title: Quantitative analysis of midface fat compartments mass with ageing and body mass index, anatomical study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de chirurgie plastique centre hospitalier Saint-Joseph-Saint-Luc, 20, Quai-Claude-Bernard, 69365 Lyon cedex 7, France; Laboratoire d'anatomie de l'université Claude-Bernard Lyon 1, 8, avenue Rockefeller, 69008 Lyon, France. Electronic address: alex.mertens@wanadoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Mertens
authors.affiliation: Service de chirurgie plastique centre hospitalier Saint-Joseph-Saint-Luc, 20, Quai-Claude-Bernard, 69365 Lyon cedex 7, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Foyatier
authors.affiliation: Department of Plastic-Reconstructive and Aesthetic Surgery, University of Lyon UCBL1, hospices civils de Lyon, 103, grand rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Mojallal
mesh_terms: D000368:Aged; D000375:Aging; D015992:Body Mass Index; D002102:Cadaver; D004210:Dissection; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D050151:Subcutaneous Fat / Q000033:anatomy & histology*
keywords: Anatomical study; Compartiments graisseux; Face lift; Facial ageing; Facial fat compartment; Fat grafting; Filler; Vieillissement facial; Étude anatomique