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Its contraction raises the lower eyelid and the cheeks when laughing. As its tone and viscoelastic properties are lost with ageing, it loosens and sags together with the superficial malar fat pad and skin. Its lower border can reach the level of the nostrils. When it sags, its fibres are dissociated, becoming more open and less compact as a result, creating a ring with gaps in this area of the cheek.


The fat compartments The deep and superficial malar fat pads are important considerations when treating the mid-face (Figures 2 and 3) — they greatly contribute to the shape, curve and fullness of the cheeks and mid-face. The analogy with the shape of an apple (‘pomme’ in French) has given rise to the term ‘pommettes’ to describe this area. The deep fat (sub-orbicularis oculi fat pad; SOOF)


forms a dense fibrous fat pad, covering the bony support. This pad is a shield of protection for the bone, as is Charpy’s fat pad (retro-orbicularis oculi fat pad; ROOF) in the upper orbit. Static and fixed, neither sliding nor moving when the face moves, the deep malar fat pad does not sag with ageing. However, like the superficial fat pad, deep malar fat undergoes a partial atrophy with ageing. The superficial malar fat covers the orbicularis oculi muscle. Some authors2


divide this fat pad into a number This orbital part of the orbicularis oculi covers the


lower lid, the orbital rim, the malar area, part of the cheek, the frontal process of maxilla, and some of the other facial muscles (origins of the large and small zygomatic muscles and the levator labii superioris). As a sphincter muscle responsible for voluntary movements, it is a constrictor of the eyelid, but also an elevator of the cheek and superficial malar fat pad that covers it.


Figure 1 Nerves of the orbital and zygomatic regions (From: Sadick17


)


of compartments. For the authors of the current article, however, this distinction has no anatomical or functional importance, and so, in terms of treatment and restoration, this is of no consequence. In comparison with the deep fat, the superficial


malar fat structure is softer, less dense, and less fibrous. Subcutaneously, it is attached to the skin cover, moving with the skin when the face moves and expresses,


The deep and


superficial malar fat pads are important considerations when treating the mid-face, they greatly contribute to the shape, curve and fullness of the cheeks and mid-face.


30


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Figure 2 (A) Superficial malar fat; and (B) orbicularis oculi muscle and deep malar fat


January/February 2012 | prime-journal.com


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