Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Cells Tissues Organs 2010;191:47–56 DOI: 10.1159/000226276 Histotopographic Study of the Fibroadipose Connective Cheek System Veronica Macchi a Cesare Tiengo b Andrea Porzionato a Carla Stecco a Enrico Vigato a, b Anna Parenti c Bruno Azzena b Andreas Weiglein d Francesco Mazzoleni b Raffaele De Caro a a Section of Anatomy, Department of Human Anatomy and Physiology, b Department of Medical and Surgical Specialities, Clinic of Plastic Surgery, and c Section of Pathologic Anatomy, Department of Medical Diagnostic Sciences and Special Therapies, University of Padua, Padua, Italy; d Institute of Anatomy, University of Graz, Graz, Austria auricular district to the nasolabial fold (p ! 0.05). In the pa- rotid region, the mean thicknesses of the superficial and deep fibroadipose connective tissues were 1.63 and 0.8 mm, respectively, whereas in the region of the nasolabial fold the superficial layer is not recognizable and the mean thickness of the deep fibroadipose connective layer was 2.9 mm. The connective subcutaneous tissue of the face forms a three- dimensional network connecting the SMAS to the dermis and deep muscles. These connective laminae connect adi- pose lobules of various sizes within the superficial and deep fibroadipose tissues, creating a three-dimensional network which modulates transmission of muscle contractions to the skin. Changes in the quantitative and qualitative character- istics of the fibroadipose connective system, reducing its vis- coelastic properties, may contribute to ptosis of facial soft tissues during aging. Copyright © 2009 S. Karger AG, Basel Key Words Aging  Fibroadipose connective system  Microanatomy  Platysma  Ptosis  Rhytidectomy  Superficial musculoaponeurotic system Abstract The purpose of this study was to investigate the morphology of the superficial musculoaponeurotic system (SMAS). Eight embalmed cadavers were analyzed: one side of the face was macroscopically dissected; on the other side, full-thickness samples of the parotid, zygomatic, nasolabial fold and buc- cal regions were taken. In all specimens, a laminar connec- tive tissue layer (SMAS) bounding two different fibroadipose connective layers was identified. The superficial fibroadi- pose layer presented vertically oriented fibrous septa, con- necting the dermis with the superficial aspect of the SMAS. In the deep fibroadipose connective layer, the fibrous septa were obliquely oriented, connecting the deep aspect of the SMAS to the parotid-masseteric fascia. This basic arrange- ment shows progressive thinning of the SMAS from the pre- Accepted after revision: February 13, 2009 Published online: June 24, 2009 Prof. Raffaele De Caro Section of Anatomy, Department of Human Anatomy and Physiology University of Padua, Via A. Gabelli 65 IT–35127 Padua (Italy) Tel. +39 049 827 2327, Fax +39 049 827 2328, E-Mail rdecaro@unipd.it © 2009 S. Karger AG, Basel 1422–6405/10/1911–0047$26.00/0 Accessible online at: www.karger.com/cto Abbreviations used in this paper SMAS superficial musculoaponeurotic system V.M. and C.T. contributed equally to this study.