Progress of midfacial fat compartments and related clinical applications_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEN Lihong , WANG Jinhuang , LI Yang ,  LIU Dalie

Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou Guangdong, 510282, P.R.China;

Corresponding author：

LIU Dalie, Email: liudalie8811@126.com

Keywords：

Midface; fat compartment; aging; deep medial cheek fat; Ristow’s space

DOI：

10.7507/1002-1892.201710088

Video：

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Objective 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. Methods The recent literature concerning the midfacial fat compartments and related clinical applications were extensively reviewed and analyzed. Results 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. Conclusion 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.

Citation： WEN Lihong, WANG Jinhuang, LI Yang, LIU Dalie. Progress of midfacial fat compartments and related clinical applications. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 248-251. doi: 10.7507/1002-1892.201710088 Copy

1.	Little JW. Volumetric perceptions in midfacial aging with altered priorities for rejuvenation. Plast Reconstr Surg, 2000, 105(1): 252-266.
2.	Ko AC, Korn BS, Kikkawa DO, et al. The aging face. Surv Ophthalmol, 2017, 62(2): 190-202.
3.	Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg, 2007, 119(7): 2219-2227.
4.	Rohrich RJ, Ghavami A, Lemmon JA, et al. The individualized component face lift: developing a systematic approach to facial rejuvenation. Plast Reconstr Surg, 2009, 123(3): 1050-1063.
5.	Raskin E, Latrenta GS. Why do we age in our cheeks? Aesthet Surg J, 2007, 27(1): 19-28.
6.	Rohrich RJ, Arbique GM, Wong C, et al. The anatomy of suborbicularis fat: implications for periorbitalrejuvenation. Plast Reconstr Surg, 2009, 124(3): 946-951.
7.	Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment.Plast Reconstr Surg, 2008, 121(6): 2107-2112.
8.	Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg, 2009, 124(1): 266-271.
9.	Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septalboundaries of the subcutaneous fat compartments. Plast Reconstr Surg, 2008, 121(5): 1804-1809.
10.	Gierloff M, Stöhring C, Buder T, et al. Aging changes of the midfacial fat compartments: a computed tomographic. Plast Reconstr Surg, 2012, 129(1): 263-273.
11.	Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg, 2000, 26(12): 1107-1112.
12.	Hamra ST. The deep-plane rhytidectomy.Plast Reconstr Surg, 1990, 86(1): 53-61.
13.	Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg, 2007, 120(5): 1367-1376.
14.	Gosain AK, Amarante MT, Hyde JS, et al. A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery. Plast Reconstr Surg, 1996, 98(4): 622-636.
15.	Gosain AK, Klein MH, Sudhakar PV, et al. A volumetric analysis of soft-tissue changes in the aging midfaceusing high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg, 2005, 115(4): 1143-1152.
16.	Schaverien MV, Pessa JE, Rohrich RJ. Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg, 2009, 123(2): 695-700.
17.	Wan D, Amirlak B, Rohrich RJ, et al.The clinical importance of the fat compartments in midfacial aging. Plast Reconstr Surg Glob Open, 2013, 1(9): e92.
18.	Cotofana S, Schenck TL, Trevidic P, et al. Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg, 2015, 136(5 Suppl): 219S-234S.
19.	González-Ulloa M, Flores ES.Senility of the face basic study to understand its causes and effects.Plast Reconstr Surg, 1965, 36: 239-246.
20.	Jang MS, Kim HY, Dhong HJ, et al. An analysis of Asian midfacial fat thickness according to age group using computed tomography. J Plast Reconstr Aesthet Surg, 2015, 68(3): 344-350.
21.	Rohrich RJ, Ghavami A, Constantine FC, et al. Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg, 2014, 133(6): 756e-767e.
22.	Flowers RS. Tear trough implants for correction of tear trough deformity. Clin Plast Surg, 1993, 20(2): 403-415.
23.	Freeman MS.Transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty: a new technique for the effacement of nasojugal deformity. Arch Facial Plast Surg, 2000, 2(1): 16-21.
24.	Rohrich RJ, Ghavami A, Mojallal A. The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg, 2011, 128(3): 775-783.
25.	Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg, 2002, 110(3): 885-896.
26.	Gerber DL, Barton FE Jr, Little JW, et al. Management of the jowl. Aesthet Surg J, 2001, 21(1): 55-60.
27.	Wang Wj, Xie Y, Huang RL, et al. Facial contouring by targeted restoration of facial fat compartment volume. Plast Reconstr Surg, 2017, 139(3): 563-572.
28.	Cattin TA. A single injection technique for midface rejuvenation. J Cosmet Dermatol, 2010, 9(3): 256-259.
29.	Braz AV, Sakuma TH. Midface rejuvenation: an innovative technique to restore cheek volume. Dermatol Surg, 2012, 38(1): 118-120.
30.	Surek CK, Vargo J, Lamb J. Deep pyriformspace: anatomical clarification and clinical inplications. Plast Reconstr Surg, 2016, 138(1): 59-64.
31.	Pilsl U, Rosmarin W, Anderhuber F. The premaxillaryspace: alocation for filler injection? Dermatol Surg, 2014, 40(3): 301-304.
32.	Einan-Lifshitz A, Holds JB, Wulc AE, et al. Volumetric rejuvenation of the tear trough with repo and ristow. Ophthal Plast Reconstr Surg, 2013, 29(6): 481-485.

