CLINICAL ANATOMY OF FACIAL FAT COMPARTMENTS IN FACIAL REJUVENATION: A LITERATURE REVIEW

Nadia Purnama Dewi; Ade Teti Vani

doi:10.59003/nhj.v6i1.2264

Authors

Nadia Purnama Dewi Universitas Baiturrahmah
Ade Teti Vani Universitas Baiturrahmah

DOI:

https://doi.org/10.59003/nhj.v6i1.2264

Keywords:

facial fat compartments, clinical anatomy, facial rejuvenation, facial aging, dermal filler

Abstract

Background: Facial rejuvenation has undergone a paradigm shift from tissue-tightening approaches to volume restoration. The discovery that facial adipose tissue is organized into distinct anatomical fat compartments has significantly improved the understanding of facial aging and has become the foundation of modern aesthetic procedures, including dermal filler injections and autologous fat grafting. Therefore, a comprehensive understanding of the anatomy of facial fat compartments is essential to achieve optimal aesthetic outcomes while minimizing the risk of complications. Objective: This literature review aims to examine the scientific evidence published over the past decade regarding the anatomy of facial fat compartments, age-related morphological changes, and their implications for facial rejuvenation procedures. Methods: This study employed a literature review approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was conducted in PubMed, Scopus, ScienceDirect, Web of Science, SpringerLink, and Wiley Online Library to identify English-language articles published between 2016 and 2026. Studies addressing the anatomy of facial fat compartments and their relevance to facial rejuvenation procedures were included and synthesized using a narrative approach. Results: The reviewed literature demonstrates that the face comprises superficial and deep fat compartments separated by retaining ligaments and fibrous septa. Age-related changes, including fat atrophy, redistribution, and volume alteration within individual compartments, contribute to the characteristic features of facial aging. A thorough understanding of the anatomy of facial fat compartments improves the accuracy of filler placement, facilitates more natural facial contour restoration, and reduces the risk of complications, particularly vascular injuries. Conclusion: The anatomy of facial fat compartments constitutes a fundamental basis for modern facial rejuvenation. Integrating anatomical knowledge with evidence-based injection techniques plays a crucial role in improving the safety, effectiveness, and overall success of facial aesthetic procedures.

Downloads

Download data is not yet available.

References

Cotofana, S. and Lachman N. Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery. J der Dtsch Dermatologischen Gesellschaft. 2019;17:399–413.

Cotofana S, Fratila AAM, Schenck TL, Redka-Swoboda W, Zilinsky I, Pavicic T. The Anatomy of the Aging Face: A Review. Facial Plast Surg. 2016;32(3):253–60.

Rumiana Tenchov, Janet M. Sasso, Xinmei Wang and QAZ. Antiaging Strategies and Remedies: A Landscape of Research Progress and Promise. ACS Chem Neurosci. 2024;15(3):408–46.

Sykes JM, Cotofana S, Trevidic P, Solish N, Carruthers J, Carruthers A, Moradi A, Swift A, Massry GG, Lambros V RB. Upper Face: Clinical Anatomy and Regional Approaches with Injectable Fillers. Plast Reconstr Surg. 2015;136(5 Suppl):204S-218S.

Greco, T.M., Ditre, C.M. and Ozog D. Anatomy and Aesthetic Principles. In: Joel L. Cohen MD (FAAD, FACMS), David M. Ozog MD (FAAD F, editor. Botulinum Toxins: Cosmetic and Clinical Applications. 2017.

Wan D, Amirlak B, Giessler P, Rasko Y, Rohrich RJ, Yuan C, Lysikowski J, Delgado I DK. The differing adipocyte morphologies of deep versus superficial midfacial fat compartments: a cadaveric study. Plast Reconstr Surg. 2014;133(5):615e-622e.

Fundar1 S, Blasio A Di, Blasio C Di, Schembri-Wismayer and P. Anatomy and aging of cheek fat compartments. Med Dent Res. 2018;

Liu J, Gao M, Hu H, Pang H, Liu Y ZP. Facial Injectable Fillers in Aesthetic Medicine: Clinical Applications and Safety Strategies. Med Sci Monit. 2025;31:e949944.

