Clinical analysis of malar fat pad re-elevation

Primary suture suspension of the malar fat pad has been described as a safe and simple component of global facial rejuvenation. This review evaluates the efficacy and indications for re-elevation of the malar fat pad elevation. A retrospective review of the medical records of patients who underwent malar fat pad elevation was performed between 1994 and 2000. Of 472 procedures, 14 involved re-elevation of the malar fat pad. These cases were examined for complications, risks, and results. Secondary midface elevation was performed using a subcutaneous approach to the malar fat pad through a pre-hairline incision and vertical suspension of the malar fat pad to the temporoparietal fascia. The indications for re-elevation of the malar fat pad included nasolabial asymmetry, malar fat pad malposition, and malar fat pad asymmetry. Primary elevation of the malar fat was performed in 472 patients. Fourteen of these patients had suboptimal results that necessitated re-elevation of their malar fat pads. Their average age was 57.5 years. Of the 14 malar fat pad elevations, 12 included SMAS procedures, nine were combined with platysmal plication/submental lipectomy, six with forehead lift, and three with eyelid procedures. The average interval between original malar fat pad elevation and the re-elevation was 40 months. Average follow-up was 15 months. Complications were seen in five patients, with the most significant being persistent eye irritation. Two patients had some minimal scar hypertrophy, which was self-limiting. Minor preauricular skin slough developed in one patient. Restoration of the youthful position of the deep structures in patients with a previous mid-facelift was successfully achieved by re-elevating the malar fat pad in a vertical direction. Re-elevation of the malar fat pad demonstrated effective and reliable long-term results. It is appropriate in the small number of patients who require revision or improvement of midface rejuvenation using the malar fat pad suspension technique.     

Cardiac fat pat change after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis

Cardiac fat pad is a metabolically active organ that plays a role in energy homeostasis and cardiovascular diseases and generates inflammatory cytokines. Many studies have shown remarkable associations between cardiac fat thickness and cardiovascular diseases, making it a valuable target for interventions. Our meta-analysis aimed to investigate the effects of the 2 most popular bariatric surgeries (sleeve gastrectomy [SG] and Roux-en-Y gastric bypass [RYGB]) in cardiac fat pad reduction. A systematic review of the literature was done by searching in Scopus, Web of Science, Cochrane, and PubMed for articles published by September 16, 2022. This review followed the meta-analysis rules based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the inclusion criteria out of 128 potentially useful studies, including a total number of 822 patients. The results of subgroup analysis on the type of surgery showed that bariatric surgeries decreased the mean fat pad diameter, but the reduction was greater in SG than in RYGB. Epicardial and pericardial fat type showed a significant decrease of fat pad diameter. The results of subgroup analysis indicated RYGB had a significant reduction in mean fat pad volume. Computed tomography scan and cardiac magnetic resonance imaging showed a significant reduction of the mean cardiac fat pad volume. Epicardial and paracardial fat type showed a significant decrease in volume. The cardiac fat pad diameter and volume were significantly reduced after bariatric surgeries. SG showed greater reduction in fat pad diameter in comparison with RYGB, and RYGB had a significant reduction in mean fat pad volume.     

Facial fat: descriptive and functional anatomy, from a review of literature and dissections of 10 split-faces

The aim of this study is to describe the anatomy of the fat in the face, based on a review of the literature and dissections of 10 half-faces. The facial fat can be divided in two layers. The first-one is superficial, between the skin and the superficialis fascia. Its function is essentially protective and its morphological implications are major, especially according to the facial aging. The other layer is deep, under the superficialis fascia. Its principal function is mechanical and its morphological implications are less important. This layer is made of several fat pads in continuity, excepted the buccal fat pad which is separated from the others by its own capsula. The other fat pads are the intra orbialis fat pad, the sub orbicularis oculi fat pad (SOOF), the retro orbicularis oculi fat pad (ROOF), the galeal fat pad and the temporal fat pad.     

The plantar fat pad and the diabetic foot – a review

There has been much debate concerning the pathologic consequences of diabetes on the plantar fat pad and its subsequent association with the development of a foot ulcer. This review article documents two theories regarding pathophysiology in diabetic foot ulcer formation as they are related to the plantar fat pad and discusses current treatment options for this pathophysiological phenomenon. Traditionally, fat pad atrophy in diabetic patients was thought to result as an irregular arrangement of collagen fibrils within the septal walls as a result of glycation as well as diminishing adipocyte size due to thickened septal walls. Contrary to this traditional theory, a model depicting distal fat pad migration from under the metatarsal heads has been described in the diabetic patient. Such pad migration renders the metatarsal heads vulnerable to increased pressure, which, in turn, predisposes to foot ulceration. This migratory fat pad theory plays a significant role in approaches to the prevention of diabetic foot ulceration and subsequent amputation. Various methods of fat pad supplementation and claw toe management are impacted by the pathophysiological changes described and new avenues of therapy may be based on these changes.     

Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad

Our aim was to assess whether there was any significant difference in change in patellar tendon length after knee arthroplasty, when the infrapatellar fat pad was either preserved or excised. Three-year radiographic follow-up was studied on 73 primary knee arthroplasty patients. The infrapatellar fat pad was completely preserved in 38 cases and completely excised in 35. At 3 years there was a significant patellar tendon shortening of 4.2% (P = .0004) in the fat pad excision group and no significant change in the fat pad preservation group (P = .82). The difference between the 2 groups was significant (P = .004). Our results show that patella tendon length does not always shorten after knee arthroplasty and that preservation of the infrapatellar fat pad may be a factor in preventing such shortening.     

The New Anatomical Viewpoint of the Nose: The Interdomal Fat Pad

To the plastic surgeon, the nose is one of the most interestingand challengingfacial structures and its anatomy is well defined. From the point of view of aesthetic surgery, the nasal tip area is an especially important structural unit, and the most di.cult to address in rhinoplasty. The objective of this study was to demonstrate the existence of the nasal interdomal fat pad as a distinct anatomical structure that occupies the interdomal space and is apart from subcutaneous fat. In our study we proved the existence of the interdomal fat pad by histochemical studies and anatomical observations in 88 patients who underwent primary external rhinoplasty and three fresh cadavers. All specimens were examined by hemotoxylen-eosin, Sudan black, and oil red staining, as well as S100 protein immunoreactivity staining. The mass of the interdomal fat pad was greater in patients with bulbous noses and/or divergent alar cartilage than in patients with thin skin. We speculated that the interdomal fat pad may be the major anatomic structure contributingto unexpected results in difficult cases, such as those involvingbulbous noses. According to our study, the existence of the interdomal fat pad should be kept in mind duringthe preoperative planning of rhinoplasty.     

髌下脂肪垫解剖学观测及其临床意义

目的：为膝关节疼痛的诊和治疗提供解剖学依据。方法：在１２具 对髌下脂肪垫和髌韧带等组织结构进行了观测。结果：髌下脂肪垫表面与髌韧带的后面结合疏松,但与髌骨下缘紧密连结。滑膜覆盖于髌脂肪垫的关节腔内部分,并形成翼状臂。脂肪垫伸向股骨和股骨间在前交韧带之前,形成一繁带附着髁间窝前部,其将脂肪垫系于股骨。胫骨近端的前方与髌韧带之间,形成一系带附着髁间窝前部,其将脂肪垫系于股骨。胫骨近端的前方与髌韧带下部     

Suture suspension of the malar fat pad

Background: Elevation of the malar fat pad by use of suture suspension to rejuvenate the central third of the face has been previously described. Objective: The authors evaluated the ability of suture suspension to successfully elevate the malar fat pad. Methods: Four fresh frozen cadaver dissections were studied. With the standard preauricular, subcutaneous approach, the malar fat pad was identified, and a suspension suture was placed at the inferior and lateral aspect of the fat pad. The vector of pull was directed vertically, and the tension that was applied to the suture was measured. The dermis was then elevated from the malar fat pad to examine suture placement and ensure that the dermis was not caught in the suture. Results: An average tension of 11 lb was applied before rupture of the suture. In none of the cases did the suture pull through the malar fat pad. Conclusions: Suture suspension is an effective technique for elevation of the malar fat pad. The results are easy to reproduce and are very effective in addressing the changes that accompany aging and the descent of the malar fat pad. (Aesthetic Surg J 2002;22:446-450.)     

A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa’s disease

The infrapatellar fat pad of Hoffa is commonly injured but rarely discussed in the orthopaedic literature. Hoffa’s disease is the extension of various traumatic events due to impingement and inflammation of the infrapatellar fat pad and known as a vague reason for anterior knee pain. Inflammation is foreground during acute phase of the disease while impingement due to fibrosis and scar tissue of infrapatellar fat pad plays a major role in the chronic phase. The osteochondroma of the infrapatellar fat pad secondary to the Hoffa’s disease can be more problematic. Although, the fibrocartilaginous transformation and osteochondral metaplasia of infrapatellar fat pad was pointed out frequently in the literature, the published papers seem far from clarifying the relation between chronic impingement and formation of osteochondroma. We present a case of a giant ossifying chondroma in the infrapatellar fat pad that resulted from chronic Hoffa’s disease. Complete open resection was performed successfully after arthroscopic examination. The infrapatellar fat pad contains the entire progenitor cells for the development of an osteochondroma and chronic impingement may have promoter affect on this issue, thus, an osteochondroma may occur at the end-stage Hoffa’s disease.     

