was shown to be an independent, separate compartment. This study demonstrates an inferior migration of the midfacial fat compartments and an inferior volume shift within the compartments during aging. Additional distinct compartment-specific changes (e.g., volume loss of the deep medial cheek fat and buccal extension of the buccal fat pad) contribute to the appearance of the aged face.

Redraping the inferior orbicularis arc.

The surgical technique of redraping of the inferior arc of the orbicularis oculi muscle is used primarily to produce lower lid and midfacial smoothing in patients undergoing aesthetic surgery. The midfacial fat compartments, suborbicularis oculi fat and malar fat, are bound to the orbicularis muscle by the superficial muscular aponeurotic system so that redraping the orbicularis muscle also repositions the midface. Orbicularis arc redraping should be accompanied by lateral canthoplasty to ensure stability to the shape of the eyelid fissure postoperatively. Modifications in orbicularis redraping and canthoplasty technique are necessary in patients with prominent eyes and distensible lower lids. Supraplacement of canthal fixation is needed in patients with prominent eyes, and lid shortening is needed in patients who have distensible lower lids. This technique also can be used in patients undergoing reconstructive surgery for correction of lower lid retraction because of its ability to recruit periorbital skin upward into the lower lid. For more severe cases of lower lid retraction after aesthetic surgery, adjunctive procedures such as spacer implants in the lower lid and periosteal flap canthoplasty can be used together with the orbicularis arc redraping to rehabilitate patients.