Facial plast Surg 2017; 33(05): 470-482
DOI: 10.1055/s-0037-1606855
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Facial Layers and Facial Fat Compartments: Focus on Midcheek Area

Yves Saban
Ear Nose Throat, Facial Plastic Surgery, Maxillo-Facial Surgery, Nice, France
Roberto Polselli
Ear Nose Throat, Facial Plastic Surgery, Marina di Carrara, Italy
Dario Bertossi
Department of Maxillofacial Facial Surgery, Policlinico GB Rossi, Verona, Italy
Charles East
Rhinoplasty London, Facial Plastic Surgery, London, United Kingdom
Olivier Gerbault
Department of Plastic Surgery, Polyclinique Esthétique Marigny 3-5, Cours Marigny, France
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29.September 2017 (online)


Facial cosmetic procedures are doubtless in constant augmentation directly related to 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 related to muscle actions and facial fat compartmentalization in the midcheek area. A “lip–lid” superficial system associated with the malar fat pad represents the first layer; two deeper lip levator systems stratification explains the deep fat compartments as an anatomic division related to fasciae extensions. Facial grooves and segments correspond to these systems action. Moreover, the importance of ultrastructural studies has been underlined.