It was once thought that the secret to returning the face to its former youthful appearance involved simply lifting and re-draping sagging skin. Then as surgical procedures evolved, lifting and redistribution of the muscle was incorporated. Eventually it was realized that facial fat loss significantly impacted the appearance of the face as we aged. When fat loss is the culprit we can refer to the effect as “pseudoptosis”. Granted, the skin itself is affected by aging as well, especially when it has suffered from sun damage. As we age elastin fibers break down and the skin’s elasticity is compromised. Coupled with thinning of the skin, the face takes on a “sagging” appearance. As we mature, the facial fat loss compounds the issue. Even when our skin is very healthy and plump, this volume loss can occur and still create that deflated appearance.
Fat loss may become apparent as early as in the late 20′s and up, usually becoming very apparent in the mid to late thirties. You might feel that you look gaunt, worn out, and your under eyes may have developed sunken circles underneath them. Your cheeks may not be as high as they once were, and deep lines (called nasolabial folds) which run from your nose to your mouth may begin to form. All of these together creates an older looking you. All of which may be easily fixable.
Efforts to restore volume to the face has included facial implants, redistribution of the underlying muscle, and eventually the use fat and injectable fillers into the dermis and also into the muscle. Recently, surgeons at UT Southwestern Medical Center have discovered 4 key fat pockets found deep under the skin that when injected with even small amounts of fillers (such as fat, hyaluronic acid, etc.) can significantly rejuvenate the appearance of the face. I have had fat injections, Restylane, Sculptra and Juvederm in an effort to keep the effects of aging at bay. And it works! A little goes a long way and if you keep up the maintenance, your face will thank you for it.
In a study lead by Dr. Rod Rohrich, Chief of Plastic Surgery at UT Southwestern Medical Center study, researchers injected 14 cadavers with dye and latex to mark the boundaries of these deep fat pockets. The doctors concluded that these fat injections returned the lateral projection of the face and gave the face a naturally rejuvenated, fresh look without the negative effects of prior methods.
“**METHODS:: Fourteen hemifacial cadaver dissections were performed using the dye injection technique to identify deep medial cheek, submentalis, and sub-orbicularis oris fat compartments. Latex injection was used to investigate the arterial supply
So what about when too much of a good thing is simply too much? Even today some surgeons are still injecting a considerable amount of fat into the dermis to rejuvenate the face. Overstuffing patients with can make your face look bloated, and undefined. The goal should be a softer appearance such as you were when you were younger, not a bloated, “fat-faced” version of yourself. This volume restoration to specific areas is what is going to get us there. Injecting fat into these deep fat compartments will reduce the amount of fat needed for your procedure and give us a naturally rejuvenated look, not a puffy, pulled -too-tight result.
I certainly welcome new research which can eventually make it to the operating table near me! I hope that the method will become more mainstream and these new findings will be made available to us in the form of an advanced treatment. I suspect I may need more fat grafting in the coming years and hope this method will be perfected by then.
Sites & Sources:
**Plast Reconstr Surg. 2008 Jun ;121 (6):2107-2112 18520902 The Youthful Cheek and the Deep Medial Fat Compartmen. (R. Rohrich, J. Pessa, B. Ristow
Dept. of Plastic Surgery, University of Texas Southwestern Medical School; California Pacific Medical Center)