Continuing medical education article-facial aesthetic surgery

The anterior, middle, and posterior cheeks were noted to be laden with fat, containing roughly half of the total facial and neck fat mass in fresh human cadavers dissected according to aesthetic subunit principles. Slightly greater than half of the subcutaneous fat in the cheeks (57%) is above the SMAS, whereas slightly less than half (43%) is below the SMAS. The fat-laden cheek aesthetic subunits were found to have secondary supporting retaining ligaments located within their borders that provided poor support and primary supporting retaining ligaments along their borders, which provided strong support. These anatomic arrangements, along with the fact that the anterior and middle cheek subunits serve as lining and cover for the hollow intraoral cavity, account for the characteristic and reproducible saggy appearance of the midface and cheeks when subjected to the forces of gravity, motion, time, and the elements.