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

2008; Lippincott Williams & Wilkins; Volume: 121; Issue: 3 Linguagem: Inglês

10.1097/01.prs.0000299636.97607.5f

1529-4242

Rod J. Rohrich, Joel E. Pessa,

Hair Growth and Disorders

Sir: We thank Dr. McCafferty for his kind and thought-provoking comments. We agree that skin plays a significant role in the aging process. As he described, skin–-dermis and epidermis–-forms the roof of each subcutaneous fat compartment. Support for any compartment is diminished by interrupting the dermal attachments from adipose tissue to skin. It is interesting to conceptualize that fat supports skin, as shown in the study, and that skin likewise supports fat. It is likely that both mechanisms play a role in the aging process. Lambros has lectured for years describing his concept of deflation, and the identification of separate and independent compartments will allow researchers to determine where fat is being preferentially lost or gained. For example, numerous etiologies have been proposed to explain why the nasolabial fold occurs. It may be that an additional factor is simply that this fold represents a form of “pseudoptosis.” Loss of fat, in this case, deep cheek fat, leads to an excess skin envelope. Loss of adipose volume equates with diminished support for the skin and superficial fat compartments. Certainly this concept is supported by recent clinical data from fat injection into the deep medial cheek fat, for both cosmetic surgery patients and patients with site-specific fat atrophy secondary to use of protease inhibitor drugs. The next logical progression of this research would be to study volumetric changes of specific fat compartments that might occur with age, as suggested in Dr. McCafferty’s letter. It should be possible to study individual compartments using injection techniques combined with noninvasive radiology, such as computed tomography scans or magnetic resonance imaging. This would lend additional support to the concept of deflation as a mechanism of aging and quantify the amount of fat atrophy that occurs. Tensile strength measurements should be able to quantify how skin contributes to the aging process. As the study of facial aging progresses, it is becoming apparent that this is a three-dimensional process and that changes in multiple tissues contribute to the overall effect. The extent to which any tissue contributes to the total effect certainly awaits further research in this interesting and complex field. Rod J. Rohrich, M.D. Joel E. Pessa, M.D. Department of Plastic Surgery Univeristy of Texas Southwestern Medical Center Dallas, Texas