470

Facial Layers and Facial Fat Compartments:

Focus on Midcheek Area
Yves Saban, MD, PHM1 Roberto Polselli, MD2 Dario Bertossi, MD3 Charles East, MB, FRCS4
Olivier Gerbault, MD5

1 Ear Nose Throat, Facial Plastic Surgery, Maxillo-Facial Surgery, Address for correspondence Yves Saban, MD, PHM, Private Office 31
Nice, France Avenue Jean Médecin, 06000 Nice, France
2 Ear Nose Throat, Facial Plastic Surgery, Marina di Carrara, Italy (e-mail: yves.saban@gmail.com).
3 Department of Maxillofacial Facial Surgery, Policlinico GB Rossi,
Verona, Italy
4 Rhinoplasty London, Facial Plastic Surgery, London, United Kingdom
5 Department of Plastic Surgery, Polyclinique Esthétique Marigny 3-5,
Cours Marigny, France

Facial Plast Surg 2017;33:470–482.

Abstract Facial cosmetic procedures are doubtless in constant augmentation directly related to

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fillers and botulinum toxin injections. Many articles are published in the literature to
warn about the complications of these aesthetic procedures. The need for a clear
anatomic classification and review of deeper ultrastructural studies on adipose tissues
in the midface area are obvious. This study aims: (1) To present midface anatomy of
clinical relevance in a practical way for surgeons and cosmetologists. (2) To analyze the
facial fasciae related to the fat compartments. (3) To show pictures of anatomic
dissections of these anatomic structures. (4) To suggest an anatomic classification. The
authors analyzed the facial anatomic layers and the facial fat compartments through
facial anatomical dissections and experience in the field of facial surgical and cosmetic
procedures. The authors propose a dynamic three-dimensional concept of facial layers
Keywords related to muscle actions and facial fat compartmentalization in the midcheek area. A
► facial anatomy “lip–lid” superficial system associated with the malar fat pad represents the first layer;
► facial fat two deeper lip levator systems stratification explains the deep fat compartments as an
compartments anatomic division related to fasciae extensions. Facial grooves and segments corre-
► facial layers spond to these systems action. Moreover, the importance of ultrastructural studies has
► facial cosmetology been underlined.

Following the observation concerning the scientific topics
discussed in medical meetings and scientific articles since
the 2000s, we notice the incredible increase of communica-
tions concerning the facial volumes related to facial beauty,
and the facial muscles according to aging and wrinkles. The
comparison of this observation with the real social trend that
establishes the emergence of filling products, fat, or fillers in
the cosmetic market and of neuromuscular modulators, such
as botulinum toxin explains the renewed importance of the
anatomic studies of the facial fat compartments, facial mus-
cles, and septa. Undoubtedly, the simple explanation is the
huge financial market in this area that is expanding despite
times of economic crisis in western countries. Moreover,
active researches on stem cells are exceeding a simple
cosmetic interest and constitute a major way for the future
of the medicine. Facial fat is known as a heterogeneous entity
that can be subdivided into different anatomical compart-
ments. Recent research states that each of these compart-
ments has different adipocytes and different extracellular
collagenous matrix, which gives them different properties.

