Structure of the Fat Layers
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Deep and Superficial Fat Compartments
While the layer concept describes the layered anatomy of the face, the superficial and deep fat layers of the face are not a confluent contiguous mass.
Recent laboratory studies of the facial anatomy have demonstrated that the facial fat is partitioned or compartmentalized into discreet pockets of fat. These separate fat compartments are created/separated by fascial membrane, or by, in other words, an outgrowth of the connective tissue called fascia.
The deep fat layer of the face consists of discreet compartments, or fat pockets, separated by connective tissue.
Superficial fat compartments, aka subcutaneous layer, are closely attached to the skin.
The subcutaneous (superficial fat) layer right underneath the skin is comprised of distinct separate fat compartments. It is closely attached to the skin.
Volumetric Facial Ageing - Deflation of the Deep Fat Pockets
It is not entirely clear why but superficial fat pockets and deep fat pockets age differently and play different roles in the aged look of a face. In a person with a stable weight (if there is no major weight loss), –
- Deep fat pockets start deflating around eyes in our late 20s, and then in our 30s other deep fat pockets on the cheeks and temples begin deflating too
- Superficial fat pockets persist throughout life unless there is a major weight loss. They contribute to the drooping and sagging look of the ageing face.
- Then the overlaying skin, connective tissue and the superficial fat pads lose the support of the now deflated deep fat pockets and start hanging and draping along the anchoring muscle and retaining ligaments lines/points, and we start observing the “valleys” on the face: the cheek region, near the eyes and on the temples. And “folds occur at transition points between thick and thinner superficial fat compartments”).
That is why we no longer think that it is the stretching of the facial tissue alone, under the forces of gravity, that is mostly responsible for the facial ageing.
Where the volume is lost vs where the loss is visible
Implications
On the picture bellow, you can see the difference between where the volume is lost and where the volume deficiency is perceived:
Actual Fat Loss in the Deep Fat Pockets
Vs
The Areas where the Ageing from the Fat Loss is Visible
What is the implication?
To achieve the natural looking rejuvenation results, the volume should be restored where it is lost, not necessarily where the loss volume is visible.
Restoring Facial Volume – what options do I have?
Temporary volume and contour restoration i.e., temporary fillers
- Radiesse – Calcium Hydroxylapatite based filler
- Sculptra- Poly-L-Lactic acid-based filler
- Ellanse- Poly-Caprolactone
- Facial threads- Polydioxanone
- Skin boosting and collagen stimulating treatments
- Hyaluronic Acid based fillers (dissolvable)
- Autologous fat injections, facial fat grafting and microlipoinjection
- Facial implants
The challenge with restoring a youthful look for women in their late 30s and 40s is that addressing the skin quality alone (dermis and epidermis, layer 1 in the facial anatomy layers picture), – for example by laser resurfacing, micro-needling, IPL/photo facial, chemical peels, device assisted skin tightening, topical use of retinoids, vitamin C, AHA/BHA – is going to produce younger looking skin/surface on the middle-aged deflated and flattened facial structure, thus failing to fully achieve the goal of an overall young looking face.
Hyaluronic Acid Fillers for the Overall Volume
Hyaluronic acid fillers for the facial volume and contour are thicker and longer lasting than any other fillers. They should be injected in the deeper layers of the face, where the deep fat pockets are deflated.
Ideally the filler material must be stable, reversible, and durable should not cause allergy, cancer or be teratogenic. When it is injected, it feels natural with short administration time and low complication risk. Post -injection there is only minimal inflammation, migration, with predictable and consistent results.The optimal results are achieved when patient expectations coupled with experienced practitioner judgment and ideal injection technique are applied.
