In the process of aging, fat packages undergo certain changes, their variants are different:
- hypotrophic;
- hypertrophic;
- ptotic.
Understanding the ageing-related changes that occur in deep On estet-portal.com, read what deep fat packs exist, what age-related changes occur with them, and also how to correct these anatomical formations.
- Anatomy of the face: deep fat pads
- Anatomy of the aging processes of deep fat pads
- Correction of deep fat pads Anatomy of the face: deep fat pads
Deep fat pads:
Mesial infraorbital fat pad
, medial SOOF (Medial suborbicularis oculi fat, Medial SOOF) Adjacent to the periosteum of the medial part of the lower edge of the orbit, and is located under the orbicular muscle of the eye. It extends from the medial angle of the eye to the outer canthus. The zygomaticocutaneous ligament separates the medial SOOF inferiorly from the deep medial buccal fat pad.
Lateral infraorbital fat pad,
lateral SOOF (Lateral suborbicularis oculi fat, Lateral SOOF) Located in the lateral part of the lower edge of the orbit in the sagittal plane, does not rise above the lateral canthus. The upper boundary is formed by the lateral thickening of the orbit. The medial half is covered by the orbicular muscle of the eye. The lateral SOOF lies above the prominent part of the zygoma, but does not reach the upper edge of the zygomatic arch. The lateral SOOF sits above another, deeper fat pad, so it does not have direct contact with the periosteum. Its medial border is the medial SOOF.
Deep medial cheek fat
(DMCF) Located below the level of the SMAS, its upper part lies under the orbicular muscle of the eye. Upper border — this is the zygomaticocutaneous ligament that separates it from the medial SOOF, laterally it borders on the deep buccal fat (Bish's lump) and the large zygomatic muscle. Medial Border — this is the piriform ligament surrounding the base of the nose, and the lower border — This is the fat located under the circular muscle of the mouth (suborbicularis oris fat). This fat pad is located on the periosteum of the upper jaw.
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Deep buccal fat pad, Bish's lump
(Buccal fat) is located below the cheekbone from the front side of the mandibular branch, surrounds the medial pterygoid muscle of the upper jaw and the masticatory muscle. This fat pad has a buccal extension that is adjacent to the medial buccal fat pad, deep medial buccal fat pad, median buccal fat pad, orbicularis oculi fat pad, mandibular fat pad, and premasticatory fat pad. Anatomy of the aging processes of deep fat pads
Medial and lateral SOOF
. Both packages lie on the periosteum, and their aging is characterized by hypotrophy with low tendency to ptosis. Hypotrophic involution of the medial SOOF leads to formation of a retraction zone in the infraorbital region. It has been noted that a decrease in the medial SOOF aggravates the tear trough and V-shaped deformity of the lower eyelid. The medial SOOF supports the tissues of the lower eyelid, so reducing its volume increases the relaxation of the lower eyelid tissue and the intraocular fat pad. Hypotrophy of the lateral SOOF reduces the projection of the malar region and cheekbone, which facilitates the ptosis of the superficial cheek fat pads.
Deep medial buccal fat pad
(DMCF). This package is characterized by gradual and pronounced volume reduction and caudal migration. Hypotrophy of the deep medial buccal fat pad occurs to a greater extent in the upper two-thirds and slightly — in the lower third, where caudal fat migration compensates for malnutrition.
Deep buccal fat pack
(Buccal fat). Part of this fat package, which determines the aesthetic appearance of the cheek, is a lump of Bish. It is mainly characterized by hypotrophic type aging. Some authors have observed a decrease in the volume of Bisch's lump in elderly patients, which leads to a lack of support for the superficial medial buccal and middle buccal fat pads, exacerbating their prolapse. Other authors have described anteroinferior protrusion of the deep buccal fat pad resulting in increased bulge and cheek droop. Correction of deep fat pads
First of all, it must be taken into account that the deep fat pads in mainly need
an increase in volume.
Therefore, the correction plan should include the use of a volumizer.
The filler will only have a lifting effect if it is injected into certain anatomical zones within certain deep fat pads, which, by restoring the lost volume, have a lifting effect on the superficial fat pads.
In patients with types of aging
1 (hypotrophic) and 2 (hypotrophic/ptotic)
, correction should be aimed at eliminating the main defects, which are, first of all, a decrease in the volume of the deep medial buccal fat pack and, secondarily, lateral SOOF. Therefore, in order to reduce fatty hypotrophy, it is necessary to first increase the volume of the deep medial buccal fat pack and provide the initial lifting effect of the soft tissues of the cheeks. Then, restoring the volume of the lateral SOOF, to achieve an increase in the projection of the cheekbone, which will further enhance the lifting effect of the soft tissues of the cheeks.
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patients with aging type 2
, following anatomical logic, it is advisable to increase the amount of filler injected into the lateral SOOF, because such patients require a lifting effect to a greater extent than patients with type 1m aging. And finally, it is necessary to perform injections in the medial SOOF to correct the retraction in the periorbital region. In patients
with ageing type 3 (ptotic/hypertrophic)
, the main defects are ptosis and descending migration of adipose tissue of superficial fat pads. In this case, it is necessary to achieve lifting of ptotic fat pads by increasing the volume of the lateral SOOF. Restoring the volume of this package will increase the projection of the cheekbone and provide a lifting effect of the superficial fat package. Note that it is not recommended to inject very large volumes into the area of the deep medial buccal fat pad because in this type of patient the lower part of the maxilla is already characterized by hypertrophy and excess volume. Aging type 3 patients require medial SOOF correction to correct periorbital retraction.
A similar approach is applicable to patients
with ageing type 4 (hypertrophic/ptotic)
, in which it is necessary to increase the volume of the lateral SOOF to lift the soft tissues of the cheek and balance the excessive the volume of the lower part of the maxillary region. Usually, the deep medial buccal fat pad is not corrected, except in its upper part, on the border with the lateral SOOF. You may also be interested in:
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