Issue Theme The Evidence Base in 21st Copyright © 2017 by Thieme Medical DOI https://doi.org/
Century Facial Plastic Surgery; Guest Publishers, Inc., 333 Seventh Avenue, 10.1055/s-0037-1606855.
Editor, Charles East, MB, FRCS New York, NY 10001, USA. ISSN 0736-6825.
Tel: +1(212) 584-4662.
 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
On the other hand, recent clinical publications have
reported adverse outcomes and severe complications, such
as blindness, nasal or forehead necrosis, which are not
epiphenomenal and moreover can happen even to experi-
enced physicians. These accidents have opened a new field of
anatomic researches on specific anatomic sectors, facial
vascularization, and on new technologies which could
seem less important few years ago. Thus, safety and effec-
tiveness of cosmetic procedures need to be balanced in
modern cosmetic practice.
A study of anatomic variations about the periorbital and
midface muscles and a simpler classification of the fat pads
will be presented hereafter that may bring progress in better
and simpler morphologic understanding of these structures
and aesthetic analysis.
Historical Studies of the Facial Layers
The superficial fascia (SF) has been described as the super-
ficial musculoaponeurotic system (SMAS) by Mitz and
Peyronie in 1976,1 following Tessier’s suggestion (1974)
during a meeting of the French Society; however, it was
first described in the 19th century by Velpeau (1825)2 as a
unit: “the SF is formed on the overall surface of the body and
may be thin or very thick; may be a loose tissue or very
fibrotic.” Similar descriptions were stated by Paillard3 in
1827 and later by others; but in 1910, Sterzi,4 an anatomist
from Padova made the first and the most complete ana-
tomic and histologic study of the subcutaneous tissue and
the SF, completely ignored by plastic surgeons. Micheli-
Pellegrini5,6 in 1988 and 1992 tried to propagate this
research. Some conclusions in Sterzi’s works are: “on slim
cadavers, the SF is more evident than on obese ones; the
subcutaneous tissue has two layers divided by the SF, which
is a fibrous membrane seen on the neck, face, head…; it is
situated on the subcutaneous tissue between the superficial
and the deep fat layers; muscle fibers can be seen on it; in
the cervicofacial area it is the same, but in the deep fat layer
on the neck and in a significant part of the head it becomes
loose fibrous tissue, which allows it to slide over the
muscular fasciae or the periosteum;… on babies the SF is
very thin and more elastic, whereas on old people it is
thicker and less elastic, contributing to the flaccidity of the
skin.” Regarding the mimetic muscles and the SF, Sterzi
stated that “the orbicularis muscles and those from the chin
are directly fixed to the dermis, and it is not possible to
demonstrate that they are surrounded by a true fascia; at
the parotid region, there is a clear fascia that has continuity
with the zygomatic muscles and with the anterior and
posterior layers of the platysma.”
Surgical Anatomy of the Facial Anatomic
Layers: The Importance of the Facial Fasciae
The face can be considered to be divided into two very
different anatomic–functional spaces, separated by the
deep facial fascia: the superficial space of facial expres-
sion innervated by the facial nerve (i.e., the facial mask)
Saban et al. 471
and the deep visceral space innervated by other nerves
such as trigeminal, oculomotor nerves, or spinal accessory
nerve.
The mimic face is a stratification of five anatomical layers.
From superficial to deep, one can describe: layer number 1:
skin; layer number 2: subcutaneous fat and tela retinaculum
cutis; layer number 3: SMAS; layer number 4: sub-SMAS space
which can be either a fat layer (deep fat) or an areolar and
undermining plane; layer number 5: deep facial fascia, which
separates the superficial space or space of the facial expression,
from the visceral deep space or masticatory space.
Numbering these anatomical layers (called 1, 2, 3, 4, and
5) may help the surgeon to know in real time at which depth
he is performing his surgical dissection. The colors and
frames differentiate the three superficial layers: brilliant
white of the dermis, yellow lobules of the fat, brown of the
SMAS muscle or brilliant transparency of the aponeurosis, all
constituting simple landmarks. So the surgeon may decide to
follow the most favorable plane of dissection.
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The SMAS and the Muscles of Facial Expression Which
Do Not Belong to the SMAS
The concept that the SMAS, layer number 3, represents a
unique layer covering the face and the neck is attractive.
This is not only a new concept: old anatomical works have
already established that a double layer of fibrous tissue, the
SF covers the whole human body underneath the skin. The
SMAS (►Fig. 1) is a composite anatomical double fascia
layer derived from and part of the SF, which can include
different mimic muscles in between its two fasciae. Where
the fascia is present without intervening muscle, the super-
ficial and deep layers of the sheath are fused. The superficial
fascial layer is thin where it overlies the muscles. In con-
trast, the deep layer of the fascia is thicker, more supporting
and provides a gliding surface at the interface with the
underlying fourth layer.7 This layer can be relatively thin
and transparent, and then the underlying structures can
become visible (►Fig. 1). This does not mean that these
deeper structures are part of the SMAS nor that the SMAS
has disappeared. Conceptually, we can distinguish the
anatomy, the surgery, and the function. Surgically the
SMAS can be dissected as a muscular-aponeurotic layer;
inversely, functionally, the mimetic muscles, which are part
of it, conserve their function related to their interrelation-
ship due to their functional nervous link and of the ana-
tomic fibrous septa that interconnect them. Moreover, all
these muscles present an extensive range of variations
either in their presence or their direction or their power.
Layer Number 4 (►Fig. 2) Is A “Spaced Layer”
Limited by two fasciae: superficially by the SMAS and deeper
by the deep facial fascia, this space does not have its fascia; it
can be alternatively an areolar gliding space (Merkel’s space;
areolar space between parotid SMAS and parotid capsule or
masseteric aponeurosis) or a fatty compartment (as cheek fat
pads), then called deep fat compartment.
In facial surgery, such as deep face lifts, the dissection
performed in the layer number 4 requires lifting the SMAS
Facial Plastic Surgery Vol. 33 No. 5/2017
472 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 1 The SMAS layer. Anatomic dissection of the right hemiface
showing the layer number 3: SMAS. The skin and subcutaneous fatty
layer have been removed. The layer number 3, the SMAS, is exposed.
One can recognize, from cephalic to caudal: frontalis muscle, super-
ficialis temporalis fascia, orbicularis oculi pars orbitalis and pars
palpebralis, preparotid fascia, and platysma muscle which most
lateral fibers are investing the parotid SMAS, going upward till the
zygomatic area. Deeper structures such as the zygomaticus major and
minor muscles, the suborbicularis oculi fat are visible by transparency
through a very thin aponeurotic almost invisible SMAS layer. SMAS,
superficial musculoaponeurotic system.
(layer number 3); the SMAS can be used as a landmark for the
dissection. Its brilliant light reflections and its fibrous aspect
are different from the subcutaneous lobules of yellow fatty
tissue; these visual landmarks can be used by the surgeon
who is going to progress between two fibrous layers: the
SMAS superficially and the deep facial fascia in-depth. This
plane number 4 allows an easy dissection, even if the facial
fibrous layers numbers 3 and 5 are weak with a risk to be
accidentally crossed, then exposing the deeper structures.
The dissection is performed without major obstacle in the
plane between the SMAS superficially and the deep facial
fascia in-depth, until a vertical line drawn from the lateral
side of the orbital process. At this level, one can find from top
to bottom many of the various facial ligaments (►Fig. 2).
Thus the layer number 4 appears at the same time as a space
of sliding and as an area crossed by powerful structures
controlling the position and the mobility of the superficial
soft tissue forming the facial mask. Moreover, these liga-
ments and deep mimic muscles form anatomic boundaries
that divide the subcutaneous fat and deep fat in distinct
subcompartments.8 This is particularly visible in the central
face area: located in the layer number 4, the deep mimic
muscles and the retaining ligaments are perpendicular
structures crossing the different facial layers and connecting
the deep anatomic elements to the skin or other muscles. So,
we could compare the SMAS as a ship’s sail and the deep
muscles and the ligaments (which correspond to muscles “in
regression”) to a tie rod.
Facial Plastic Surgery Vol. 33 No. 5/2017
Saban et al.
Fig. 2 Layer number 4: “spaced” layer and facial ligaments—three-
fourth right posterolateral view of the lateral face (“metaface”).
Anatomic dissection (different dissection than ►Fig. 1) performed in
