Beyond “Volume Loss”
“Volume loss” is an oversimplification. Facial aging involves complex fat redistribution: some compartments atrophy, others descend, some appear to increase because they accumulate fat from upper areas. Facial fat is organized in compartments separated by fibrous septa. Each compartment ages differently. Understanding this anatomy is fundamental for effective interventions.
“You cannot treat ‘facial fat’ — you need to treat each compartment specifically. Malar fat needs to be elevated. Jowl fat needs to be redistributed. These are different approaches.”
- — Dr. Robério Brandão
The Main Fat Compartments
Location: In aging: In surgery: )) }
Aging Patterns by Region
Upper Third
- • Temporal fat: Significant atrophy → hollow temples
- • Retro-orbicular fat: May herniate → eyelid bags
- • General trend: deflation
Middle Third
- • Malar fat: Descends → nasolabial fold
- • SOOF: Atrophy + ptosis → palpebromalar groove
- • Trend: ptosis + combined deflation
Lower Third
- • Jowl fat: Accumulates ptosed fat
- • Nasolabial fat: Descends laterally
- • Trend: accumulation of descended fat
Neck
- • Submental fat: May increase or descend
- • Subplatysmal fat: Less affected by age
- • Trend: accumulation + combined laxity
Surgical Implications
Reposition, Don’t Remove
The modern paradigm is to reposition ptosed fat, not remove it. Excessive removal creates a skeletonized appearance that worsens over time.
Treatment by Compartment
Each compartment requires a specific approach: elevation, redistribution, or volume supplementation (autologous fat or filler).
Combination with Volumization
Where there’s real atrophy (temples, periorbital), adding volume may be necessary beyond lifting. Lipofilling or fillers are options.
Frequently Asked Questions
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