| ObjectIn the process of aging, soft tissue which is the key point of facial appearance changes greatly. Soft tissue in face is divided into six layers from outside: skin, subcutaneous tissue, SMAS ( superficial musculo - aponeurotic system) , mimetic muscle, deep fascia and layer in which facial nerve lies. Conclusions from several studies are that skin and subcutaneous tissue change greatly in aging process. Study on subcutaneous tissue was neglected formerly. With development of aesthetic surgery, midface has become a hot spot. In aging process, both thickness and distribution of subcutaneous tissue change greatly. Descent of fat pad causes displacement of facial organ and deepening of wrinkles. The main character of aging face is the transition from youth curve to the old one.Face rejuvenation operation aims to not only removing wrinkles but also pulling up skin ptosis and rebuilding youth curve. So, we invented an electrical measurement software and measured young and old Oriental women with this measurement software. We also measured thickness of fat pad in midface with B type ultrasonic machine in order to acquire variation rules of fat pad and facial curve in aging process of the Oriental. At the same time we dissected cadavers macroscopically and microscopically to definite range and distribution of fat pad in midface and to find its fixed structures among skin, fat pad and muscle in order to lay foundation for facial rejuvenation operation.Methods1. 10 antiseptic cadaveric head specimens were dissected macroscopically and microscopically in order to definite location, distribution of malar fat pad, and to observe the fixed structures between skin and fat pad and between fat pad and SMAS. The dissection was performed by naked eye and microscopes.2. A straight line paralleled to inferior eyelid border and four vertical lines through inner canthus, pupil, outer canthus and the outer border of malar process were drawn. Distance of superior border of fat pad to the horizontal line along the four vertical lines was measured.3. We developed a measurement soft ware with the Windows XP Professional and the Microsoft Visual C ++6.0 software. Normal and lateral views of subjects were gotten by digital camera. We got several indexes of face measurement which reflect aging process. They are distance of superior border of fat pad and the lowest point of inferior eyelid ( sbfp - lie) , length of nasolabial groove (ln-lg) , length of nasojugal grove (lnjg) , angle of nasolabial groove (anlg) , angle of nasojugal groove ( arijg) , distance of maximum projection of cheek mass to inferior eyelid(mp - ie) , and the distance of inferior border of fat pad to inferior border of mandible (ibfp - im ) .4. We Marked points in face before measuring thickness of fat pad with B ultrasonic machine. Five vertical lines were made: line 1 through inner canthus;line 2 through inner border of pupil;line 3 through outer border of pupil;line 4 through outer canthus;line 5 through outer border of malar process of maxillary. Seven horizontal lines were made: line 0 through intersection of margin of mandible and line 4, line A through midpoint of labial commissure and margin of mandible;line B through labial commissure;line C through middle point of labial commissure and alar rim;line D through alar rim;line E through the lowest point of infraorbital border .5. After the research we introduced a new method that suspending midface fat pad . We performed rejuvenation operation on 120 cases by this method.Results1. The superior boundary of midface fat pad locates in front of inferior eyelid pars orbitalis musculi orbicularis oculi , and the medial boundary arrives at nasolabial groove, upper lip and angle oris, and the inferior boundary arrive at margin of mandible, and the lateral boundary is in front of tragus. There is subcutaneous fat tissue in face except pars palpebralis musculi orbicularis oculi. The fat pad looks like an obverse triangle. Its topmost locates inferior lateral of angle oris at the level of angulus mandibulae. It can reach margin of mandible in old - age group. The bottom of fat pad presents a curve along orbicularis oculi. The medial boundary is nasolabial groove, and the lateral boundary is a line from the junction of zygomatic bone and zygomatic arch to inferior lateral of labial commissure or mandible angle. The electronic measurement soft ware can measure distance of straight line, distance of curve, angle formed by two line and area inside curve.2. A straight line paralleled to lower eyelid border and four vertical lines through inner canthus, pupil, outer canthus and the outer border of malar process were drawn. Distance of superior border of fat pad to the horizontal line along the four vertical lines was measured. We found that the distance in old group was significantly longer than that in young group.3. There are three areas where skin combine tightly with subcutaneous fat. Fine fibers connect the two layers. We measured the ranges of three compact areas in the anterior part of face and their inner, outer, superior and inferior border of the three compact areas.4. There are four fixed structures between fat pad and its deep - seated tissue : (1) zygomatic ligament;( 2) Anterior platysma - cutaneous ligament;(3 ) Zygomatic - cutaneous ligament;(4) Amicula of buccal process of buccal fat pad. Fibrous tissue which wraps up buccal fat pad at 3rd areas goes through o-verlying fat pad and ends to skin. They fix the fat pad in midface. The fat pad o-verlies the surface of facial nerve and no branches of facial nerve pass through fat pad.5. The midface fat pad is divided into two parts by zygomatic cutaneous ligament. The upper one locates in front of the surface of zygomatic bone and the other locates at cheek. So the two fat pad should be called the malar fat pad and the cheek fat pad respectively. There is a mass of fat behind zygomatic arch which should be called the baccal fat pad. The body surface symbol of zygomatic- cutaneous ligments is nasojugal grove.6. The measurement soft ware we developed can measure indexes include distance of line , distance of curve, angle of two lines, and areas inside a curve. Through measurements we found that : (l) distance of " sbfp - lie" in young group is significantly smaller than that in middle and old - age group. (2) angle of " lnjg" in young group is significantly bigger than that in middle and old- age group;(3)location of inferior border of fat pad in old - age group is significantly lower than that in young and middle - age group;(4)' lnjg' in old - age group is significantly longer than that in middle - age group and ' lnjg' in middle - age group is significantly longer than that in young group;(5)distance of " mp - ie" in young group is shorter than that in middle and old - age group;(6) There isn' t nasojugle groove and mentocheek groove in youth group and distance of " lnjg" in old - age group is longer than that in middle - age group.7. With type - B ultrasonic machine we found that fat pad of old - age group at Point F3, E3, E4, E5, D4, D5 , C5, B5, A4, A5 , 0 were significantly thicker than those in middle age and young group. There were no differences of thickness of fat pad between young and middle - age group.8. The new suspensory method which elevates cheek and malar fat pad was recommended after this research, and the results of rejuvenation were satisfying.Conclusions1. Fat pad in midface is an incrassate fatty fascia tissue in the midface. Because there are fibers in this kind of tissue, it can tolerant suspension. There are fixed structures above and below the fat pad to keep its position. The fat pad is above the facial nerve, and no branches of face nerve go through fat pad. So, it is a suitable layer for dissection. In addition, we found zygomatic cutaneous? 7 ?ligament which separates the fat pad into malar fat pad and cheek fat pad, and clarified some confused concept.2. The electronic measures soft ware applied in this research has the following characteristics: ( 1) The data is accurate;(2 ) The measured items are a-bundant;(3 ) It is convenient and short cut;(4) Compatibility is good. We measured the Oriental women with the measurement soft ware and got data about them. Through measurements we found that these indexes can reflect aging looking. They are deepening of the nasolabial groove, exposure of lower border of arcula, nasojugal and mento - cheek grove becoming manifesting, inferior boundary of fat pad exceeding the lower margin of mandible, occurrence of carnosity at mandible and mental region .3. We measured the thickness of fat pad in midface with B type ultrasonic machine and got data about them. We found fat pads of old women in inferior lateral direction are thicker than those of young women.4. The new surgical method gotten through research has achieved satisfactory results. |
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