颧脂肪垫的解剖学研究与老化分析

Anatomic study of malar fat pad and aging analysis

目的通过对颧脂肪垫的解剖学研究，探讨面中部老化机制。方法选取10具甲醛固定后的成人尸头标本20侧，应用显微手术器械在10倍解剖显微镜下逐层解剖，仔细观察面中部纤维，区分不同区域皮肤与皮下脂肪层的结合方式，对其进行标记，注意其位置及范围，观察脂肪垫的范围、形状、位置，记录支持结构的解剖学位置并照相保存。结果①颧脂肪垫近似一个三角形，底部沿下睑眼轮匝肌支持韧带上层呈一弧线；内侧界为鼻唇沟和口下颌沟；外侧界从颧大肌在颧骨表面的止点区到达口角外下方或下颌缘。②颧脂肪垫系由较韧的纤维结缔组织组成的网状结构，其间有较大的脂肪颗粒；沿鼻唇沟水平方向牵拉，使颧脂肪垫纤维更加紧密，垂直方向牵拉，使颧脂肪垫纤维变得疏松，纤维之间距离增大。③在面部皮肤层和颧脂肪垫之间存在4个连接紧密的区域，从内向外分为I区、Ⅱ区、Ⅲ区和Ⅳ区，I、Ⅱ、Ⅲ区为与鼻唇沟平行的长条形，Ⅳ区为不规则的四边形。④颧脂肪垫与深层组织固定的结构有6条韧带：眼轮匝肌支持韧带上、下层、颧弓韧带、颧骨皮韧带、颧骨下皮韧带、颈阔肌皮肤前韧带、颊上颌韧带。结论颧脂肪垫与皮肤连接紧密，而与深层组织只有6条韧带相连接，随着时间的推移，颧脂肪垫支持韧带的松弛导致颧脂肪垫随着皮肤的老化下垂而下移，从而形成特征性的衰老面容。

Objective To discuss the midface aging mechanism through anatomic study of malar fat pad. Methods 10 fresh adult cadaveric heads （20 sides） fixed by vascular perfusion of formalin were used for anatomic study with microsurgery technique under microscope. The midfacial ligament and connective tissue between skin and subcutaneous fat were observed carefully in different parts of midface. The location, shape and extent of malar fat pad was also recorded and photographed. Results （1） The malar fat pad has a triangle shape. The bottom is a curve along the orbicularis retaining ligament at the lower eyelid. The fat pad is extended internally to the nasolabial fold and labiomandibular fold, externally from the major zygomatic muscle end point at the malar surface to the angulus oris and submandibular edge. （2）The malar fat pad is composed of meshed fibrous tissue, with big fat particles in it. It becomes tight when being stretched in horizontal direction along nasolahial fold and loosen when being stretched in vertical direction. （3）There is tight connection between skin and fat pad, which is divided into four areas as I , II , III, IV. The areas I , II , III are strip-shaped parelled to the nasolabial fold. The area IV is a irregular quadrilateral. （4） There are six fixation ligaments between malar fat pad and deep tissue： orbicularis retaining ligament upper layer of lower eyelid, orbicularis retaining ligament substratum of lower eyelid, zygomaticus ligament, zygomatic cutaneous ligament, zygomatic cutaneous ligament substratum, platysma cutaneous forward ligament, cheek maxilla ligament. Conclusions There are four closely connected areas between the facial skin and malar fat pad which makes malar fat pad and skin keep relatively consistent. The malar fat pad moving down mainly resulted from slack of ligaments support which is one of the reasons for aging face.