The loss of volume and descent of fat pads in this region represents a significant component of facial aging that may not be sufficiently treated by more traditional facelift techniques, such as the smas lift. Malar fat reduction surgery in mumbai, india facial plastic. Buccal fat pads protrude outward from the face due to obesity, excess mastication, aging, or fat pad looseness because of facial bone reduction and commonly manifest as buccal hypertrophy commonly called chubby face or baby fat or two protruding lumps at both sides of the mouth corner on smiling also called circumoral fat, thus making the. Jan 01, 2006 in addition to redistribution of facial fat and concomitant loss of surrounding fullness, the fat pockets become more discernible as separate entities, as do many of the underlying facial structures, such as the submaxillary glands and bony protuberances.
There is an easily dissected plane deep to the fat pad that extends to the nasolabial crease. Oct 30, 20 over time, gravity pulls the malar fat pad down off the zygomatic arch and the orbicularis oculi muscle. The malar fat pad is elevated, allowing for the correction of the deflation and descent seen in the midface. Descent of the malar fat pad also contributes to the midface portion of the jowl. Dermal fillers are a wonderful way to look youthful, removes wrinkle, fine lines, and saggy skin. With aging, the zygomatic ligaments which support the malar fat pad stretch, allowing descent, reducing the prominence of the cheek and deepening the nasolabial fold. Nov 17, 2018 malar fat pad refers to the youthful cheek.
The fat layer under the skin here is called the malar fat pad and is thicker than elsewhere. It lies beneath the skin and is what makes the cheeks appear full and youthful looking. The buccal fat pad also called bichats fat pad, after xavier bichat, and the buccal pad of fat, is one of several encapsulated fat masses in the cheek. Loss of fat in the submalar area causes an overall hollowness that in later years causes a gaunt and old appearance. The malar fat pad is a triangular shaped fat pad in the midface which is located in the subcutaneous plane superficial to the smas.
In an older face there is often a descent of the malar pads and a deepening of the tear trough. Malar fat pad suspension through intraoral approach. The purpose of this study was to explain how the malaris muscle is able to produce an antiaging effect on the midface. It could play a role in midface aging prevention as that observed in subjects with prominent cheekbones like asian people. Mar 16, 2016 it does not correct the descent of the malar fat pad. The malar fat pad and overlying skin literally slide down off of the upper cheek bone structures and comes to rest on the lower cheek and. Facial aging involves loosening and sagging of skin and fat soft tissues. This results in the area under the eyes appearing hallowed. Because of the malar fat pads tight adherence to the skin but loose connection to the smas, it translocates along the surface of the smas to ultimately reside inferior and medial to its prior position. Fawzy a fat compartments and retaining ligaments of the face. Skeletal resorption of anterior facial skeleton also contributes to descent. Cheek fillers cheek augmentation advanced cosmetic medicine. Midface surgery case studies beverly hills cheek lift cases.
Due to its superficial location, any bulge or pouching in this region is particularly noticeable. Liposuction of the malar fat pads the dermatologist. If not projected forward by good bone structure the fat pad soft tissue, tends to sag. As people age and their skin loses elasticity and tone, the cheeks and eyelids tend to sag, creating a tired or haggard look. Can my malar fat pads be removed by facial liposuction. Note, that every person has a nasolabial fold and that its elimination will look unnatural 6 white part of the lip as we age this part of the lip looks longer and the red lips become thinner. It does not correct the descent of the malar fat pad. The surgical dissection of the malar fat pad starts from the malar eminence at the plane of the orbicularis oculi muscle and superficial to the origin of the zygomaticus and levator muscles, which are invested by the smas. With age, there is anterioinferior gravitational descent along with fat volume loss. Midface surgery case studies beverly hills cheek lift. As people age and their skin loses elasticity and tone, the cheeks and eyelids tend to. The malar fat pad is also known as the cheek fat pad. The malar fat pad lies superficial to the smas and the lip elevator muscles. However, there is a type of midface descent with an excess of skin and fluid which are known as.
I would perform a brow lift through a hairline incision and use an extended smas technique in the cheek area, carrying the vector of pull high. The deep plane facelift utilizes a plane of dissection below the superficial muscular aponeurotic system smas of the midface, allowing for direct lysis of key facial retaining ligaments and maximum mobilization of the superficial soft tissue. Furthermore, descent of the bichat fat pad over the upper mandible can increase lower facial jowling. In the upper level, aging is primarily caused by ptosis of the fibroadipose layer attached to the skin. It is a deep fat pad located on either side of the face between the buccinator muscle and several more superficial muscles including the masseter, the zygomaticus major, and the zygomaticus minor. Descent of the malar fat pad from the prezygomatic to infrazygomatic region leaves the upper midfacial skin deflated. The heaviness of the upper eyelids is due to a fall in the forehead or brow ptosis. Buccal fat pad removal fats wish aesthetic surgery clinic.
