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The Youthful Cheek and the Deep Medial Fat Compartment

Rohrich, Rod J. M.D.; Pessa, Joel E. M.D.; Ristow, Brunno M.D.

Plastic and Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - p 2107-2112
doi: 10.1097/PRS.0b013e31817123c6

Purpose: This article introduces the concept of pseudoptosis as a mechanism of midfacial aging: diminished volume of a specific deep fat compartment leads to an excess skin envelope and the illusion of a more prominent nasolabial fold. Tha anatomy of this deep fat compartment, and of two others, is described.

Methods: Fourteen hemifacial cadaver dissections were performed using the dye injection technique to identify deep medial cheek, submentalis, and sub–orbicularis oris fat compartments. Latex injection was used to investigate the arterial supply.

Results: The deep medial fat compartment was defined in each subject. Two separate areas of deep medial fat exist. The more medial compartment abuts the pyriform membrane. The lateral component lies directly on the maxilla. The anatomy of submentalis and suborbicularis fat was defined.

Conclusions: Loss of volume of deep medial cheek fat leads to pseudoptosis and is an additional determinant of the nasolabial fold. Augmentation of deep medial fat has four effects: it increases anterior projection (not addressed by lateral redraping alone); it diminishes the nasolabial fold; the V-deformity is corrected; and a youthful cheek with natural boundaries is recreated. The term “malar fat” is probably a misnomer: this region is composed of both distinct superficial and deep fat compartments. Submentalis and sub–orbicularis oris fat play a role is the formation of the labiomental hollow and aging lip respectively. Understanding the anatomy of this area lends greater precision to our ability to rejuvenate the aging face.

Dallas, Texas, and San Francisco, Calif.

From the Department of Plastic Surgery, University of Texas Southwestern Medical School, and from California Pacific Medical Center.

Received for publication April 2, 2007; accepted June 23, 2007.

Disclosure: The authors have no financial interest in any technology, instruments, or patents related to the outcome of this research.

Joel E. Pessa, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, Texas 75390-9132,

©2008American Society of Plastic Surgeons