The Functional Anatomy of the Superficial Fat Compartments of the Face – A Detailed Imaging Study

Background: The superficial (subcutaneous) facial fat compartments contribute to the signs of facial aging, but a comprehensive anatomic description of their location and their functional behavior during the application of soft tissue fillers still remains elusive. Methods: We investigated 30 fresh frozen cephalic specimens from 13 male and 17 female Caucasian body donors (age: 78.3 ± 14.2 years, body mass index: 23.1 ± 5.3 kg/m2). Upright positioned contrast enhanced CT scans and additional MR imaging was performed. 3D reconstruction based measures were conducted to evaluate the position of the applied contrast agent in each compartment separately. Successive anatomical dissections were performed to confirm the imaging findings. Results: Positive correlations were detected between the amounts of injected material and the inferior displacement for the superficial nasolabial (rp = 0.92, p = 0.003), middle cheek (rp = 0.70, p = 0.05) and jowl (rp = 0.92, p = 0.03) compartments but not for the medial cheek (rp = 0.20, p = 0.75), lateral cheek (rp = 0.15, p = 0.75), the superior superficial temporal compartments superior: rp = -0.32, p = 0.41; or the inferior superficial temporal compartment: rp = -0.52, p = 0.29. Conclusion: This study confirms the presence of distinct subcutaneous fat compartments and provides evidence for an individual behavior when soft tissue fillers are applied: inferior displacement of the superficial nasolabial, middle cheek and jowl compartments, in contrast to an increase in volume without displacement, i.e. an increase in projection of the medial cheek, lateral cheek and both superficial temporal compartments. Author disclosure: None of the other authors listed have 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. Funding: The imaging part of this study received funding from Q-Med AB, Sweden (Grant Nr: 15092016). Acknowledgements: We would like to thank Markus Schlager for his support in the imaging parts of this study and Robert H. Gotkin, MD for his guidance during the writing process. Corresponding author: Sebastian Cotofana, MD, PhD, Associate Professor, Albany Medical College, 47 New Scotland Avenue MC-135, Albany, NY 12208, Phone: 518-262-5667, Email: ©2018American Society of Plastic Surgeons