Age‐associated increases in the size of the infrapatellar fat pad in knee osteoarthritis as measured by 3T MRI

Obesity, as a primary risk factor for osteoarthritis (OA), has been shown to alter joint loading, but may also result in metabolic changes characterized by chronic, low‐level inflammation due to increased circulating levels of adipose‐derived cytokines, or “adipokines.” The presence of the infrapatellar fat pad in the knee suggests that local changes in adipokine concentrations may influence knee OA. This study examined the hypotheses that the volume of the infrapatellar fat pad is correlated to the body mass index (BMI) of OA patients, and that fat pad volume is greater in subjects with OA. Fat pad volume was measured in sequential magnetic resonance (MR) images taken over one year in a cohort of 15 control and 15 knee OA subjects. No differences were observed in the fat pad volume between the two groups at baseline, 3, 6, or 12 months. In control subjects, no significant correlations were present between any parameters (age, BMI, weight, volume of fat pad at any time point). However, in the osteoarthritic group, fat pad volume was correlated with age at every time point. One possible explanation is that local factors related to knee OA may also induce enlargement of the fat pad with age. Alternatively, subjects who are prone to growth or enlargement of the fat pad may also be more prone to symptomatic OA. These findings provide intriguing preliminary data on the potential role of the infrapatellar fat pad in OA, although additional study is required to better understand the mechanisms of this relationship. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1149–1154, 2010     

应用分流注水器行肿胀麻醉及脂肪抽吸术治疗颈背脂肪垫

目的：手术切除是治疗颈背脂肪垫的传统方法,但术后会遗留大的瘢痕。我们应用分流注水器行肿胀麻醉及脂肪抽吸术治疗颈背部脂肪垫,并评价其疗效。方法：本组12例患者,颈背脂肪垫部位以三通分流注水器注射肿胀液,以负压吸引器带直径2～2.5mm吸脂针抽吸脂肪组织,术后加压包扎。结果：应用分流注水器可减少注水时间并减轻患者痛苦。早期随访,颈肩部外形满意,无血肿、血清肿及皮肤坏死等并发症发生;长期随访,未见颈背脂肪垫复发,相关不适症状消失。结论：以肿胀麻醉及脂肪抽吸术治疗颈背部脂肪垫,创伤小,无并发症,安全有效。应用分流注水器省时省力,且能有效缓解患者痛苦。     

重建前交叉韧带血供的实验研究和临床应用

目的：探讨加速前交叉韧带替代物血供重建的方法。方法：用狗作动物模型，将两侧髌韧带内侧1／3游离，左侧直接包埋于髌下脂肪垫，右侧髌下脂肪垫切除后将韧带游离置于关节腔。术后2、4、6、8周灌注，取材，观察髌下脂肪垫对游离髌韧带血供重建的影响。临床应用于前交叉韧带断裂重建术20例（Jones 髌下脂肪垫覆盖术），结果：髌下脂肪垫包裹的游离髌韧带血供重建速度较未被包裹的一侧大大加快，其韧带内的细胞坏死，胶原崩解亦较对照组明显减少，临床应用19例疗效满意。结论：在作交叉韧带重建手术，应尽量保留并利用髌下脂肪垫等软组织，包裹替代物，以促进其血循环重建，减少坏死，保持韧带活力，使替代物发挥稳定膝关节的功能。     

Buccal fat pad pedicle flap for midface augmentation.

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.     

无覆盖带蒂颊脂垫瓣在修复口腔缺损中的应用

目的：介绍无覆盖带蒂颊脂垫瓣用于口腔缺损修复的实践。方法：将颊脂垫瓣转移到相应的口腔缺损区,暴露的颊脂垫瓣表面无需植皮,可以自行上皮化。结果：共治疗口腔缺损病例13例,均获成功,颊脂垫瓣封闭效果好。结论：无覆盖带蒂颊脂垫瓣作为局部区域性组织转移瓣,对口腔内颊部、软腭和牙槽等部位软组织缺损的修复尤为适宜,是一种口腔内软组织缺损理想的充填材料。     

北方汉族女性颧脂肪垫厚度和位置的初步超声测量

目的 探讨应用超声测量端坐位时颧脂肪垫的厚度,并得到脂肪垫的分布,找出青年人和老年人颧脂肪垫的差异,为悬吊颧脂肪垫的年轻化手术提供依据.方法 将24例北方汉族女性按照年龄随机分为3组.用Good-Q型超声机测量颧脂肪垫的厚度,对所得数据进行方差分析.结果 青年组与中年组在脂肪垫分布上没有显著差异.但是老年组在F与3、F与4、E与4、E与5、D与4、D与5、C与5、B与5、A与4、A与5交点和O点比青、中年组厚.结论 老年人面颊外侧脂肪增多,可能造成脂肪向外下方移位,导致出现衰老容貌.     

