The retaining system of the face: Histologic evaluation of the septal boundaries of the subcutaneous fat compartments

BACKGROUND: Because the concept of subcutaneous fat compartments has many significant implications for cosmetic and reconstructive surgery, it is important to verify the original findings and validate the concept. The authors studied the histology of the septal boundaries between several adjacent fat compartments. METHODS: Eighteen hemifacial cadaver specimens were used (five male and four female cadavers; age range, 39 to 87 years). Tissue marking dye was injected into the central forehead and the medial, middle, and lateral temporal cheek compartments. Dye was allowed to diffuse for 4 hours until a skin blush was noted, at which point dye-setting solution was injected to fix the dye. En bloc transverse specimens were harvested and stored in formalin overnight. Standard histologic processing was performed. RESULTS: Each compartment partitioned dye in a consistent and reproducible manner. A fibrous condensation of connective tissue formed the diffusion barriers. These septa originated from underlying fascia and inserted into the dermis of the skin. A septal barrier originated from the fascia of the frontalis muscle, so these septal barriers are not necessarily related to the superficial musculoaponeurotic system but can occur anywhere between superficial fascia and skin. CONCLUSIONS: These findings support the concept that subcutaneous fat is compartmentalized, specifically by fascial condensations that travel from superficial fascia to dermis. These septa form an interconnecting framework that limits shearing forces on the face. This framework provides a "retaining system" for the human face. Implicit in this concept is the suggestion that the face ages three dimensionally, with separate compartments changing relative to one another by both position and volume.