Owsley J Q
Division of Plastic Surgery, University of California, San Francisco.
Plast Reconstr Surg. 1993 Mar;91(3):463-74; discussion 475-6.
The anatomic presence of a discrete malar fat pad has not been widely recognized. In his paper on the "deep plane rhytidectomy," Hamra describes the increased thickness of the subcutaneous fat over the anterior midface. Cadaver and clinical studies confirm the consistent presence of a localized subcutaneous malar fat pad overlying the body of the zygoma and maxilla. Downward displacement of the infraorbital skin and underlying malar fat pad causes an increased prominence of the nasolabial fold. The surgical dissection of the malar fat pad starts from the malar eminence at the plane of the orbicularis oculi muscle and superficial to the origin of the zygomaticus and levator muscles, which are invested by the SMAS. There is an easily dissected plane deep to the fat pad that extends to the nasolabial crease. Surgical correction of the prominent nasolabial fold is enhanced by undermining the malar fat pad and advancing it laterally by traction on the skin flap with additional upward fixation by sutures between the lateral edge of the fat pad and the subcutaneous fascia at the lateral malar eminence.
离散性颧脂肪垫的解剖学存在尚未得到广泛认可。在其关于“深层平面除皱术”的论文中，哈姆拉描述了面中部前皮下脂肪厚度增加的情况。尸体研究和临床研究证实，在颧骨体和上颌骨上方始终存在一个局限性皮下颧脂肪垫。眶下皮肤和下方颧脂肪垫的向下移位会导致鼻唇沟更加明显。颧脂肪垫的手术解剖从眼轮匝肌平面的颧突开始，在颧大肌和提肌的起点浅面进行，这些肌肉由SMAS覆盖。在脂肪垫深面有一个易于解剖的平面，延伸至鼻唇沟。通过分离颧脂肪垫并通过牵拉皮瓣将其向外侧推进，同时在脂肪垫外侧边缘与颧突外侧皮下筋膜之间进行缝合额外向上固定，可增强对明显鼻唇沟的手术矫正效果。
