Summary
The ideal treatment of the nasolabial fold, the tear trough, the labiomandibular fold
and the mentolabial sulcus is still discussed controversially. The detailed topographical
anatomy of the fat compartments may clarify the anatomy of facial folds and may offer
valuable information for choosing the adequate treatment modality.
Nine non-fixed cadaver heads in the age range between 72 and 89 years (five female
and four male) were investigated. Computed tomographic scans were performed after
injection of a radiographic contrast medium directly into the fat compartments surrounding
prominent facial folds. The data were analysed after multiplanar image reconstruction.
The fat compartments surrounding the facial folds could be defined in each subject.
Different arrangement patterns of the fat compartments around the facial rhytides
were found. The nasolabial fold, the tear trough and the labiomandibular fold represent
an anatomical border between adjacent fat compartments. By contrast, the glabellar
fold and the labiomental sulcus have no direct relation to the boundaries of facial
fat. Deep fat, underlying a facial rhytide, was identified underneath the nasolabial
crease and the labiomental sulcus.
In conclusion, an improvement by a compartment-specific volume augmentation of the
nasolabial fold, the tear trough and the labiomandibular fold is limited by existing
boundaries that extend into the skin. In the area of the nasolabial fold and the mentolabial
sulcus, deep fat exists which can be used for augmentation and subsequent elevation
of the folds. The treatment of the tear trough deformity appears anatomically the
most challenging area since the superficial and deep fat compartments are separated
by an osseo-cutaneous barrier, the orbicularis retaining ligament. In severe cases,
a surgical treatment should be considered. By contrast, the glabellar fold shows the
most simple anatomical architecture. The fold lies above one subcutaneous fat compartment
that can be used for augmentation.
Keywords
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Article info
Publication history
Published online: June 04, 2012
Accepted:
April 30,
2012
Received:
August 29,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
