Midface restoration with handcarved eptfe orbital rim. Rather it is fat mixed in with other tissues giving it a more fibrofatty quality to it. Volume loss and descent of the malar fat pad can create a depression under the eyes that casts dark shadows on the area. I dont believe she has a significant malar fat pad. 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. However, there is a type of midface descent with an excess of skin and fluid which are known as. The malar fat pad is responsible for the normal convex appearance of the cheeks.
With my composite facelift technique, the cheek fat malar fat and lower eyelid muscle are lifted in tandem with the skin. 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. Nasojugal fold tear trough depression with aging, pronounced depressions may occur between the rim of the orbital bone and the nasal sidewall due to the relaxation of suspensory ligaments of the eye and the descent of the malar fat pad. 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. 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. 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. Analysis of facial soft tissue changes with aging and.
These sequelae of aging result in deepening of the nasolabial folds, progressive hollowing of the cheeks, and loss of prominence of the malar eminences. However, this issue can easily and quickly be repaired with a tear trough correction. In fact, lower blepharoplasty wastes an important tissue volume represented by the anterior orbital fat. Hollowness below the eyes with evident tear troughs may develop, which can be very evident. The malar fat pad is elevated, allowing for the correction of the deflation and descent seen in the midface. Consequently, patients appear exhausted and haggard regardless of sleep or under eye concealer. Yes its ideally suited to your issue and yes its only 5 minutes. The purpose of this study was to explain how the malaris muscle is able to produce an antiaging effect on the midface. 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. With age, there is anterioinferior gravitational descent along with fat volume loss. Buccal fat pad removal fats wish aesthetic surgery clinic. Natural facelifts seattle facelifts bellevue facelifts. Elevation of the malar fat pad with a percutaneous technique.
The term jowls refers to lower face jawline sagging when the midface and the lower face has dropped and is usually treated surgically with a facelift. Is the malaris muscle the antiaging missing link of the. These problems led to the search for a more effective way to address the malar fat pad descent. 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. Get the best dermal fillers treatment in delhi by our cosmetic surgeon at skinnovation clinics. They can also diminish certain facial lines, such as smile lines. The inferior orbital fat triangular in shape, overlies the zygomaticus major, the zygomaticus minor, and the lower orbicularis oculi.
As far as aging goes, it really does have to do with skin quality which is influenced by uv ray exposure, diet and genetics. 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. Tear troughs are usually treated with filler and can be aided by blepharoplasty or a midface lift. Individuals in their early 30s may have descent of the malar fat pad. 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. 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. Over time, gravity pulls the malar fat pad down off the zygomatic arch and the orbicularis oculi muscle.
Recent studies show that malar fat pad aging occurs on two levels. I can treat eye bags or malar bags, but first of all, we need to consider which youve got. 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. If not projected forward by good bone structure the fat pad soft tissue, tends to sag. She has what would be described as a minus orbit with a weak zygomaticomaxillary complex. Skeletal resorption of anterior facial skeleton also contributes to descent. Furthermore, descent of the bichat fat pad over the upper mandible can increase lower facial jowling. As people age and their skin loses elasticity and tone, the cheeks and eyelids tend to. Mini face lift surgery cosmetic surgery for face dr. 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. 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. 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 malar fat pad is also known as the cheek fat pad. Lifting the malar fat pad for correction of prominent. Approaches to midface and cheek lifting aesthetic surgery. The buccalmaxillary retaining ligament courses through the fat pad. This shifting of malar fat pad and reduction of fat makes cheeks appear hollow. To achieve an adequate functional and aesthetic result, the surgeon must address the descended subbrow fat pad, in addition to skin and eyelid fat adjustment, during blepharoplasty. Nov 17, 2018 malar fat pad refers to the youthful cheek. 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. 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. Laxity of the smas is often a contributing cause of midface descent. The fat layer under the skin here is called the malar fat pad and is thicker than elsewhere. 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. 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.
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. Pdf malar fat pad suspension through intraoral approach. Loss of fat in the sub malar area causes an overall hollowness that in later years causes a gaunt and old appearance. Due to its superficial location, any bulge or pouching in this region is particularly noticeable. It is not well known because of its inconsistency in caucasians. The cheek ligaments are released and cheek fat pads and muscles also known as the malar fat mound are elevated. There is an easily dissected plane deep to the fat pad that extends to the nasolabial crease. 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. 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. 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. Malar fat pad repositioning, which restores the shape and volume of the face, is a fundamental step in facial rejuvenation procedures.
