DESTIN, FLA. — Knowing anatomy can count when it comes to restoration of facial volume lost through aging. When dermatologists inject fillers based on the location and depth of multiple, discreet compartments of fat, outcomes can be optimized, Dr. Marian Northington said.
These anatomic findings primarily come from studies by Dr. Rod J. Rohrich and Dr. Joel E. Pessa of the University of Texas, Dallas. They dissected cadavers to map out the facial fat compartments. One study of 14 dissections revealed two areas of deep medial fat. One compartment is more medial and up against the pyriform membrane, and the other is more lateral and lies directly on the maxilla (Plast. Reconstr. Surg. 2008;121:2107-12). “When this deep medial fat compartment is filled with saline, you see immediate improvement, an anterior projection,” Dr. Northington said.
The researchers also found the term “malar fat” refers to a region with two distinct fat compartments, one deep and one superficial. The point is that “malar fat is not just one layer of fat. This will be helpful with our approach to these patients in the future,” Dr. Northington said at the meeting.
The discreet fat compartment findings also might partially explain why facial aging is not a uniform process in some people, Dr. Northington said.
These researchers discovered something else important, Dr. Northington said: a deep-to-subcutaneous fat compartment lateral to the zygomaticus muscle. Begin filler injections in this area, she recommended, because other facial areas may need less volume as a result.
The periorbital area also can improve. “This is a big pearl. If you replace that cheek volume, you will improve the lower eyelid” as well, said Dr. Northington, who is on the dermatology faculty at the University of Alabama at Birmingham. “Patients are very happy with this.”
If fillers are used to recontour the jawline while also replacing volume, inject the lower face last. “If you inject [the cheek], you will need less down” at the jawline, she said.
In their 2008 study, Dr. Rohrich and Dr. Pessa also assessed the submentalis fat compartment and the suborbicularis fat compartments. They determined that the submentalis plays a role in the formation of the labiomental hollow and the suborbicularis affects the aging lip.
In an earlier study, the same researchers injected dye and performed 30 hemifacial cadaver dissections (Plast. Reconstr. Surg. 2007;119:2219-27). Among their findings was that the nasolabial fold is one unit with discrete anatomic boundaries. They also found that the forehead is comprised of three anatomic compartments of fat: medial, middle, and lateral temporal units.
The benefits of facial volume replacement realized in recent years can be further improved by knowledge of these anatomic findings “When fillers first came out, we were really just filling lines, such as nasolabial folds. We’re now looking at replacing cheek or temple volume,” Dr. Northington said.
Dr. Northington had no relevant conflicts.