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The Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery

McCafferty, Leo R. M.D.

Plastic and Reconstructive Surgery: March 2008 - Volume 121 - Issue 3 - p 1061
doi: 10.1097/01.prs.0000299635.55815.2e

Plastic Surgery, 580 South Aiken Avenue, Suite 530, Pittsburgh, Pa. 15232,,


I congratulate Dr. Rohrich and Dr. Pessa on a very interesting, illuminating, and well-executed study (Plast. Reconstr. Surg. 119: 2219, 2007). Certainly the description of the fat compartments along with the septal boundaries, perhaps contributing to ligaments, “fusion zones,” or areas of fixation, adds to the anatomical knowledge of the aging face. The article points out that aging (as seen in Fig. 2 of the article) leads to abrupt contour changes between the fat compartments, and it is speculated that these contour changes may be due in part to volume loss, as Lambros suggests, or malposition from “a number of causes.” The authors mention that an attenuation of ligaments alone would be insufficient to explain these changes.

The author of the Discussion (Plast. Reconstr. Surg. 119: 2228, 2007) also points out that the surgeon encounters areas of fixation during lateral to medial dissection when performing a face lift. I submit also that every snip of the scissor and sweep of the blade separates the skin from these underlying compartments. The skin would seem to form the roof of the described compartments and may provide some support to each. One could argue that the endogenous and exogenous histological skin changes1 that occur with aging and photoaging, respectively, result in the aged skin being less able to provide support for each of these compartments. Perhaps skin is not getting as much credit as it deserves in this aging process. I agree with the authors that a number of factors are responsible for the aging face. Possibly attempting to analyze the loss of skin support, the weight of that skin, and loss of soft-tissue volume respective to each compartment would be worth studying. I thank Dr. Rohrich and Dr. Pessa for stimulating us to further analyze facial aging and for an excellent study that adds to our knowledge of facial anatomy.

Leo R. McCafferty, M.D.

Plastic Surgery

580 South Aiken Avenue, Suite 530

Pittsburgh, Pa. 15232

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1. Makrantonaki, E., and Zouboulis, C. C. Characteristics and pathomechanisms of endogenously aged skin. Dermatology 214: 352, 2007.

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