Quantitative analysis of midface fat compartments mass with ageing and body mass index, anatomical study

Volume restoration is not a new concept in facial rejuvenation. The deep fat compartments would appear to be more greatly subjected to age-related volumetric deflation. However, this view lacks scientific evidence. The purpose of the present study is to quantify fat mass variability in the superficial and deep compartments of the midface as a function of age and BMI.

A cadaveric anatomical study was performed by dissection of superficial and deep facial fat compartment of 40 body. The studied compartments were identified by methylene blue injection and were weighed. The data obtained were analyzed as a function of subject age (two groups: ≤75 or >75), sex, and BMI (three groups: <20, ≥20≤25, or >25).

The mean weight of the deep compartments was significantly lower in the group with subjects aged >75 years (1.48g vs 3.41g, P<0.001) and the deep-to-superficial fat ratio decreased significantly by more than 50% (0.2 vs 0.44, P<0.001). No statistically significant difference as concerns the mean weight of the superficial compartments (7.93g vs 6.73g). The deep-to-superficial fat ratio as a function of BMI was largely significantly lower in subjects with BMIs<20 (0.15, vs 0.31 and 0.34, P<0.001).

The present anatomical study confirmed that fat atrophy affects in priority the deep midface compartments with ageing and in subjects with a BMI less than 20. Thus to obtain natural-looking results in facial rejuvenation, the volumetric restoration of these deep compartments should be considered a priority.