the spaced layer number 4. This “spaced” layer is located between the
SMAS and platysma (layer number 3) that is lifted anteriorly, and the
deep facial fascia (layer number 5), which is still covering the parotid–
masseteric area; deep to this transparent layer number 5, one can
observe from caudal to cephalic the dark colored masseter muscle
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through which facial nerve buccal branches are running, the light
brown colored parotid salivary gland. Please note the anterior
extension of the parotid gland on top of the masseter muscle. The
frontalis branch of the facial nerve is indicated (black arrow); at the
cephalic part, the frontal branch of the temporal artery runs ante-
riorly, cephalic to the frontal nerve. The dissection cannot go forward
anteriorly: facial ligaments that are perpendicular crossing structures
are blocking the progression. From top to bottom: zygomatic
ligaments; Mac Gregor’s patch containing an artery that is the
perforating branch of the transverse facial artery arising from below
the anterior parotid pole; parotid and masseteric ligaments in front of
the masseter; caudally the mandibular notch where the facial neu-
rovascular pedicle is crossing the mandible inferior border. These
ligaments form a vertical line that separates the “metaface” dissected
here, and the “mesoface” or midface of facial expression located
anteriorly. (Image provided courtesy of Saban and Polselli. 14)
The Retaining Ligaments of the Face and the Boundaries
of the Fat Compartments
The main authors who described the ligaments of the face are
Mac Gregor (1959), Psillakis,9 Furnas,10 Stuzin et al.11 These
are two types: the proper osteocutaneous retaining liga-
ments (zygomatic, Mac Gregor, mandibular ligaments) and
the superficial/deep fascia bands (the anterior platysma-
cutaneous, the masseteric-cutaneous, the platysma-auricu-
lar or parotid-cutaneous) (►Fig. 2). Furnas and Stuzin et al’s
anatomical works have highlighted the presence of numer-
ous fibrous strips, directly inserted on the periosteum of the
zygomatic bone posteriorly to the zygomaticus minor
muscle, that insert fan-shaped at the level of the skin situated
4.5 cm anterior to the tragus, with vertical bundles 8  3
 0.5 mm; there are true bony attachments, the pulling of
which determines a real cutaneous mobilization.
The masseteric-cutaneous ligaments must be transected
in the surgical procedures that need to proceed more ante-
riorly. The platysma-cutaneous and cutaneous-masseteric
ligaments correspond to variable oblique aponeurotic exten-
sions between the anterior border of the platysma, the
masseter, and the dermis of the midcheek; for Stuzin et al
 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
and Furnas, they form a dimple and constitute an excellent
support during the face lift. The branches of the facial nerve
run underneath the premasseteric fascia.
The mandibular ligament inserts on the periosteum 1 cm
over the mandibular border in its previous first third, on the
line of insertion of the platysma and the depressor anguli
oris; it runs fan-shaped horizontally 5 mm toward the skin.
The traction on the skin (pinch test) allows highlighting this
ligament. This marks the boundary between the attached
muscular anterior segment and the neurovascular middle
segment of the mandible. It opposes gravity: lateral to the
mandibular ligament, the jowl can form, while medially only
wrinkles, mainly the marionette lines, can be observed. The
ramus marginalis mandibularis nerve always crosses the
mandible dorsally to the mandibular ligament, in a subpla-
tysmal position. The injections performed at the level of the
ligament do not present any danger, except for certain
vascular branches of the submental artery that is caudal to
the ligament.
One can state that these ligaments create a barrier of
fixation, which separates the lateral part of the face or
metaface from the mesoface or midface; midface is the
face of the facial expression and thus the one that ages faster.
In the metaface, posteriorly, deep to the deep facial fascia, lay
the temporal and masseter masticatory muscles and the
parotid gland covered with its capsule, which joins with
the premasseteric fascia forming the deep facial fascia.
Following Mendelson and Jacobson,12 “the superficial
muscles are more closely related to the overlying subcuta-
neous layer than they are to the deeper structures. The
superficial flat muscles have a minimal direct attachment
to the bone. They are indirectly stabilized to the skeleton by a
ligament, located at the lateral border of the muscles. The
frontalis is fixed by the superior temporal ligament along the
superior temporal line, the orbicularis oculi is stabilized by
the main zygomatic ligament at its inferolateral border, and
the platysma is stabilized at its upper border by the upper
key masseteric ligament.”
To summarize the compartmentalization of the face, one
can consider the facial fasciae, the facial muscles of expres-
sion and their surrounding fat allowing their gliding
mechanism. Classification is not yet clear, and there is no
consensus in nomina anatomica about these anatomic struc-
tures. Keeping in mind the facial layers from 1 to 5, one can
use their nomenclature to name the fat compartments,
following the same denominations. From a layered stratifi-
cation viewpoint, the superficial mimic face is divided into
two main fat spaces: subcutaneous (the superficial fat com-
partment) and sub-SMAS (the deep fat compartment);
whereas, the visceral face, located deep to the deep facial
fascia is divided in the same manner into superficial struc-
tural fat compartment and deep buccal fat compartment.
Another classification could be suggested as: fat 2 (subcuta-
neous), fat 4a (superficial sub-SMAS), 4b (deep sub-SMAS),
5a (structural deep), and 5b (deep buccal sub-fascial). This
will be analyzed infra.
Looking at the three-dimensional (3D) volumes, compart-
mentalization is directly related to strong muscles fasciae
Saban et al. 473
expansions to the deep aspect of the skin and, in depth, to
fasciae connections to the bones. Thus a “3D system” is
created allowing mimic muscles to move the skin during
mimicry, to glide on the surrounding structures, to act
together with the synkinetic muscles corresponding to
embryologic development.
Considering the different midfacial areas and facial
expressions, that is, the look and the smile, one can separate
the periorbital system and the perioral system.
Following Mendelson and Jacobson,12 “the migratory path
of the evolving muscles, including their connections and the
multiple levels of the muscles, explain the definitive location
of the facial nerve branches. In the anterior face, the migrated
muscle masses are mainly located over and around the
orbital and oral cavities.”
Contributing to the brow expression and the look, the
periorbital area is dominated by the upper face function and
the brow movements. Levator muscles are only the frontalis,
while corrugator supercilii, depressor supercilii, procerus,
orbicularis oculi and its expansions are mainly depressor
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muscles.
Contributing to the smile, considering the infraorbital
area, one must consider both the periorbital muscles and
the levator muscles of the upper lip. Most of these muscles
are elevating the upper lip and the infraorbital (malar) area,
contributing to the look. Nevertheless, their function is
ambiguous as they are acting at the same time on the lower
lid, the nose, and the upper lip.
Contributing to lower face mimicry, one can divide on the
one hand the depressor muscles (depressor anguli oris, de-
pressor labii inferioris, platysma) except the mentalis muscle
that contracts the lower part of the chin. On the other hand,
two other important intervening elevator muscles are the
zygomaticus major and the levator anguli oris muscle.
Looking at the extreme range of interindividual varia-
tions of facial expressions,13 one can imagine the range of
anatomic variations in the anatomy of the mimic muscles,
mainly in the midface which mixes look and smile
expressions.
Anatomic dissections of this infraorbital area show, in
fact, a large range of anatomic variations of the orbicularis
oculi muscle, pars orbitalis, in the periorbital area.
Anatomic Variations of the Lateral and Medial Bundles
of the Orbicularis Oculi, Pars Orbitalis
In classic anatomy textbooks, even the most famous ones, the
zygomaticus minor muscle, for example, may be unclear. It
must have a bony insertion on the zygomatic bone, medially
to the zygomaticus major. However, many times it is drawn
without any bony insertion and presenting an extension
upward to the superficialis temporalis fascia. This cannot be
the zygomaticus minor muscle neither the zygomaticus
major nor the orbicularis oculi, the orientation of which is
acting like a sphincter. Some anatomists consider this muscle
to be the most lateral portion of the orbitalis pars of the
orbicularis oculi muscle. Nevertheless, this is a different
muscle that can be called “zygomaticus superficialis”
(►Fig. 3); it takes an aponeurotic insertion on the fascia
Facial Plastic Surgery Vol. 33 No. 5/2017
474 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area Saban et al.

