BACKGROUND:: Recent anatomical findings have suggested that facial fat distribution is complex and changes with age. Here, we developed a grafting technique based on the physiological distribution and volume changes of facial fat compartments to achieve a youthful and natural-looking face. METHODS:: Forty cadaveric hemifaces were used for the dissection of fat compartments and neurovascular structures in the mid-face area. Seventy-eight patients were treated for cheek atrophy using our targeted restoration of mid-face fat compartment volume. The outcome was evaluated by a two-dimensional assessment, the malar lipo-atrophy assessment and a satisfaction survey. RESULTS:: The medial and lateral parts of the deep medial cheek fat compartment (DMC) were separated by a septum arising from the lateral border of the levator angular oris muscle. The angular vein traveled between the DMC and the buccal fat pad, 12 mm from the maxilla bone. A total volume of 29.3 ml fat was grafted per cheek for each patient. A 12-month follow-up revealed an average volume augmentation rate of 27.1%. Pleasing and elevated anterior projection of the cheek and ameliorated nasolabial groove were still obvious by 12 months after the procedure. In total, 95.2% of the patients were satisfied with their results. CONCLUSION:: The present study provides the anatomical and clinical basis for the concept of compartmentally based fat grafting. It allows for the restoration of facial fat volume close to the physiological state. With this procedure, a natural and youthful facial contour could be rebuilt with a high satisfaction rate.
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