As we age, we naturally observe various changes in the face. Some individuals experience sagging cheeks, others develop deeper nasolabial folds, and some see their jawline lose definition. These patterns of facial aging are complex and cannot be fully explained by the loss of skin elasticity alone. This article explores the core mechanism of facial aging—”remodeling of facial fat pads”—and how it creates different aging patterns depending on the shape of the face.
What Are Facial Fat Pads?
Facial fat pads are structural units of adipose tissue that contribute to the shape and volume of the face. These pads are distributed throughout the face, each with specific anatomical locations and functions. Major facial fat pads include:
- Buccal fat pad (cheek region)
- Infraorbital fat pad (beneath the eyes)
- Malar fat pad (above the zygomatic bone)
- Mandibular fat pad (along the jawline)
Beyond providing volume, these fat compartments serve as cushions between facial muscles and the skin, facilitate smooth facial expression, and play a critical role in defining the face’s overall contour and three-dimensional appearance. In youth, these pads remain firm and anchored, lending vitality and firmness to the face.
How Facial Fat Pads Change with Aging
With aging, facial fat pads undergo three key processes: atrophy, descent, and redistribution.
- Atrophy refers to a reduction in both the size and number of adipocytes (fat cells). This leads to volume loss and facial sagging. Particularly in the zygomatic and periorbital regions, fat pad atrophy results in hollow under-eye areas or exaggerated cheekbone protrusion.
- Descent describes the downward migration of fat pads due to gravitational pull and weakening of supportive structures. This is especially pronounced in the midface, where fat pads such as the Suborbicularis Oculi Fat (SOOF) descend, leading to under-eye hollows and nasolabial fold deepening.
- Redistribution refers to disproportionate fat loss in some facial regions and accumulation in others. For example, fat may decrease in the midface and periorbital area, while increasing along the jawline and neck. This imbalance contributes to the transformation from a youthful “V-line” to an aged “U-line.”
Different Aging Patterns by Facial Shape
Since the structure and distribution of fat pads vary with facial shape, aging patterns also differ. Let’s examine the typical aging characteristics and treatment strategies for various face shapes:
- Oval Face: Balanced aging pattern. Midface descent and mild nasolabial folds. Treatment: Midface volumization using hyaluronic acid (HA) fillers.
- Square Face: Fat redistribution along the jawline causes double chin, angularity increases with cheek fat loss. Treatment: Lipolysis injections and midface fillers.
- Round Face: Prominent fat descent (“bulldog folds”). Treatment: Skin boosters to support dermal structure and delay sagging.
- Heart-Shaped Face: Noticeable imbalance between cheek and jaw with malar fat atrophy. Treatment: Volume restoration in cheeks and chin/jawline with fillers.
- Long Face: Midface atrophy elongates appearance; jawline sagging. Treatment: Combined midface fillers and lifting-effect skin boosters.
Non-Surgical Approaches to Manage Fat Pad Remodeling
- Fillers: HA fillers restore volume in atrophied areas like the cheeks, zygomatic region, and under-eyes. Injection plans vary based on facial shape.
- Skin Boosters: Injected deeply to improve hydration and elasticity, reinforcing skin structures that support fat pads.
- Botulinum Toxin (Botox): Relaxes overactive facial muscles to reduce mechanical stress on fat pad positions, slowing their descent.
- Lipolysis Injections: Break down accumulated fat under the chin and along the jawline, especially beneficial for square and round faces.
Factors That Influence Fat Pad Remodeling
- Genetics: Family history determines fat distribution and aging tendencies.
- Lifestyle: Smoking, alcohol, poor sleep, and stress hinder collagen/elastin synthesis and accelerate fat pad degeneration.
- Weight Fluctuations: Frequent gain/loss alters fat distribution and elasticity.
- Sun Exposure: UV radiation damages structural proteins, weakening fat pad support systems.
Preventive Care to Delay Fat Pad Remodeling
- Daily SPF 30+ sun protection and physical barriers (hats, sunglasses)
- Skincare with retinol, vitamin C, and peptides
- Healthy lifestyle: Balanced diet, hydration, sleep, exercise, no smoking
- Facial massage and exercises to stimulate circulation and muscle tone
Conclusion
Facial fat pad remodeling is an inevitable but manageable aspect of aging. By understanding the role of fat pads and how their changes differ by face shape, individuals can adopt targeted interventions. Non-surgical treatments—including fillers, skin boosters, Botox, and lipolysis—combined with preventive habits can significantly delay the onset of visible aging and preserve youthful facial contours.
Summary by Facial Type
- Oval: Midface descent, mild folds → HA filler
- Square: Jaw fat accumulation, cheek atrophy → Lipo + filler
- Round: Buccal descent, sagging → Skin boosters
- Heart: Zygomatic atrophy, lower imbalance → Cheek + jawline filler
- Long: Midface hollowness, jaw sag → Fillers + lifting boosters
