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The Functional Anatomy of the Deep Facial Fat Compartments

A Detailed Imaging-Based Investigation

Cotofana, Sebastian, M.D., Ph.D.; Gotkin, Robert H., M.D.; Frank, Konstantin, M.D.; Koban, Konstantin C.; Targosinski, Stefan, M.D.; Sykes, Jonathan M., M.D.; Schlager, Markus; Schlattau, Alexander, M.D.; Schenck, Thilo L., M.D., Ph.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 53–63
doi: 10.1097/PRS.0000000000005080
Cosmetic: Original Articles
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Background: Injection of soft-tissue fillers into the facial fat compartments is frequently performed to ameliorate the signs of facial aging. This study was designed to investigate the functional anatomy of the deep facial fat compartments and to provide information on the effects of injected material in relation to age and gender differences.

Methods: Forty fresh frozen cephalic specimens of 17 male and 23 female Caucasian body donors (mean age, 76.9 ± 13.1 years; mean body mass index, 23.6 ± 5.3 kg/m2) were investigated. Computed tomographic and magnetic resonance imaging procedures were carried out using colored contrast-enhanced materials with rheologic properties similar to commercially available soft-tissue fillers. Anatomical dissections were performed to guide conclusions.

Results: No statistically significant influences of age or gender were detected in the investigated sample. Increased amounts of injected contrast agent did not correlate with inferior displacement of the material in any of the investigated compartments: deep pyriform, deep medial cheek, deep lateral cheek, deep nasolabial (located within the premaxillary space), and the medial and lateral sub–orbicularis oculi fat.

Conclusions: Increasing volume in the deep midfacial fat compartments did not cause inferior displacement of the injected material. This underscores the role of deep soft-tissue filler injections (i.e., in contact with the bone) in providing support for overlying structures and resulting in anterior projection.

Albany and New York, N.Y.; Sacramento, Calif.; Munich, Germany; Zurich, Switzerland; and Salzburg, Austria

From the Department of Medical Education, Albany Medical College; private practice; Facial Plastic and Reconstructive Surgery, University of California, Davis Medical Center; the Department for Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University; the Division of Thoracic Surgery, University Hospital Zurich; and the Department of Radiology, Paracelsus Medical University Salzburg & Nuremberg.

Received for publication January 6, 2018; accepted July 11, 2018.

Disclosure: None of the authors has any commercial associations or financial disclosures that might pose or create a conflict of interest with the methods applied or the results presented in this article.

Sebastian Cotofana, M.D., Ph.D., Albany Medical College, 47 New Scotland Avenue, MC-135, Albany, N.Y. 12208,, Instagram: professorsebastiancotofana

©2019American Society of Plastic Surgeons