Fig. 3 Zygomaticus superficialis: orbicularis oculi inferior–lateral

extension and zygomatic muscles. Anatomic dissection of the right
hemiface (different dissection than ►Figs.1 and 2; lateral view).
Subcutaneous dissection exposing the SMAS layer number 3, the skin
and subcutaneous fatty layers are elevated anteriorly. Inserted
cephalically on the superficialis temporalis fascia, a powerful
superficial (layer number 3: SMAS) muscle is running anteriorly and
downward, below the caudal border of the orbicularis oculi muscle. Fig. 4 Levator genae muscle: orbicularis oculi muscle inferior–medial
Located lateral and caudal to the orbicularis oculi pars orbitalis, extension. Anatomic dissection of the right hemiface (different

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superficial to the zygomaticus major located in-depth and caudally, dissection than ►Figs. 1–3; front view). Subcutaneous dissection has
this muscle lies in the same layer as the orbicularis oculi. Its fibers are been performed showing an oblique muscle inserted below the
attaching to the deep aspect of the skin. This inconstant anatomic medial canthal tendon and running obliquely till the midcheek where
variation of the orbicularis oculi pars orbitalis may be called it inserts on the deep aspect of the skin. This muscle does not belong
“zygomaticus superficialis muscle.” SMAS, superficial musculoapor- to the orbicularis oculi and is different from the LLSAN that is more
eurotic system. (Image provided courtesy of Saban and Polselli. 14 ) medial; it is not the levator labii superioris muscle that is inserted
more laterally on the orbital rim and running to the upper lip. This is an
anatomic variation of the orbicularis oculi pars orbitalis, or a different
and inconstant muscle that may be named “levator genae” (cheek
temporalis superficialis and extends to the upper lip, located elevator). See also ►Fig. 5. LLSAN, levator labii alaeque nasi; SMAS,
in the same superficial layer as the orbicularis oculi.14 Rüge, a superficial musculoaponeurotic system.
German anatomist described an “auriculolabialis” muscle.
This “zygomaticus superficialis” muscle acts like a high
risorius, pulling laterally and upward the upper lip and the in the midface may lead to consider the “levator genae”
lateral cheek, and creating, therefore, wide crow feet wrin- (cheek elevator) acting as the support for the deep aspect of
kles which can extend till the temple hair. It often results in the superficial nasolabial fat pad.
skin expansions responsible for midcheek vertical wrinkles. Following the anatomic variations of the orbicularis oculi
Following the same analysis, one can consider the varia- muscle expansions, one can consider the most medial bundle
tions of the most medial bundles of the orbitalis pars of the in the upper lid that is named depressor supercilii (►Fig. 6). It
orbicularis oculi muscle. This bundle belongs to the proper
orbicularis oculi muscle and has a sphincter-shaped anat-
omy. Nevertheless, sometimes, in people presenting a huge
midcheek and nasojugal groove separating the nasolabial
segment from the adjacent midcheek segments, the ana-
tomic dissection shows a particular muscle (►Figs. 4 and 5).
This muscle is darker and thicker than the adjacent orbicu-
laris oculi, even if it lies in the same anatomic layer, and is
directly connected to it, sharing the same aponeurosis; it gets
a bony insertion on the frontal process of the maxillary bone,
cephalic to the levator labii superioris alaeque nasi muscle,
below the medial canthal tendon; then it runs obliquely in
the nasojugal midcheek segment surrounded by the nasola-
bial fat and goes straight to the deep aspect of the midcheek
skin where it inserts. So this muscle is responsible for the
superomedial elevation of the midcheek, of the thickness of
Fig. 5 Levator genae muscle: CT scan original picture. One can
the nasojugal segment, and of the nasojugal and midcheek
observe an oblique muscle inserted on the frontal process of the
grooves. Its action leads to oblique wrinkles below the bunny maxillary bone, the direction of which is not a sphincter but is
lines. One may call this muscle “levator genae” or midcheek attaching to the cheek. It is a cheek elevator muscle (“levator genae”
elevator. Moreover, the anatomic variations of these muscles in Latin). CT, computed tomography.

