Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume

The Midface

Wenjin Wang, M.D., Ph.D.; Yun Xie, M.D., Ph.D.; Ru-Lin Huang, M.D., Ph.D.; Jia Zhou, M.D., Ph.D.; Herrler Tanja, M.D., Ph.D.; Peijuan Zhao, M.D., Ph.D.; Chen Cheng, M.D., Ph.D.; Sizheng Zhou, M.D., Ph.D.; Lee L. Q. Pu, M.D., Ph.D.; Qingfeng Li, M.D., Ph.D.

Disclosures

Plast Reconstr Surg. 2017;139(3):563-572. 

In This Article

Abstract and Introduction

Abstract

Background: Recent anatomical findings have suggested that facial fat distribution is complex and changes with age. Here, the authors developed a grafting technique based on the physiologic distribution and volume changes of facial fat compartments to achieve a youthful and natural-appearing face.

Methods: Forty cadaveric hemifaces were used for the dissection of fat compartments and neurovascular structures in the midface area. Seventy-eight patients were treated for cheek atrophy using the authors' targeted restoration of midface fat compartment volume. The outcome was evaluated by a two-dimensional assessment, malar lipoatrophy assessment, and a satisfaction survey.

Results: The medial and lateral parts of the deep medial cheek fat compartment were separated by a septum arising from the lateral border of the levator anguli oris muscle. The angular vein traveled between the deep medial cheek fat compartment and the buccal fat pad, 12 mm from the maxilla. A total volume of 29.3 ml of fat was grafted per cheek for each patient. A 12-month follow-up revealed an average volume augmentation rate of 27.1 percent. Pleasing and elevated anterior projection of the cheek and ameliorated nasolabial groove were still obvious by 12 months after the procedure. In total, 95.2 percent of the patients were satisfied with their results.

Conclusions: The present study provides the anatomical and clinical basis for the concept of compartmentally based fat grafting. It allows for the restoration of facial fat volume close to the physiologic state. With this procedure, a natural and youthful facial contour could be rebuilt with a high satisfaction rate.

Introduction

Facial volume loss in both bony and soft tissues results in hollowness and skin ptosis, which leads to concave facial contour and a deepened nasolabial fold and midcheek groove, conveying a tired and exhausted appearance.[1] Autologous fat grafting has become well accepted for facial rejuvenation by both physicians and patients because of the long-lasting effect and safety profile.[2,3] Thus far, multiple techniques have been suggested to optimize fat grafting, such as structural fat grafting (Coleman technique), the 3M3L technique, and nanofat grafting.[4–7]

With the pioneering works by Rohrich and colleagues and the growing number of studies on facial fat distribution, we now understand that facial fat is highly compartmented and not a uniform continuous structure.[8–10] Multiple layers of fat compartments, including both superficial and deep fat compartments, can be identified in the temporal and midcheek area.[11,12] These fat compartments play distinct roles in defining the facial contour and change differently during aging. Therefore, this should be accounted for during facial contouring by fat grafting to avoid a universally augmented balloon-like face.[13,14] Thus, it is necessary to develop a suitable technique for autologous fat grafting that will allow surgeons to restore volume loss while taking into account the physiologic distribution and changes of different fat compartments during aging to rebuild a youthful and natural-appearing face.

Thus far, there is no consensus in the literature regarding the grafting technique and the injection site.[15–17] In this study, we propose the concept of target volume restoration for cheek fat compartments, by which fat is injected according to the physiologic pattern of fat distribution in the youthful face in a compartment-specific manner.

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