1. Little JW. Volumetric perceptions in midfacial aging with altered priorities for rejuvenation. Plast Reconstr Surg, 2000, 105(1): 252-266.
2. Ko AC, Korn BS, Kikkawa DO, et al. The aging face. Surv Ophthalmol, 2017, 62(2): 190-202.
3. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg, 2007, 119(7): 2219-2227.
4. Rohrich RJ, Ghavami A, Lemmon JA, et al. The individualized component face lift: developing a systematic approach to facial rejuvenation. Plast Reconstr Surg, 2009, 123(3): 1050-1063.
5. Raskin E, Latrenta GS. Why do we age in our cheeks? Aesthet Surg J, 2007, 27(1): 19-28.
6. Rohrich RJ, Arbique GM, Wong C, et al. The anatomy of suborbicularis fat: implications for periorbitalrejuvenation. Plast Reconstr Surg, 2009, 124(3): 946-951.
7. Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment.Plast Reconstr Surg, 2008, 121(6): 2107-2112.
8. Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg, 2009, 124(1): 266-271.
9. Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septalboundaries of the subcutaneous fat compartments. Plast Reconstr Surg, 2008, 121(5): 1804-1809.
10. Gierloff M, Stöhring C, Buder T, et al. Aging changes of the midfacial fat compartments: a computed tomographic. Plast Reconstr Surg, 2012, 129(1): 263-273.
11. Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg, 2000, 26(12): 1107-1112.
12. Hamra ST. The deep-plane rhytidectomy.Plast Reconstr Surg, 1990, 86(1): 53-61.
13. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg, 2007, 120(5): 1367-1376.
14. Gosain AK, Amarante MT, Hyde JS, et al. A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery. Plast Reconstr Surg, 1996, 98(4): 622-636.
15. Gosain AK, Klein MH, Sudhakar PV, et al. A volumetric analysis of soft-tissue changes in the aging midfaceusing high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg, 2005, 115(4): 1143-1152.
16. Schaverien MV, Pessa JE, Rohrich RJ. Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg, 2009, 123(2): 695-700.
17. Wan D, Amirlak B, Rohrich RJ, et al.The clinical importance of the fat compartments in midfacial aging. Plast Reconstr Surg Glob Open, 2013, 1(9): e92.
18. Cotofana S, Schenck TL, Trevidic P, et al. Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg, 2015, 136(5 Suppl): 219S-234S.
19. González-Ulloa M, Flores ES.Senility of the face basic study to understand its causes and effects.Plast Reconstr Surg, 1965, 36: 239-246.
20. Jang MS, Kim HY, Dhong HJ, et al. An analysis of Asian midfacial fat thickness according to age group using computed tomography. J Plast Reconstr Aesthet Surg, 2015, 68(3): 344-350.
21. Rohrich RJ, Ghavami A, Constantine FC, et al. Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg, 2014, 133(6): 756e-767e.
22. Flowers RS. Tear trough implants for correction of tear trough deformity. Clin Plast Surg, 1993, 20(2): 403-415.
23. Freeman MS.Transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty: a new technique for the effacement of nasojugal deformity. Arch Facial Plast Surg, 2000, 2(1): 16-21.
24. Rohrich RJ, Ghavami A, Mojallal A. The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg, 2011, 128(3): 775-783.
25. Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg, 2002, 110(3): 885-896.
26. Gerber DL, Barton FE Jr, Little JW, et al. Management of the jowl. Aesthet Surg J, 2001, 21(1): 55-60.
27. Wang Wj, Xie Y, Huang RL, et al. Facial contouring by targeted restoration of facial fat compartment volume. Plast Reconstr Surg, 2017, 139(3): 563-572.
28. Cattin TA. A single injection technique for midface rejuvenation. J Cosmet Dermatol, 2010, 9(3): 256-259.
29. Braz AV, Sakuma TH. Midface rejuvenation: an innovative technique to restore cheek volume. Dermatol Surg, 2012, 38(1): 118-120.
30. Surek CK, Vargo J, Lamb J. Deep pyriformspace: anatomical clarification and clinical inplications. Plast Reconstr Surg, 2016, 138(1): 59-64.
31. Pilsl U, Rosmarin W, Anderhuber F. The premaxillaryspace: alocation for filler injection? Dermatol Surg, 2014, 40(3): 301-304.
32. Einan-Lifshitz A, Holds JB, Wulc AE, et al. Volumetric rejuvenation of the tear trough with repo and ristow. Ophthal Plast Reconstr Surg, 2013, 29(6): 481-485.

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