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Facial Aging: A Quantitative Analysis of Midface Volume Changes over 11 Years.

BACKGROUND
Anatomic studies have identified separate superficial and deep facial fat compartments, leading some to theorize volume loss from the deep midface causes overlying superficial fat pseudoptosis. Unfortunately, a paucity of evidence exists regarding whether facial fat volume is truly lost with age and if so, lost equally or differentially from the superficial and deep compartments. The aim of this study is to quantify volume changes occurring with age within the superficial, deep, and buccal fat compartments of the midface.


METHODS
A retrospective longitudinal study was performed evaluating individuals 30-65 years of age who underwent a facial CT followed by a second facial CT ≥ 10 years later. Superficial midface, deep midface, and buccal fat volumes were quantified using Horos radiology software.


RESULTS
Nineteen subjects met inclusion criteria. Mean total fat volume decreased significantly from 46.47 to 40.81 cc (p < 0.01). The mean superficial and deep fat volumes both decreased significantly from 26.10 to 23.15 cc (p < 0.01) and 11.01 to 8.98 cc (p < 0.01), respectively. No significant difference was observed in buccal fat volume over time (9.36 cc to 8.68 cc; p = 0.04). Patients lost an average of 11.3% of their initial superficial fat volume and 18.4% of their initial deep fat volume.


CONCLUSION
Significant volume loss was observed from both superficial and deep facial fat compartments over a mean 11.3 years. Patients lost a greater percentage of deep facial fat volume, providing support for the theory of pseudoptosis caused by deep midface fat loss.