The aging process of deep fat compartments in the midface and midfacial rejuvenation: An ultrasound-based analysis

Background: The midfacial fat is highly compartmentalized, and the deep fat compartments provide structural support for the midface. Understanding the age-related changes in the midfacial deep fat compartments is important for midfacial rejuvenation physiologically. However, previous studies showed conflicted results of these changes. Objectives: This study aims to quantify the age-related changes of deep fat compartments in the midface using ultrasound. Methods: A cross-sectional study was conducted to evaluate subjects with age more than 25 years old and the subjects were divided into four age groups equally (25-34, 35-44, 45-54, and >= 55). The thickness of the suborbicularis oculi fat compartment (SOOF) and deep medial cheek fat compartment (DMCF) was measured using a portable ultrasound device. Mean thickness differences among different age groups were analyzed by one-way analysis of variance. Multiple linear regression adjusted for body mass index (BMI) and sex was also conducted. Results: A total of 60 subjects were enrolled. The thickness of SOOF and DMCF tends to decrease with age. The mean decrease of SOOF and DMCF from the youngest group to the oldest group was 0.63 mm (36%) and 0.70 mm (25.83%), respectively. The relationship between aging and thickness of SOOF and DMCF remains significant after adjusting for BMI and sex (both P < 0.001). Conclusion: The thickness of deep fat compartments decreases with the natural aging process. The study may offer clinical implications for targeted volume rejuvenation to achieve a more youthful and natural face.