Central (third) fat pad of the upper eyelid.

A clinical study on the surgical anatomy of the upper-eyelid fat pads was performed on 55 consecutive patients who underwent a blepharoplasty. It was confirmed that the periorbital fat is encapsulated in compartments and that the number of fat pads varies. In 56% of the cases there were two fat pads and in the 44% three fat pads in the upper eyelid. The third fat pad is anatomically and histologically an accessory medial extension of the lateral fat pad. However, for the sake of clarity, the term central fat pad of the upper eyelid is proposed as a denominator of this structure. The purpose of this article is to make the less experienced surgeons aware of variations in the configuration of the periorbital fat and to remind them that after two fat pads are removed from the upper eyelid there might still be a third.     

兔髌下脂肪垫损伤动物模型的制备和组织病理变化

目的;制备髌下脂肪垫损伤的动物模型,观察其病理变化。方法：损伤组应用水囊在膝关节前方压迫髌下脂肪垫,对所压迫的膝关节进行屈伸运动,取下脂肪垫与滑膜,进行ＨＥ染色。结果：损伤后的指肪垫及滑膜可见脂肪垫内小血管扩张,血管内充血,及小片状出血,脂肪间质水肿,淋巴细胞,浆细胞肥大细胞和巨噬细胞浸润,可风脂肪垫表面滑膜细胞增生,及滑膜绒毛状增生。结论：脂肪垫及滑膜符合急性挤压伤的表现,并出现一些慢性损伤的变     

Plantar fat pad atrophy: a cause of metatarsalgia?

The aim of this prospective study was to evaluate if atrophy of the plantar fat pad in splay-foot deformities was a major cause of metatarsalgia. A sonographic method of measuring the thickness of the plantar fat pad under the second and third metatarsal heads was developed. The method was tested on 25 volunteers and the intraobserver reliability was calculated to be 97.1% for the second metatarsal and 96.7% for the third metatarsal. Sonographic measurement of the plantar fat pad was then performed on 100 symptomatic feet Pain frequency and pain intensity were determined by using a verbal rating scale (VRS) and a visual analog scale (VAS). The intermetatarsal angle 1/2 was measured and then compared to the thickness of the fat pad for each patient. A correlation between the increase of the intermetatarsal angle and the decrease of the fat pad thickness could not be demonstrated (r = 0.041). The frequency of metatarsalgia did not correlate with a decrease of the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.978; Durbin-Watson test: 1.999; p value = .0507) and the third metatarsal head (t statistic: 3.199; Durbin-Watson test: 1.962; p value = .0019). The pain intensity showed a similar lack of correlation with the thickness of the plantar fat pad under the second metatarsal head (t statistic: 1.828; Durbin-Watson test: 2.365; p value = .0706) and the third metatarsal head (t statistic: 1.846; Durbin-Watson test: 2.371; p value = .0678). This study shows that a splay-foot deformity is not associated with a decrease of the thickness of the plantar fat pad. Furthermore, alterations of the thickness of the plantar fat pad are not relevant to the intensity and frequency of metatarsalgia.     

Cheek and neck sculpturing: simultaneous buccal fat pad removal and subcutaneous cheek and neck lipoplasty

A combined procedure removing the buccal fat pad by excision and the subcutaneous fat of the cheek and neck by lipoplasty is described; this results in an improved contour in both the cheeks and neck. The technique has been applied in 28 patients of various ages without complications and with satisfactory results. Both the immediate results of the operation and the results noted 1 year or more after the operation are very satisfactory. Excellent results have been noted for nine young patients, and good results were obtained in 19 older patients. A review is given of the findings previously reported in the literature. At present, we are inclined to believe that removal of the buccal fat pad and lipoplasty of the subcutaneous fat of the cheeks and neck offers more improvement than either procedure alone. It is hoped that this combined procedure will give a solution to the troublesome problem of chubby cheeks and lead to a method of safely recontouring the cheek to a more youthful and beautiful appearance.     

Central (third) fat pad of the upper eyelid

A clinical study on the surgical anatomy of the upper-eyelid fat pads was performed on 55 consecutive patients who underwent a blepharoplasty. It was confirmed that the periorbital fat is encapsulated in compartments and that the number of fat pads varies. In 56% of the cases there were two fat pads and in the 44% three fat pads in the upper eyelid. The third fat pad is anatomically and histologically an accessory medial extension of the lateral fat pad. However, for the sake of clarity, the term central fat pad of the upper eyelid is proposed as a denominator of this structure. The purpose of this article is to make the less experienced surgeons aware of variations in the configuration of the periorbital fat and to remind them that after two fat pads are removed from the upper eyelid there might still be a third.Presented at the 10th Congress of the International Society of Aesthetic Plastic Surgery, Zürich, Switzerland, September 11, 1989