The Facial Adipose Tissue: A Revision

Abstract

Recent advantages in the anatomical understanding of the face have turned the focus toward the subcutaneous and deep facial fat compartments. During facial aging, these fat-filled compartments undergo substantial changes along with other structures in the face. Soft tissue filler and fat grafting are valid methods to fight the signs of facial aging, but little is known about their precise effect on the facial fat. This narrative review summarizes the current knowledge about the facial fat compartments in terms of anatomical location, histologic appearance, immune-histochemical characteristics, cellular interactions, and therapeutic options. Three different types of facial adipose tissue can be identified, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). These various fat types differ in the size of the adipocytes and the collagenous composition of their extracellular matrix and thus in their mechanical properties. Minimal invasive (e.g., soft tissue fillers or fat grafting) and surgical interventions aiming to restore the youthful face have to account for the different fat properties in various facial areas. However, little is known about the macro- and microscopic characteristics of the facial fat tissue in different compartments and future studies are needed to reveal new insights to better understand the process of aging and how to fight its signs best.

The layered anatomy of the jawline

“…Two different types of arrangement were demonstrated: one type (Ghassemi Type 1) is located lateral to the LMS with relatively small fibrous septa enclosing lobules of fat cells, whereas another type of arrangement (Ghassemi Type 2) is located medial to the LMS, where the subcutaneous fat consists of a dense collagen‐muscle fiber meshwork surrounding the fat cells. The change in this arrangement, loose adhesion of skin vs tight adhesion of skin to the underlying musculo‐aponeurotic layer, results in the formation of a sulcus when age‐related changes drive soft‐tissue laxity . The soft tissues lateral to the LMS migrate either medially and/or inferiorly resulting in the formation of the LMS, which becomes more prominent with advancing age.…”

“…Three different types of facial adipose tissue have been described, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). The boundaries between these different types play a crucial role in the formation of the above‐mentioned age‐related clinical manifestations . Another important shift in paradigms occurred after the introduction of the 5 Layers of the face: Layer 1: Skin, Layer 2: Subcutaneous fat including retinacula cutis (composed of fibrous connective tissue), Layer 3: Superficial musculo‐aponeurotic system (SMAS), Layer 4: Deep fat, and Layer 5: Periosteum or deep fascia .…”

“…One of the recent advances in our understanding is provided by the identification of different types of subcutaneous fat. 5 Three different types of facial adipose tissue have been described, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). The boundaries between these different types play a crucial role in the formation of the above-mentioned age-related clinical manifestations.…”

“…The boundaries between these different types play a crucial role in the formation of the above-mentioned age-related clinical manifestations. 5 Another important shift in paradigms occurred after the introduction of the 5 Layers of the face: Periosteum or deep fascia. 6 This layered arrangement of the face provides anatomic guidance for the identification of discrete anatomic structures, thereby increasing the safety of minimally invasive applications and/or enabling the surgeon to target desired structures for the best esthetic outcomes.…”

Aesthetic dermatology: What's new, what's true?

“…Facial adipose tissue is different from abdominal adipose tissue in several regards. It consists of subcutaneous fat pads (sWAT) and dermal white adipose tissue (dWAT) (Kruglikov et al, ). A remarkable modulation of dWAT content can be observed during the aging process.…”