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

Abstract

Background: 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. Methods: 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/m2) 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. Results: 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. Conclusions: 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.

Lifting vs volumizing—The difference in facial minimally invasive procedures when respecting the line of ligaments

“…Recent studies have shown that over time fat is redistributed from subcutaneous locations such as the superficial and deep facial fat compartments to intra‐abdominal or ectopic locations such as the liver or the bone marrow . This supports the fatty deflation theory and explains the absolute (not relative) descent of some of the superficial and deep facial fat compartments with aging . Applying soft tissue filler can reflate the targeted facial fat compartments leading to restoration of volume.…”

The Influence of the Insertion Angle on Middle and Lower Face Tissue-Mechanics When Treating the Nasolabial Folds with Facial Suspension Threads—An Experimental Split-Face Cadaveric Study

“…The cadaveric model, utilizing fresh, nonembalmed body donors, has provided previously reliable and clinically relevant results when investigating and validating various facial structures and procedures. This model was chosen in the past to describe the facial fat compartments, [34][35][36] facial danger zones, the pathophysiology behind injection-related visual compromises, 37,38 and when establishing the surfacevolume-coefficient, a novel parameter to describe soft tissue filler effectiveness. 29,32 However, the present study is the first to investigate the biomechanical effects of facial suspension threads in a cadaveric model.…”

A New Approach in the Correction of the Midcheek Groove: The Liquid Malar-lift Technique

“…Another structure of interest is the infraorbital nerve, which exits the infraorbital foramen and is thereafter enclosed in a fascial sheet together with the infraorbital artery and vein. 3 For a safe filler application, it is noteworthy that the medial border of the DMCF is formed by this fascial sheet. On the other hand, it should be taken into account that the angular vein forms the lateral border of the DMCF and the medial border of the DLCF.…”

“…On the other hand, it should be taken into account that the angular vein forms the lateral border of the DMCF and the medial border of the DLCF. 3 Filler application into the superficial fat compartments using a cannula is relatively a safe procedure.…”