FACIAL FAT COMPARTMENTS

Facial fat differs from fat in other regions of the body as it is compartmentalized.
Each facial fat compartment exhibits fibrous septal boundaries, a regional perforator blood supply,
and a specific tendency toward deflation in aging.
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Facial nerve branches are often superficially positioned at transition points between
compartments.
Facial fat compartments exist both superficial and deep to the SMAS – superficial and deep.

Compartmentalization of the Superficial Fat Compartments
Separated into specific compartments by the terminal extension of the deeper retaining ligaments,
which percolate through the cheek from deep to superficial to insert into the skin as retinacular
cutis.
The retaining ligaments penetrate the superficial fascia at specific locations and thereby form the
fibrous septum which are formed between compartments.
Rather than being diffuse in their penetration of the SMAS, the retaining ligaments penetrate the
superficial fascia at specific locations and thereby form the fibrous septum which are formed
between compartments.
These junctional boundaries also are the location where the vascular perforators to cheek skin
penetrate from deep to superficial.
The surgical significance of this is that when encountering numerous perforators while performing
subcutaneous dissection, anatomically the dissection is transiting from one superficial fat
compartment to another.
Compartments:
1. Lateral compartment
2. Middle compartment
3. Superficial malar compartment
4. Nasolabial fold compartment
5. Jowl compartment
Lateral Compartment
Located in the preauricular region
Narrow, thin, following the superficial temporal artery cephalically within the temporal region.
3 to 5 cm in width and consists of dense, vascular, and fibrous fat.
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This compartment is directly situated overlying the parotid gland, and as the dissection proceeds
anterior to the parotid, the middle compartment is encountered, and the dissection becomes less
fibrous.

Middle Fat Pad

Lies medially to the parotid and lateral to the anterior boarder of the masseter.
Thicker, less fibrous, and less vascular.
The anterior boarder of the middle compartment is bounded by the masseteric ligaments and
superiorly by the zygomatic ligaments, such that the anterior boundary is adjacent to the lateral
malar and jowl compartments.
The transition between the middle, malar, and jowl compartment anatomically demarcates the
transition between the fixed and mobile regions of the cheek.

Superficial Malar Compartment
Situated along the lateral aspect of the zygomatic eminence and extends anteriorly toward the
paranasal region, providing volume to the anterior cheek.
When dissecting from the lateral cheek (middle compartment), the malar compartment is
identified as the surgeon encounters numerous perforators from the transverse facial artery as well
as dense fibrous zygomatic ligaments (termed McGregor’s patch).
The upper masseteric ligaments are similarly encountered along the inferior aspect of the zygoma.
As the zygomatic branches are superficially positioned just deep to the SMAS lateral to the zygoma,
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accurate plane identification is an important safety consideration

Jowl Compartment
Consists of fluffy, thick fat and is situated between the mandibular ligaments and the masseteric
ligaments overlying the facial portion of the platysma.
Tends to be avascular.
In aging, attenuation of support from the masseteric ligaments allows the platysma and overlying
jowl fat to descend into the neck, which obscures the definition of the mandibular border.
As the jowl compartment tends not to deflate in aging, jowl descent accompanied by adjacent
perioral deflation is responsible for this fat compartment’s becoming more apparent in middle age
and elderly patients.
Nasolabial Fold Compartment
Just lateral to the nasolabial fold and anterior to the malar compartment.
Thick, dense fat and rarely deflates in aging.
For this reason, the nasolabial compartment typically becomes more obvious in aging as the
adjacent
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Deep Facial Fat Compartments

Lie deep to mimetic muscles and overlie the periosteum of the orbit, midface, and pyriform
aperture.
The deep facial fat compartment which affects lower lid morphology is situated deep to the
orbicularis oculi and is divided into a lateral and medial component.
The anterior cheek is supported by the deep malar fat pad, which similarly has a medial and lateral
component.
1. The medial component of deep malar fat is situated along the pyrform aperture and blends
the perioral region with the cheek in youth.
2. The lateral component of deep malar fat contributes to anterior malar projection and blends
the anterior cheek with the lateral cheek, where it abuts the buccal extension of the buccal
fat pad.
3. This lateral component also abuts the orbit, blending the eyelid and cheek in youth
Deflation
Occurs with age and is responsible for many of the morphologic changes seen from youth to
middle age.
Compartment-specific rather than homogeneous within the cheek, and different compartments
deflate
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5 different ages.
Typically, early deflation of the lateral cheek becomes evident in patients in their 40s (deflation
occurring within the lateral and middle compartments), while malar deflation becomes noticeable
in the fifth decade.
Malar deflation results from a loss of fat in both the superficial and deep malar compartments.
As malar deflation affects the anterior cheek and the lower lid, the shape changes associated
with malar deflation include a loss of anterior cheek volume as well as an increase in the
vertical height of the lower lid (infraorbital V-deformity).
The surgical importance of differentiating between superficial and deep deflation is that superficial
deflation can be improved by repositioning superficial fat via the SMAS, while deep deflation
requires volumetric augmentation for correction.
In combination with a facelift, it is our preference to use autogenous fat grafting to correct the
appearance of deep compartment deflation, adding volume in the supraperiosteal plane overlying
the anterior zygoma and pyriform aperture.
Volume addition to the deep compartment improves cheek and perioral volume as well as
ameliorating the infraorbital V-deformity, shortening the vertical height of the lower lid.