Facial Plastic Surgery Vol. 33 No. 5/2017

 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 6 Depressor supercilii muscle; anatomic dissection of the central
hemiface (different dissection than ►Figs.1–4 ; front view). The
dissection has been performed below the subcutaneous fat of the
radix and glabella. A skin–subcutaneous fat flap is pulled laterally on
the right side. Procerus muscles are inserted on both sides of the nasal
bones, close to the midline. One can observe the depressor supercilii
muscles inserted superolaterally to the procerus; deeper and more
lateral the medial fibers of the orbicularis oculi muscle are pulled with
the skin flap.
is a well-known muscle, which also presents anatomic
variations and can be absent.
To summarize, there is not one single orbicularis oculi
muscle, pars orbitalis; there may be at least three expansions
that are acting without any sphincter action: depressor
supercilii, zygomaticus superficialis, and levator genae.
These muscles are present from birth and explain both
interindividual variations in facial expressions already visi-
ble in childhood and different ways of aging.
Inferior Orbicularis Oculi Muscle, Pars Orbitalis,
Anatomic Variations of the Middle Bundles
Clinical Value
Looking at the strength of the orbicularis oculi pars orbitalis
muscle sphincter fibers in the midcheek area, one can
observe during anatomic studies that sometimes these fibers
can extend very low in the midcheek and can be very
powerful (►Fig. 7) (see also ►Fig. 1), while in others they
can be dispersed and weak (►Fig. 8), invested by the sub-
cutaneous fat. The physiologic action of this muscle is not to
close the lids, which is related to the pars palpebralis of the
orbicularis oculi muscle, from which it is separated by the
orbicularis retaining ligament (ORL) bony insertions. They
are responsible for the elevation of the cheek during the
smile, giving volume to the midcheek area, and sometimes
deepening the palpebromalar groove. Thinking in 3D, these
loose connections between a weak orbicularis and the skin
through a weaker tela retinaculum cutis explains why people
presenting loose and rare fibers show a vertical negative
vector responsible for bad midface aging appearance.
Moreover, precise dissections of the caudal extension of the
orbicularis oculi bundles in the midcheek area lead us to
propose what could be called the “superficial levator lip–lid
system” or lip–lid system. The orbicularis muscle does not end
Saban et al. 475
Fig. 7 Orbicularis oculi pars orbitalis inferior anatomic variations: Strong
type. The inferior part of the orbicularis oculi is exposed after resection of
the skin and subcutaneous fat, while the residual skin is pulled downward
showing one of the zygomatic ligaments crossing the muscle fibers and
running from the bone to the skin. The orbicularis fibers are strong, without
free space and not invested by subcutaneous fat lobules. From these fibers,
multiple fasciae creating the tela retinaculum cutis link the muscle to the
skin, through the subcutaneous fat, thus generating the midcheek facial
three-dimensional segment.
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where there are no more visible muscular fibers during the
dissection: a true layer of fibrous extensions follows, extending
the muscle layer1 medially to the levator labii alaeque nasi
muscle where its fascia fuses with the neighbor ones,2 caudally
to the nasolabial fold where it inserts, fusing with the dermis
and the connecting fibers of the tela retinaculum cutis of the
upper lip. These connections of the lip–lid system give another
viewpoint of the relationships between the upper lip and the
lower lid related to the nasolabial fold.
To summarize the relationships between orbicularis oculi
muscle and midcheek appearance, one must consider the
whole midcheek anatomy.
The three superficial layers forming the facial mask in the
midcheek area are the skin, the subcutaneous fat (malar fat
pad), and the “superficial levator lip–lid system” related to
the orbicularis oculi muscle pars orbitalis and its expansions.
Fig. 8 Orbicularis oculi par orbitalis inferior anatomic variations:
Weak type. Compared with ►Fig. 7; in this case, muscles fibers are
weaker and invested by fat lobules. One can also observe the
nasolabial fat compartment, still not dissected, lying medial.
Facial Plastic Surgery Vol. 33 No. 5/2017
476 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
They are directly related embryologically to the lamina
infraorbitalis. The other muscles, even the mimic muscles,
and fat pads are located deeper.
To understand the relationships between the anatomy
and the facial appearance and their variations, one must
consider the variants of the midcheek anatomy.
The basic anatomy is to consider the link between these
three layers. In anatomy, there are three different layers, but
functionally there is only one, which may be called super-
ficial cutaneoadipomuscular system. The parameters are the
following:1 the skin is exposed to the exogenous alterations
and the endogenous actions related to the muscle contrac-
tions;2 the subcutaneous fat must be conceived not like a free
layer but, on the contrary, as completely linked and attached
to the deep aspect of the skin and to the superficial aspect of
the orbicularis oculi muscle (which can be invested by the fat
lobules), thanks to the tela retinaculum cutis directly related
to the numerous and strong fibrous septa arising out of the
muscle and attaching to the skin, thus creating a honeycomb
net filled with fat lobules. The height and thickness of the
subcutaneous fat will give the midcheek volume. According
to Rohrich and Pessa,8 this malar fat pad corresponds to the
medial cheek fat pad compartment.3 The orbicularis oculi
orbitalis pars is responsible for the strength and the exten-
sion of the malar area superficial appearance.
The best aesthetic anatomy could be summarized as the
following (►Fig. 9):1 complete orbicularis oculi muscle in-
cluding the lateral and medial extensions (levator genae,
zygomaticus superficialis) and complete sphincter muscular
bundles;2 nice subcutaneous fat amount reaching a high level
close to the eyelashes and over passing the lid–cheek junc-
tion;3 good quality of skin and good healthy way of life. The
better the anatomy, the better is the midcheek appearance.
On the contrary (►Fig. 10), weak orbicularis oculi muscle
presenting rare bundles, low level of subcutaneous fat, loose
tela retinaculum cutis, and bad quality of life will lead to a
bad facial appearance with huge negative vectors, deep folds,
and tear trough deformity.
Fig. 9 Strong “lip–lid” midcheek anatomical type. Complete
muscular bundles of the “lip–lid system” leads to nice facial
appearance, without vertical negative vectors.
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Saban et al.
Fig. 10 Weak “lip–lid” midcheek anatomical type. Incomplete
muscular bundles do not give good support to the lip–lid system thus
resulting in bad facial appearance including vertical negative vectors
and subcutaneous fat dissociation in nasolabial and malar fat pads,
and deep facial grooves.
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Subcutaneous Fat Compartments in Midface
Going forward in the subcutaneous fat analysis, each of the
three midcheek segments has a distinctly different thickness
of subcutaneous fat. The subcutaneous layer is thinnest in the
lid–cheek segment adjacent to the lid proper. In the malar
segment, the layer is moderately thick and uniform, whereas it
is markedly thicker in the nasolabial segment, which has the
thickest layer of subcutaneous fat of the face. Where the
subcutaneous fat is thicker, the retinaculum fibers are length-
ened and more prone to weakness and distension. The thick
subcutaneous fat in the nasolabial segment is named the malar
fat pad, which is confusing terminology, given that its position
is predominately medial to the prominence of the zygoma in
the perioral part of the midcheek.12
The superficial nasolabial and malar fat compartments
(►Figs. 11 and 12) form the midcheek fat compartments.
Superficial and lateral to the zygomaticus major muscle, the
zygomatic fat pad (the “middle cheek” fat compartment8 is
the confusing name: it incorrectly seems to suggest that this
middle fat lies in the infraorbital area or is located in between
different layers) lies between so-called medial8 or malar fat
pad and lateral temporal-cheek fat. The superior border is
defined by the superior cheek septum.
We would like to suggest renaming these superficial fat
compartments following their anatomical usual location,
making them more natural: nasolabial (superficial 1), infra-
orbital (superficial 2), zygomatic (superficial 3), and lateral
or parotidomasseteric (superficial 4).
The Nasolabial Levator System and Deep Cheek Fat
Compartments
The nasolabial levator system is located deep to the super-
ficial midcheek levator system (i.e., the “lip–lid system”)
related to the orbicularis oculi that give the appearance
and the volume of the midcheek. According to the bony
insertions and the classic anatomy, one can consider two
parts in the nasolabial levator system: the central system and
 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 11 Superficial fat compartment. So-called cheek, or malar or
infraorbital, or medial fat pad, the need of clarifying the nomenclature
is obvious. Compare this fig. to ►Figs. 9, 10 , and 12 (see text).