Wen L, Wang J, Li Y LD. Progress of midfacial fat compartments and related clinical applications. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018;32(2):248–251.

Schenck TL, Koban KC, Schlattau A, Frank K, Sykes JM, Targosinski S, Erlbacher K CS. The Functional Anatomy of the Superficial Fat Compartments of the Face: A Detailed Imaging Study. Plast Reconstr Surg. 2018;141(6):1351–9.

Wollina U, Goldman A TG. Fillers and Facial Fat. Open Access Maced J Med Sci. 2017;5(4):403–8.

Schelke L, Velthuis PJ, Lowry N, Rohrich RJ, Swift A, Gotkin RH, Moellhoff N, Frank K, Dumbrava M CS. The mobility of the superficial and deep midfacial fat compartments: An ultrasound-based investigation. J Cosmet Derm. 2021;20(12):3849–56.

Rohrich RJ, Sinno S VE. Getting Better Results in Facelifting. Plast Reconstr Surg Glob Open. 2019;7(6):e2270.

Paluch Ł, Pietruski P, Kwiek B, Noszczyk B AM. Age-related changes in elastographically determined strain of the facial fat compartments: a new frontier of research on face aging processes. Postep Dermatol Alergol. 2020;37(3):353–9.

Eid L, Mao X, Zhao B, Mao J, Qian S, Zhang Y, Zhang Y, Zhang L, Cheng L, Zhang Y SX. Fat Compartment Gliding Theory - A Novel Technique for the Repositioning of Superficial Fat Compartments for Facial Rejuvenation. Clin Cosmet Investig Dermatol. 2023;16:3077–90.

Hong GW, Wong IKJ, Kim JH YK. Anatomical-based filler injection techniques for the midcheek groove and infraorbital region: Narrative review. JPRAS Open. 2025;48:626–37.

Clark NW, Pan DR BD. Facial fillers: Relevant anatomy, injection techniques, and complications. World J Otorhinolaryngol Head Neck Surg. 2023;9(3):227–35.

Akinbiyi T, Othman S, Familusi O, Calvert C, Card EB PI. Better Results in Facial Rejuvenation with Fillers. Plast Reconstr Surg Glob Open. 2020;8(10):e2763.

Garg S, Vashisht KR, Sushruth PR SD. Monopolar radiofrequency for reposing drooping fat planes and facial rejuvenation: A prospective study on 30 subjects towards true antiaging. J Cosmet Dermatol. 2022;21(4):1489–500.

Gadallah A, Etman AG MAEM. Facial Contouring after Permanent Filler Removal with Combined Facelift and Fat Grafting: A Case Series. Plast Reconstr Surg Glob Open. 2023;11(12):e5456.

Kim CH. Evaluating the Compartment-Specific Effects in Superficial Facial Fat Compartments After Thread-Lifts by the Tensiometer and FACE-Q. Aesthet Surg J Open Forum. 2022;4:ojac065.

Yi KH, Wan J, Kim SB KH. Temporal Fat Pad Filler Injection for Lifting Purposes: Shifting of the Superficial Layer of Deep Temporal Fascia. J Cosmet Dermatol. 2025;24(3):e70023.

Tarallo M, Cilluffo M, Papa F FB. Retaining Ligaments of the Face: Still Important in Modern Approach in Mid-Face and Neck Lift? J Pers Med. 2025;15(12):582.

Ren B GT. Dynamic Multiform Fat Grafting for Facial Rejuvenation. Plast Reconstr Surg Glob Open. 2026;14(6):e7817.

Woodward J, Cox SE, Kato K, Urdiales-Galvez F, Boyd C AN. Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization. Aesthet Surg J Open Forum. 2023;5:ojad016.

Toyoda Y, Honig S, Wilson A, Broach R PI. Filler in the Tear Trough and Lid-Cheek Junction: A Cadaveric Evaluation of Filler Type and Manipulation Technique. Aesthet Surg J Open Forum. 2023;5(Suppl 1):ojad027.001.

Qiu, H., Cao, L., Liu, S. and Wang, H. Delayed buccal lipogranuloma formed by grafted fat migration following temporal fat filling. J Cosmet Dermatol. 2023;22:3188–91.