Can my malar fat pads be removed by facial liposuction. 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. The associated ligaments holding the malar fat pad in place weaken and a nasolabial fold develops along with the malar fat pad shift. Loss of skin elasticity and integrity with associated sagging. Descent of facial structures soft tissue throughout. 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.
Mar 16, 2016 it does not correct the descent of the malar fat pad. 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. As we age, fat in the face continues to drop in certain areas, particularly the malar fat pad and the jowls. The malar fat pad is not like the buccal fat pad, it is not an isolated and thus easily extractable type of fat. The descent of the malar fat pad is also associated with loss of bone projection at the orbital rim. Cheek fillers cheek augmentation advanced cosmetic medicine. In an older face there is often a descent of the malar pads and a deepening of the tear trough. The descent of the malar fat pad over the cheek area. The heaviness of the upper eyelids is due to a fall in the forehead or brow ptosis. In the midfacial region, fat deposition in the cheeks begins to fade with advancing age. Clinical and therapeutic conclusions are therefore completely different. 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. The malaris muscle is a superficial and fine facial muscle. Facial aging involves loosening and sagging of skin and fat soft tissues.
Additionally, as time passes on the face loses volume in the process of fat atrophy. 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. 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. 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. The malar fat pad lies superficial to the smas and the lip elevator muscles. As people age and their skin loses elasticity and tone, the cheeks and eyelids tend to sag, creating a tired or haggard look. This results in the area under the eyes appearing hallowed. Effects of endoscopic foreheadmidfacelift on lower.
The displaced subbrow fat pad can be confused with a coexisting redundant upper eyelid fold and prominent prolapsed upper eyelid preaponeurotic fat pad. Tightening the facial muscles will pull the whole area up and outward and reverse the descent of the malar pads. The malar fat pad is an area composed of subcutaneous fat between the obicularis oris muscle and the deep dermis. Malar fat pad suspension through intraoral approach. Anatomically, the fat pads that form the cheeks deflate, and fall downwards and inwards. 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. Dermal fillers in delhi, dermal fillers treatment, wrinkle.
It does not correct the descent of the malar fat pad. There is resorption of the maxilla cheekbones with ageing, which. Aging changes caused by descent of the malar fat pad often unmasks the orbital fat pads from inferior migration and thinning of overlying tissue. It lies beneath the skin and is what makes the cheeks appear full and youthful looking. Midface surgery case studies beverly hills cheek lift cases. It could play a role in midface aging prevention as that observed in subjects with prominent cheekbones like asian people. Assuming my sagging malar fat pad diagnosis is correct, i would. 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.
Often, they occur because the cheek projection is not very great. As we age, the malar fat pad begins to descend from the top of the cheek bones to the lower part of the face. Changes in both the bone and the soft tissues account for her aging appearance. Fawzy a fat compartments and retaining ligaments of the face. With ageing, the upper cheeks lose fat, sag and the midface drops midface ptosis. Descent of the malar fat pad also contributes to the midface portion of the jowl. Midface surgery case studies beverly hills cheek lift. In fact, it forms a dynamic bridge between the fascia temporalis superficialis and the malar fat pad. A full normally positioned malar fat pad contributes to the high full cheek in children and young adults. The first thing i note about this patient is the descent of lower lid skin over the. 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. The infrazygomatic region has now gained the descended tissue mound causing deepening of the jowl tissue and weight to the lower face, effacing the jaw line.
The malar fat pad is a triangular shaped fat pad in the midface which is located in the subcutaneous plane superficial to the smas. Midface lift addresses the descent of the malar fat pad that contributes to the under eye hollow, the midcheek groove, the nasolabial fold and the jowl at the bottom of the cheek. Autologous fat grafting for malar fat pad prp treatments. Oct 30, 20 over time, gravity pulls the malar fat pad down off the zygomatic arch and the orbicularis oculi muscle. In the upper level, aging is primarily caused by ptosis of the fibroadipose layer attached to the skin. The endoscopic foreheadmidfacelift is a wellknown technique for rejuvenation of the upper half of the face.
A mid face lift is performed through the lower eyelid, which is usually involved in the premature aging, forming lid bags. Descent of the malar fat pad from the prezygomatic to infrazygomatic region leaves the upper midfacial skin deflated. Rejuvenation of the midface by elevating the malar fat pad. Malar fat reduction surgery in mumbai, india facial plastic. Loss of fat in the submalar area causes an overall hollowness that in later years causes a gaunt and old appearance. Its base is along the nasolabial sulcus, and its apex is toward the zygomatic prominence. The nasojugal groove is the depression that represents the transition between the lower lid, malar fat pad, and lateral nose. 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. Thus it is not amenable to excision like the buccal fat pad and is more resistant to small cannula or microliposuction. 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.
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