Differing Behavior of Facial Fat Compartments

Subcutaneous Fat Compartments in Face

A recent cadaver study of facial subcutaneous fat compartments provides insight as to how these different compartments behave following injection with soft tissue fillers, shedding light on the effects of aging. Authors Thilo L. Schenk, MD, PhD, et al, used 3D imaging and contrasting agents to identify subcutaneous fat compartments in 30 specimens (13 male and 17 female). Their findings, which were confirmed through anatomical dissection, revealed seven bilateral distinct subcutaneous facial fat compartments (not including the three subcutaneous compartments of the forehead): superficial nasolabial, superficial medial cheek, superficial middle cheek, superficial lateral cheek, jowl, superficial superior temporal and superficial inferior temporal.

The researchers evaluated the facial compartments pre- and post-injection while the specimens were in an upright position using contrast-enhanced computed tomographic scanning, magnetic resonance imaging and 3D imaging. Following filler injections, they observed inferior displacement of the superficial nasolabial, middle cheek and jowl compartments. While filler application in the medial cheek, lateral cheek, superficial superior temporal and superficial inferior temporal compartments led to increased volume without displacement (projection). They posit that the difference in outcomes may relate to surrounding ligaments that create more stable boundaries in the latter compartments.

The authors do caution that the study is not meant to offer guidance on injection techniques but rather to further our understanding of the facial subcutaneous fat compartments and their role in the appearance of aging. “It must be noted, however, that the volumes of injected fillers used in this study exceed those volumes typically used during routine facial rejuvenation procedures,” they wrote. “The large amounts injected were specifically chosen for two reasons: (1) to achieve complete filling of the respective compartments, to describe the precise anatomical location and extent of each individual compartment and to prove that boundaries truly exist, although they are not visible during surgical procedures or anatomical dissections; and (2) to simulate the effects of aging in a ‘fast-forward model’ by testing the stability of suspensory structures (ligaments, muscles, or compartment boundaries).”

The study was published in Plastic and Reconstructive Surgery (June 2018)

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