Loss of skin elasticity and integrity with associated sagging. Malar fat reduction surgery in mumbai, india facial. This shifting of malar fat pad and reduction of fat makes cheeks appear hollow. The results are easy to reproduce and are very effective in addressing the changes that accompany aging and the descent of the malar fat pad.
Dermal fillers in delhi, dermal fillers treatment, wrinkle. Approaches to midface and cheek lifting aesthetic surgery. When the smooth transition between the skin below the eyes and cheeks turns fluffy and round in shape, that accumulation of the fat on the face is known as excess malar fat. Anatomically, the fat pads that form the cheeks deflate, and fall downwards and inwards. The malar fat pad is responsible for the normal convex appearance of the cheeks. In the midfacial region, fat deposition in the cheeks begins to fade with advancing age. Malar fat pad repositioning, which restores the shape and volume of the face, is a fundamental step in facial rejuvenation procedures. The malar fat pad is not like the buccal fat pad, it is not an isolated and thus easily extractable type of fat. Laxity of the smas is often a contributing cause of midface descent. Additionally, as time passes on the face loses volume in the process of fat atrophy. The malar fat pad, which is closely mixed with the skin moves as a whole with it, and has a natural tendency to droop with age because of the distension of the orbicularis retaining ligaments 1, 2, 20.
The reposition of the malar fat pad plays a central role to restore a convex midface contour, and until now, it has been achieved mainly through large incisions or endoscopic techniques. In fact, it forms a dynamic bridge between the fascia temporalis superficialis and the malar fat pad. The descent of the malar fat pad over the cheek area. The cheek ligaments are released and cheek fat pads and muscles also known as the malar fat mound are elevated. Analysis of facial soft tissue changes with aging and. Consequently, patients appear exhausted and haggard regardless of sleep or under eye concealer. Pdf malar fat pad suspension through intraoral approach.
The malaris muscle is a superficial and fine facial muscle. Tear troughs are usually treated with filler and can be aided by blepharoplasty or a midface lift. Effects of endoscopic foreheadmidfacelift on lower. The descent of the malar fat pad is also associated with loss of bone projection at the orbital rim. After releasing the fairly minimal malar pad and elevating it attached to the skin, i would dissect across the nasolabial fold, including release along the modiolus lateral to the commissure. The first thing i note about this patient is the descent of lower lid skin over the. The lowerlid aging changes and the descent of the malar fat pad expose the bony inferior orbital rim and accentuate the nasojugal groove, which is also called the tear trough deformity.
Assuming my sagging malar fat pad diagnosis is correct, i would. These problems led to the search for a more effective way to address the malar fat pad descent. Apr 04, 2009 the subcutaneous fat spaces of the face are subdivided into 1 submental, 2 submandibular, 3 preparotid, 4 lower nasolabial, 5 upper nasolabial, and 6 malar fat pads. It is not well known because of its inconsistency in caucasians. Natural facelifts seattle facelifts bellevue facelifts. Advocates of arcus marginalis release open the orbital septum and preserve and reposition the inferior anterior orbital fat along the external edge of the inferior orbital rim. Mini face lift surgery cosmetic surgery for face dr. Elevation of the malar fat pad with a percutaneous technique. There is resorption of the maxilla cheekbones with ageing, which. The displaced subbrow fat pad can be confused with a coexisting redundant upper eyelid fold and prominent prolapsed upper eyelid preaponeurotic fat pad. A mid face lift is performed through the lower eyelid, which is usually involved in the premature aging, forming lid bags. The endoscopic foreheadmidfacelift is a wellknown technique for rejuvenation of the upper half of the face. Analysis of facial soft tissue changes with aging and their. They can also diminish certain facial lines, such as smile lines.
I can treat eye bags or malar bags, but first of all, we need to consider which youve got. Autologous fat grafting for malar fat pad prp treatments. Aging changes caused by descent of the malar fat pad often unmasks the orbital fat pads from inferior migration and thinning of overlying tissue. The excess skin and excess fat of the lower face, the fat of the cheek, and the muscle of the area around the eye all influence the surface topography, and all are moved together to their new positions. Yes its ideally suited to your issue and yes its only 5 minutes. The buccalmaxillary retaining ligament courses through the fat pad. Thus it is not amenable to excision like the buccal fat pad and is more resistant to small cannula or microliposuction. Lifting the malar fat pad for correction of prominent. The ageless programme centres on exactly this issue, which is responsible for the most dramatic changes in the face with age, jowls, sag, lack of upper cheek volume.
