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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182362b96
Cosmetic: Original Articles

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

Gierloff, Matthias M.D., D.M.D.; Stöhring, Christine M.D.; Buder, Thomas; Gassling, Volker M.D., D.M.D.; Açil, Yahja Ph.D.; Wiltfang, Jörg M.D., D.M.D., Ph.D.

Discussion
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Abstract

Background: The restoration of a natural volume distribution is a major goal in facial rejuvenation. The aims of this study were to establish a radiographic method enabling effective measurements of the midfacial fat compartments and to compare the anatomy between human cadavers of younger versus older age.

Methods: Data from computed tomographic scans of 12 nonfixed cadaver heads, divided into two age groups (group 1, 54 to 75 years, n = 6; and group 2, 75 to 104 years, n = 6), were analyzed. For evaluation of the volume distribution within a specific compartment, the sagittal diameter of the upper, middle, and lower thirds of each compartment was determined. For evaluation of a “sagging” of the compartments, the distance between the cephalad border and the infraorbital rim was determined.

Results: Computed tomography enables a reproducible depiction of the facial fat compartments and reveals aging changes. The distance between the fat compartments and the infraorbital rim was higher in group 2 compared with group 1. The sagittal diameter of the lower third of the compartments was higher, and the sagittal diameter of the upper third was smaller in group 2 compared with group 1. The buccal extension of the buccal fat pad was shown to be an independent, separate compartment.

Conclusions: This study demonstrates an inferior migration of the midfacial fat compartments and an inferior volume shift within the compartments during aging. Additional distinct compartment-specific changes (e.g., volume loss of the deep medial cheek fat and buccal extension of the buccal fat pad) contribute to the appearance of the aged face.

©2012American Society of Plastic Surgeons

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