ABSTRACT
INTRODUCTION Facial fat distribution is a primary causative factor in what morphologically is denoted as the aging face. In youth the facial contours are full and round, and project forward away from the underlying bony framework. A young face has a preponderance of fat in the upper third of the face, lending it a shape reminiscent of an inverted triangle (Fig. 1). With aging, fat remodeling leads to involution of fat compartments, bony demarcation, and a downward displacement of tissues. Compounding this dysmorphism in even slightly overweight individuals is the pocketing of fat in the lower face, leading to a ‘‘flipping of the triangle’’ seen in the young face (Fig. 2). Thus, the topography of an old face is ‘‘hills and valleys,’’ with the hills corresponding to areas of fat hypertrophy and the valleys fat atrophy. Any attempt at truly rejuvenating the old face consists of rebalancing the fat compartments via fat augmentation and microliposuction techniques.