the lateral system. The muscles elevating the ala of the nose
and the central part of the upper lip compose the central
system: levator labii alaeque nasi (LLSAN). This muscle is
mainly located in the nasojugal groove and corresponds to
the medial border of the superficial nasolabial fat pad.
Moreover, in some dissections, fibers of the zygomaticus
minor muscle could be seen passing superficially to the facial
vein and intermingling with the LLSAN, creating a lateral
dilator nasi effect responsible for a relief lateral to the ala
during the smile. According to these observations, one may
consider that these muscles are sharing the same fascia, just
deep to the orbicularis oculi system; thus a nasolabial deep
fat compartment can be individualized in between these two
layers of superficial and deep levator systems, and medial to
the facial vein (►Fig. 13). One must not confuse this naso-
Fig. 12 The superficial infraorbital fat compartment (colored in
green) has been elevated and pulled downward to show the under-
lying orbicularis oculi muscle. This infraorbital fat is separated from
the superficial nasolabial fat by fascia expansions arising from the
deeper muscles such as the division between the lip–lid system from
the orbicularis oculi pars orbitalis and the nasolabial from the central
levator system (see text).
Saban et al. 477
labial deep fat to the suborbicularis oculi fat (SOOF) that is
deeper and more lateral (►Fig. 14).
The upper lip deep lateral levator system must be con-
sidered (►Fig. 15). It is composed by the levator labii super-
ioris medially, by the zygomaticus minor in the middle, and
by the zygomaticus major muscle laterally, while the levator
anguli oris is located deeper in another plane. Precise dis-
section of this area shows fibrous septa connecting these
muscles together and to the bones (maxilla and zygoma) in
depth (►Fig. 16A). These muscles’ bony insertions form the
medial and caudal limits of the SOOF as defined by Aiache
and Ramirez15 or prezygomatic fat compartment,7 together
with the zygomatic ligaments. Superficial to these muscles is
a deep fat pad located under the orbicularis oculi muscle.
Deep to these muscles lays another fat pad which corre-
sponds to the exit point of the infraorbital nerve and where
the facial nerve’s superior buccal branches run, crossing
superficially the infraorbital sensory nerve (►Fig. 16B–D).
This last fat pad may correspond to the deep nasolabial fat
pad bordered superficially by the levator anguli oris muscle,
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and in depth by the buccinator muscle.
The observation of these muscles’ bony insertions leads to
underline an oblique line of levator muscle insertions (levator
labii superioris, zygomaticus minor, zygomaticus major) that
starts on the inferior bony orbital ridge medially and ends
downward close to the masseter muscle insertion laterally,
following the zygomatic ligaments (►Figs. 17 and 18). Thus, it
constitutes an important anatomic oblique line (the levator
oblique insertion line), caudal to the ORL, with which it forms a
Fig. 13 Deep nasolabial fat compartment. Anatomic dissection of the
right hemiface (different dissection than previous figures); front view. The
superficial fat compartments have been removed. The nasolabial fold is
marked by the upper lid skin limit section. The zygomaticus muscles have
been resected just below the level of the orbicularis oculi muscle, to free and
to show the facial vein that runs straight obliquely, very deeply in the face.
Between the nasolabial fold and the facial vein (dyed in blue) is located the
deep nasolabial fat compartment. Lateral to the facial vein is the deep
infrazygomatic fat compartment.
Facial Plastic Surgery Vol. 33 No. 5/2017
478 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 14 Deep nasolabial fat compartment. Anatomic dissection of the
right hemiface (different dissection than previous figures); lateral
view. The lip–lid system (L) corresponding to the superficial muscu-
loaponeurotic system (SMAS) (layer number 3) and extending from
the orbicularis oculi muscle is lifted anteriorly. Dissection progresses
in the spaced layer number 4. One can observe in the center of the
picture the zygomaticus major muscle (ZM); the zygomatic branch of
the facial nerve runs over it; below is the superior buccal branch
emerging from the anterior pole of the parotid gland (P) running
forward, following the Stensen’s duct (not dissected here) and crosses
the deep facial fascia superficially and the deep buccal fat pad
(Bichat’s fat pad).2 On the upper part, the flap lifting is blocked on the
orbicularis retaining ligament (O). Cephalic to the zygomaticus major
bony insertion lies the suborbicularis oculi fat (SOOF),1 which covers
the zygomatic bone and arch. Considering the ZM, it constitutes a
remarkable landmark as pointed out by Hamra: cephalic is the SOOF;1
in-depth is the deep buccal fat pad (Bichat’s fat pad);2 anterior is the
infrazygomatic fat; 3 superficial is the deep cheek fat compartment.
triangle and which corresponds to the upper limit of the
contraction of these levator muscles. In between the ORL
insertions and the oblique levator line of insertion lies the
triangular-shaped SOOF. That also explains the deep aspect of
the midcheek groove, which separates the nasolabial mid-
cheek segment from the malar midcheek segment.
Fig. 15 Deep lip levator muscular system. Dissection of ►Figs.1
and 7 continued. Deep to the lip–lid superficial system, the deep lip
levator system is formed by fasciae connections relying on the
zygomaticus major, zygomaticus minor, and levator labii superioris
muscles; the most medial is the levator labii alaeque nasi. Superficial
to it is the deep compartment divided by the facial vein into the deep
nasolabial fat compartment and deep cheek compartment.
Facial Plastic Surgery Vol. 33 No. 5/2017
Saban et al.
The Deep Facial Fascia (Layer Number 5) and the Deep
Structural and Visceral Fat Compartments
The deep facial fascia (layer number 5) separates the super-
ficial spaces of the facial mask innervated by the facial nerve
(VII), from the visceral deep spaces innervated by trigeminal
nerve (V), the oculomotor nerves (III, IV, VI), and the muscles
of orientation (sternocleidomastoid muscle and spinal
accessory nerve XI). One can consider by assimilation that
the orbital septum and the periosteum of the skull bones
correspond to the deep facial fascia.
“Considering the description of the deep facial fascia, it is a
composite anatomic structure representing a continuation of
the deep cervical fascia cephalad into the face. By assimilation
to the SMAS concept in one unique structure, it may be
possible to understand the deep facial fascia as a unique layer
separating the facial mask from the visceral face, the impor-
tance of which lies in the fact that the facial nerve branches
within the cheek lie deep to this deep fascial layer.”11
The dissection deep to the three first layers proceeds in
the spaced layer number 4 which can correspond either to a
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detachable areolar space, the Merkel’s space in the cranial
area, or to an adipose sub-SMAS deep space in the midface.
The deep facial plane has been exposed (►Figs. 2 and 18). It is
very polymorphic and organized into different areas: the
deep temporalis fascia in the temporal region; the capsule of
the parotid gland in the preauricular and retromandibular
areas; the masseteric fascia. In the buccal space, the deep
facial fascia separates the deep buccal Bichat’s fat pad from
the superficial mimic face. It results in the fusion of the
masseteric fascia and the buccinator fascia, splitting to follow
the Stensen’s duct (►Fig. 19) till its penetration into the
buccinator muscle (►Fig. 20); the superficial layer of the
deep facial fascia appears like an anterior extension of
the parotid gland capsule, while the deep layer of the deep
facial fascia corresponds to an anterior extension of the
masseteric fascia. The facial nerve is running in between
these two fasciae (►Fig. 21 [histologic section]).
Different deep fat compartments belong to these deep
facial structures, even if there is still no established con-
sensus. One could consider two different kinds of deep fat
pads following their location. They can be either “structural”
fat pads that can be crossed perpendicularly by neurovas-
cular pedicles from trigeminal nerve branches or “visceral”
which correspond to the unique buccal fat pad. The structural
fat compartments are: the temporal fat pad (suprazygomatic
fat pad), located in the division of the deep temporalis fascia
(between layers 5a and 5b); the prezygomatic fat pad (SOOF)
which presents sometimes an unusual lateral extension
which can reach the suprazygomatic fat pad, located be-
tween the layer 5a and the zygomatic periosteum (►Fig. 18).
On the contrary, the buccal fat pad (Bichat’s)16 is an im-
portant anatomic structure located deep in the 5b layer, in
the buccotemporal space (►Fig. 22), between the fascia of
the buccinator muscle and the fascia of the masseter muscle.
The buccal fat is unique in humans and cannot be considered
in the same way as the structural fat compartments. How-
ever, its morphological, aesthetic, cosmetic, and surgical
importance is considerable. Three relevant anatomic
 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area Saban et al. 479

