Discussion: Aging Changes of the Midfacial Fat Compartments: A Computed Tomographic Study DISCUSSION

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA.
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 01/2012; 129(1):274-5. DOI: 10.1097/PRS.0b013e3182362be2
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    ABSTRACT: Improvements in facelift outcomes are largely based on sound anatomical knowledge and principles. Recent discovery of the numerous fat compartments of the face has improved our ability to more precisely restore facial volume while rejuvenating it through differential SMAS treatment. Incorporation of selective fat compartment volume restoration along with SMAS manipulation allows for improved control in re-contouring while addressing one of the key problems in facial aging, volume deflation. This theory was evaluated by assessing the contour changes from simultaneous face "lifting" and "filling" through fat compartment-guided facial fat transfer. A review of 100 facelift patients was performed. All patients had an individualized component facelift with fat grafting to the nasolabial fold, deep malar and high/lateral malar fat compartment locations. Photographic analysis using a computer program was conducted on oblique facial views, pre and post-operatively, to obtain the most projected malar contour point. Two independent observers visually evaluated the malar prominence and nasolabial fold improvements based on standardized photographs in the ¾ oblique view. The nasolabial fold depth was and malar improvement were scored as a 0 to 3, with 3 representing the deepest NLF and the greatest degree of malar contour improvement. Nasolabial fold improved by at least one grade in 81%, and by over 1 grade in 11%. Through, objective computer evaluation, malar prominence average projection increase was 11.26% while the average amount of lift was 7.85%. The malar prominence score improved by at least 1 grade in 62% of the post op pts and 9% had a greater than 1 improvement. 28% of the patients had a convex malar prominence post operatively versus 6% preoperatively. Malar prominence improved by at least 1 grade in 63%, and by over 1 grade in 10%. The lift and fill facelift merges two key concepts in facial rejuvenation: 1) effective tissue manipulation via lifting and tightening in differential vectors according to original facial asymmetry and shape; and 2) selective fat compartment filling of deep malar and high malar locations as well as nasolabial fold fat grafting to precisely control facial contouring. This was shown with objective numerical grading as well as through observer assessment.
    Plastic and Reconstructive Surgery 02/2014; 133(6). DOI:10.1097/01.prs.0000436817.96214.7e · 3.33 Impact Factor
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    ABSTRACT: Anatomic studies show that facial fat is partitioned into distinct compartments. In the midface, the nasolabial fat (NLF) pad represents a superficial compartment, while the deep medial cheek fat (DMC) represents a deep compartment. While clinical observations suggest that gross morphological differences may exist between these fat depots, this has never been established at the cellular level. Adipose tissue biopsies from NLF and DMC fat pads were obtained from 63 cadaveric specimens (38 female, 25 male) aged 47-101 y (mean 71 y). Thirty-seven cadavers had normal BMI (≤25 kg/m) and 26 cadavers had high BMI (>25 kg/m). Cross-sectional areas (µm) of individual adipocytes were digitally calculated and averaged from histologic sections of the adipose tissue samples. The average adipocyte size of NLF is significantly (p<0.0001) larger than DMC throughout all specimens. The average adipocyte size in both NLF and DMC is significantly (p<0.0001) larger in high BMI subjects compared to low BMI subjects. While the overall average adipocyte size is significantly (p<0.0001) larger in females than in males, this sexual dimorphism is lost in the NLF depots of overweight subjects and in the DMC depots of normal-weight subjects. The significantly smaller adipocyte size in DMC relative to NLF 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 their morphologic behavior over time and the different patterns of volumetric facial aging.
    Plastic and Reconstructive Surgery 01/2014; 133(5). DOI:10.1097/PRS.0000000000000100 · 3.33 Impact Factor
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    ABSTRACT: The recent identification of the facial fat compartments has greatly affected our understanding of midfacial aging. This article chronicles the discovery of these fat compartments including the shift of attention from a purely gravitational to a volumetric approach to facial aging and the series of methodologies attempted to ultimately define the anatomy of these compartments. The revived interest in volumetric facial rejuvenation including compartment-guided augmentation techniques is discussed. Lastly, the article discusses interesting distributional patterns noted in these fat compartments likely related to the different mechanical and biologic environments of the deep and superficial facial fat pads.
    12/2013; 1(9):e92. DOI:10.1097/GOX.0000000000000035