While midfacial aging is apparent in the older, classic facelift patient, changes in the midface also appear in the 35 to 45yearold patient who does not manifest other signs of aging. In the lower face, the platysma muscle is elevated and secured to achieve a defined jawline, thereby eliminating the jowls and decreasing the radial expansion. The malar fat pad is an area composed of subcutaneous fat between the obicularis oris muscle and the deep dermis. Recent studies show that malar fat pad aging occurs on two levels. The orbits increase in size, whereas the maxilla decreases in size, compounding the inferior displacement of the malar fat pad and accentuation of the nasolabial fold. She has what would be described as a minus orbit with a weak zygomaticomaxillary complex. The subcutaneous fat spaces of the face are subdivided into 1 submental, 2 submandibular, 3 preparotid, 4 lower nasolabial, 5 upper nasolabial, and 6 malar fat pads. Is the malaris muscle the antiaging missing link of the.
The nasojugal groove is the depression that represents the transition between the lower lid, malar fat pad, and lateral nose. Get the best dermal fillers treatment in delhi by our cosmetic surgeon at skinnovation clinics. As we age, fat in the face continues to drop in certain areas, particularly the malar fat pad and the jowls. Descent of facial structures soft tissue throughout. Jose barrera, md has published on the position and dynamic movement of the malar fat pad and the cheek mound in jama facial plastic surgery figure.
Over time, gravity pulls the malar fat pad down off the zygomatic arch and the orbicularis oculi muscle. In fact, lower blepharoplasty wastes an important tissue volume represented by the anterior orbital fat. Loss of fat in the sub malar area causes an overall hollowness that in later years causes a gaunt and old appearance. With ageing, the upper cheeks lose fat, sag and the midface drops midface ptosis. Often, they occur because the cheek projection is not very great. The most common concerns are those of prominent laugh lines nasolabial folds, prominent marionette lines lines below the mouth and the subcheek bone submalar region hollowness. As we age, the malar fat pad begins to descend from the top of the cheek bones to the lower part of the face. The inferior orbital fat triangular in shape, overlies the zygomaticus major, the zygomaticus minor, and the lower orbicularis oculi. I dont believe she has a significant malar fat pad.
However, this issue can easily and quickly be repaired with a tear trough correction. Volume loss and descent of the malar fat pad can create a depression under the eyes that casts dark shadows on the area. The associated ligaments holding the malar fat pad in place weaken and a nasolabial fold develops along with the malar fat pad shift. As far as aging goes, it really does have to do with skin quality which is influenced by uv ray exposure, diet and genetics. A full normally positioned malar fat pad contributes to the high full cheek in children and young adults. With my composite facelift technique, the cheek fat malar fat and lower eyelid muscle are lifted in tandem with the skin. The mid face is usually addressed as an addition to the standard facelift, but in patients with an acceptable neck and lower face, the mid facelift may be done as an isolated. The malar fat pad and overlying skin literally slide down off of the upper cheek bone structures and comes to rest on the lower cheek and over the jaw bone in the form a jowl. Individuals in their early 30s may have descent of the malar fat pad. In the mandible, tooth loss causes marked resorption of the alveolar ridge, and the shape and projection of the chin also change with age. Because of the malar fat pad s tight adherence to the skin but loose connection to the smas, it translocates along the surface of the smas to ultimately reside inferior and medial to its prior position.
The most common concerns are those of prominent laugh lines nasolabial folds, prominent marionette lines lines below the mouth and the subcheek bone sub malar region hollowness. We will see below that the descent of the soof and the malar fat pad is a characteristic feature of facial aging, the formation of the socalled double convexity deformity. So to me, as an oculoplastic surgeon, eye bags are if you have got little fatty protrusions through the lower lid here, that occurs usually with age, usually familial. Restoring position and volume to the malar fat pad enhances volume and fills the nasojugal and tear trough deformity that is apparent with facial fat descent and deflation associated with aging. Tightening the facial muscles will pull the whole area up and outward and reverse the descent of the malar pads. Its base is along the nasolabial sulcus, and its apex is toward the zygomatic prominence. In addition to redistribution of facial fat and concomitant loss of surrounding fullness, the fat pockets become more discernible as separate entities, as do many of the underlying facial structures, such as the submaxillary glands and bony protuberances. Clinical and therapeutic conclusions are therefore completely different. Midface restoration with handcarved eptfe orbital rim.