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Fig. 16 Deep nasolabial fat compartment. Fibrous septa and deep fat compartments. Sequence of dissection. Dissection of ►Figs. 1, 7 , and 15
continued. (A) The dissection of the fibrous septum connections in front of the zygomaticus muscles. (B) The deep nasolabial fat pad is pulled
with forceps, showing the deeper levator anguli oris, and the facial nerve branches that are horizontally crossing this area. (C) The infraorbital
nerve is exposed, which is located under the levator labii superioris (retracted by the hooks) and superficial to the levator anguli oris in-depth. The
nerve is surrounded by the loose fat lobules, pulled by the forceps. (D) The superior buccal branch of the facial nerve crosses the infraorbital
nerve superficially within the deep nasolabial fat compartment.

structures (Stensen’s duct, facial vein, zygomaticus major

muscle), forming the “buccal star,” cross the anterior part of
this buccal space (►Fig. 23). It has four extensions: buccal,
pterygoid, pterygopalatine, and temporal (►Fig. 24); the
latter one is also known as the deep temporal fat pad of
the temporal region and is found between the deep layer of
the deep temporal fascia and the proper temporalis muscle.
Facial layers and facial fat compartments related to the
facial mimic function form a multilayer system overlying the
masticatory system and the buccal Bichat’s fat pad located in
and filling the buccal–temporal space (►Figs. 25 and 26).

Anatomy of the Facial Adipose Tissues: Ultrastructural

Fig. 17 The suborbicularis oculi fat (SOOF) and the zygomatic
ligaments. Same dissection as ►Figs. 1, 7 , 15–19 . Previous stage: the
orbicularis oculi pars orbitalis is elevated, at the level of the orbicularis
retaining ligament (ORL); caudally, the soft tissues are pulled down-
ward to show the zygomatic ligaments that resist to the traction. The
SOOF is located between these ligaments: ORL cranially and zygo-
matic ligaments caudally.
New Concepts
Three different types of facial adipose tissue can be identi-
fied17 which are located either superficially (dermal white
adipose tissue) or deep (subcutaneous white adipose tissue
[sWAT]): fibrous (perioral location), structural (major part of
the midface), and deposit (buccal fat pad and deep temporal fat
pad). Dynamically, deep sWAT is considered a slow renewal

