Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery

Abstract

Summary Objective There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy. Material and Methods The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy. Results The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the 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. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues. Conclusions The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures.

Full‐face effects of temporal volumizing and temporal lifting techniques

“…From an anatomic perspective, this is plausible as this technique administers the product deep to the deep temporal fascia. This fascia covers the temporal fossa tightly and is strongly adherent to the temporal crest and to the lateral orbital rim 8 ; this limits aesthetic effects to the temporal fossa. This resulted in the observed increase in the respective local assessment scores.…”

“…The number of soft tissue filler injections performed is constantly increasing, as these procedures beget predictable aesthetic effects to ameliorate the signs of facial aging 1‐4 . The treatments are tailored based on patient's needs, aesthetic indication, anatomic region targeted, and product selected 5‐9 . While most injectable filler treatments aim to increase local volume in an aesthetic site of interest, the potential regional or panfacial effects are often not realized.…”

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.…”

Unterlidrekonstruktion mit modifizierter Tenzel‐Plastik nach Resektion eines Lentigo‐maligna‐Melanoms

“…Dabei wurde zunächst der laterale Lidbandapparat, unter Schonung der Haut und des subkutanen Fettgewebes, durchtrennt. Gewebe aus dem periorbitalen lateralen superfiziellen muskuloaponeurotischen System (SMAS) wurde mobilisiert und nach medial verschoben [4,10]. Der größere Defekt am äußeren Lidblatt wurde schließlich über einen lateralen Wangenrotationslappen gedeckt.…”

“…Der teilweise durchgreifende und circa die Hälfte des Augenlides einnehmende Defekt wurde mit einer modifizierten Tenzel‐Plastik [3] gedeckt. Zur Rekonstruktion der hinteren Lidlamelle und somit von Tarsus und Konjunktiva, wurde das periorbitale laterale superfizielle muskuloaponeurotische System (SMAS) mobilisiert und nach medial verschoben [4]. Darauf wurde zur Rekonstruktion der vorderen Lidlamelle ein Wangenlappen rotiert [3,5].…”