Facial Plastic Surgery Vol. 33 No. 5/2017

480 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 18 The deep facial fascia and the zygomatic fat pads. Another
dissection: Lateral view of the zygomatic area after resection of the three
first layers. Below and lateral to the orbit, the suborbicularis oculi fat extends
laterally till the auricle and fuses with the suprazygomatic fat pad. Deep
temporal pedicles, dyed in blue, are crossing these two structural deep
zygomatic fat compartments perpendicularly. The caudal border is the bony
insertions of the zygomatic muscles. Where the bone (periosteum) is
visible, is the orbicularis retaining ligament that has been resected together
with the orbicularis oculi muscle. One can observe the oblique line of the
levator muscles of bony insertion. Caudally, the facial nerve has been
exposed, together with the transverse facial artery and the Stensen’s
parotid duct colored in blue by the dye. They form the transverse facial
pedicle. (Image provided courtesy of Saban and Polselli.14)
tissue with characteristic turnover times of around 10 years.18
These various fat types present differences in their adipocytes
size and collagenous matrix composition. Ghassemi et al19
stated a classification of these different fat tissues: two differ-
ent types can be identified: Type 1 can be found in the medial
and lateral midface and parts of the periorbital region, as well
as in the temple, forehead, and neck. Here, the adherence is
loose, whereas in type 2 in perioral and nasal areas, as well as in
Fig. 19 The deep facial fascia: Histologic section. The masseter
muscle is covered by its aponeurosis (arrow). The SMAS (S) and the
skin are superficial. Following anteriorly (on the right part of the
picture), one can note the splitting of the masseter aponeurosis in two
layers surrounding the Stensen’s duct (D).
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Saban et al.
Fig. 20 Deep facial fascia and Bichat’s fat pad. Another dissection
showing the Stensen’s duct crossing the buccal fat pad (Bichat’s fat
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pad); the deep facial fascia has been dissected from the masseter
muscle and is pulled anteriorly till the buccinators muscle. This deep
facial fascia separates the mimic face from the deep face.
the area of the eyebrows, a strong linkage is present between
the facial muscles, the collagenous meshwork surrounding the
adipocytes, and the skin.
Microstructural Classification of Facial Adipose Tissue
Depots
Recent researches stated that extracellular matrix in adipose
tissues (ATs) is not a passive scaffold but an active player in
different morphologic and physiologic processes20 and that
Fig. 21 Histologic section showing the parotid–masseteric fasciae
fusion over the facial nerve. Cross-section through parotid gland,
masseter muscle, facial nerve, and facial fasciae. Also, observe the
different facial layers and the tela retinaculum cutis. The glandular
acini of the salivary gland allow to follow the capsule that covers the
facial nerve superficially at its exit point of the gland, just superficial to
the masseter (central at the lowest part of the picture), and associated
with the transverse facial artery. The facial nerve is lying just below the
parotid capsule and superficial to the masseter fascia.
 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 22 Bichat’s buccal fat pad topographic anatomy. Different
anatomic dissection from other photos. All the facial layers and
superficial soft tissues have been resected, along with the layer
number 5 deep facial fascia. The buccal fat pad appears between the
masseter and the maxilla, while its temporal extension can be seen
just above the zygomatic arch.
its specific modification can even be a hallmark of metabo-
lically changed adipocytes.
Besides the macroscopic compartmental classification of
facial AT, a microstructural modification of different fat
compartments in an aging face has not been described
properly. The first attempt to describe the microscopic
differences in the structure of various facial fat compart-
ments taking into account both the morphology of adipo-
cytes and the local collagen content was undertaken only
recently by Sbarbati et al21 who subdivided the sWAT depots
using the results of transmission electron microscopy and
scanning electron microscopy into three groups:1 deposit
(metabolic) WAT;2 sWAT;3 and fibrous WAT. Based on these
results, Bertossi et al22 proposed a classification of the fat
compartments from the medium third of the face (the malar,
periorbital, labial, nasal, and buccal fat pads) using the same
methods as Sbarbati et al and have shown that these fat
compartments present some significant ultrastructural dif-
Fig. 23 The “buccal star.” Different anatomic dissection: Right side;
lateral view. The superficial anatomic structures crossing the buccal
space are forming an asterisk: Stensen’s salivary canal horizontally,
zygomaticus major muscle oblique medially, and the facial vein
oblique laterally. In depth, the bottom is formed by the buccinator
muscle while the masseter is visible laterally. (Image provided cour-
tesy of Saban and Polselli.14)
Saban et al. 481
Fig. 24 Drawing of the Bichat’s buccal fat pad. The zygomatic arch
(1, 1’) has been resected and masseter reflected2 posteriorly. The exten-
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sions of the buccal fat pad are shown and the parotid–masseteric fascia8 is
enveloping the Stensen’s parotid salivary canal5 till it penetrates the
buccinators muscle.4 It has four extensions: buccal,7 pterygoid, pterygo-
palatine, and temporal (7’). (Image provided courtesy of Testut L. Traité
d’anatomie humaine. Paris, France: Doin; 1931: pp550.)
ferences particularly in the facial connective tissue that
seems to be characterized by different embryonic origin in
comparison with the AT of the other body fat. While the body
and limbs fats have mesoderm origin, the facial connective
tissue seems to be derived from neural ectoderm.
Fig. 25 Anatomy of the facial layers in the midface area. Different
dissection from the previous ones. Right face is shown from the front
view. See also ►Fig. 26 for better understanding. The multiple facial
layers have been dissected to show their relationships. The nasolabial
superficial and deep fat compartments have been resected to show
the muscles. One can observe from lower lid to oral commissure, the
muscles: orbicularis oculi pars orbitalis; llsan; levator labii superioris;
levator anguli oris; zygomaticus major; modiolus; buccinators;
platysma; depressor anguli oris. The fat compartments: superficial;
suborbicularis oculi fat; deep fat compartment; buccal fat pad
(Bichat’s fat pad). Note also the Stensen’s parotid salivary canal, white
color, just caudal to the zygomaticus major muscle.
Facial Plastic Surgery Vol. 33 No. 5/2017
482 Facial Layers and Facial Fat Compartments: Focus on Midcheek Area
Fig. 26 Facial multilayer anatomy summarized. Oblique cross-section
of the right face, shown from medial view. The section is performed
from the medial canthus to the oral commissure. Mimic muscles and
facial fat compartments present an alternate anatomy; from cephalic
to caudal: First layers forming the lip–lid system: palpebral skin, the
superficial fat compartment (malar fat pad), orbicularis oculi muscle
pars orbitalis (superficial cutaneoadipomuscular system). Fourth
layer: superficial nasolabial fat compartment. Levator labii superioris
muscle. The deep nasolabial fat compartment where the infraorbital
and facial nerves run. Levator anguli oris. Buccal fat pad (buccal part).
Buccinator muscle. The mucosa of the oral cavity.
Conclusion
Connections of mimetic facial muscles to the dermis are
made through the subcutaneous and deep AT divided in
compartments and attached to the skin and the muscles,
forming the superficial and deep functional and aesthetic
units of the face. A superficial “lip–lid system” is described
overlying and sliding on deeper lip elevator structures; the
lip–lid system, attached to the ORL is pulling facial soft
tissues vertically upward, thus creating the palpebrojugal
groove. On the opposite, related to deep facial fat compart-
ments and inserted obliquely on the bones, the lip levator
system, is acting laterally, thus responsible of the midcheek
furrow.
Anatomic variations of mimic muscles are directly related
to the wide interindividual range of facial expressions.
Further researches on the physiology of the fat subcompart-
ments will be of great value to better understand their role
which does not look like limited to a sliding layer separating
muscles of facial expression.
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Saban et al.
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