【背景】导致面部衰老的主要原因包括组织容量减少、松弛和皱纹加重等。面中部是视觉的集中区域，该部位的年轻化在面部整体的年轻程度中占有重要比份。对于容量缺失导致的面中部衰老，自体脂肪移植是目前公认的有效方法之一。面中部脂肪室理论的提出为我们在该处实施脂肪移植提供了指导。目前，关于面中部脂肪室理论的相关研究主要集中在眼轮匝肌下脂肪室和颊内侧深脂肪室，对颊脂垫的解剖及在面中部年轻化中的作用研究较少。因此，本研究拟纳入颊脂垫容量减少的女性病例28例，将自体脂肪填充于颊脂垫内，通过比较术前术后常规照片、面中部Ogee line切线夹角变化和三方满意度评估颊脂垫内脂肪移植对面中部年轻化的效果。

【目的】 基于面中部深层脂肪室理论行颊脂垫内自体脂肪移植，分析该方法对改善面中部老化的临床效果，探讨面中部脂肪室理论的临床实践意义，为实施面中部年轻化提供一种新的手术思路。

【方法】 选取自2017年12月至2020年12月在中国医学科学院整形外科医院接受自体脂肪填充颊脂垫的面部老化患者28例，均为健康女性，年龄28～51岁。自患者腹部获取脂肪，将棉垫法纯化后的自体脂肪通过钝针移植入患者颊脂垫内。于术后3～36个月随访。术前及术后随访时实施常规数码照相，通过观察术前术后照片，测量切线夹角（患者面部45°斜位下，外眦—口角连线与Ogee line上颧部最高点—Ogee line上面中部最低点连线所形成的角度）的变化情况进而评估面部Ogee line改善程度，同时通过观察术前术后照片，获取医、患和第三方对面中部衰老改善的满意度（优、良、中、差）数据。所获得的数据做统计学分析和描述。

【结果】 共实施自体脂肪填充颊脂垫的面部老化健康女性患者28例，平均年龄为35.8±5.3岁。单侧颊脂垫脂肪移植剂量在1.2～5.5ml之间，平均为2.8±1.3ml。术后随访3～36个月，平均随访时间为6.0±11.2个月。28例患者均未出现感染、硬结、凹凸不平等并发症；6例患者发生术后淤青，10天后痊愈。所有患者Ogee line均较术前平缓柔和：术前切线夹角为6.6±1.9°，术后为3.9±1.4°，切线夹角平均减少2.7°，经配对t检验证实具有显著统计学差异（p<0.01）。医、患及第三方满意度优良率分别为92.85%、89.29%和96.43%，经Kendall协同系数W检验证实具有显著统计学差异（p<0.01）。

【结论】：于颊脂垫内行自体脂肪移植可安全有效地改善面中部容量缺失导致的面中部衰老，塑造年轻、柔和的面部曲线（Ogee line），是治疗面中部老化的一种有效方法。

Background  The main factors leading to facial aging are reduction of tissue capacity，tissue relaxation，aggravation of wrinkles and so on. As the central area of the vision，the tissue structure of the middle face plays a significant role in the overall youthfulness of the face，for the aging of the middle face caused by the volume loss of the middle face，autologous fat transplantation is currently recognized as one of the effective methods. The proposal of the theory of mid-facial fat compartments provides guidance for us to carry out fat transplantation here. The related studies on the theory of mid-facial fat compartments are mainly focused on the sub-orbicularis oculi fat compartment (SOOF) and the deep medial cheek fat compartment (DMCF)，but there are few studies on the buccal fat pad (BFP). Therefore, 28 women with reduced buccal fat pad volume were included in this study, and autologous fat was filled into the buccal fat pad. The effect of rejuvenation in the middle face was evaluated by comparing the routine photos before and after operation, the change of tangent angle of Ogee line in the middle face and tripartite satisfaction.

Objective  Based on the mid-facial fat compartments theory, the autologous fat transplantation in the buccal fat pad was performed, and the clinical effect of this method on improving mid-facial aging was analyzed, which confirmed the clinical practical significance of the mid-facial fat compartments theory, and provided a new surgical idea for the implementation of mid-facial rejuvenation.

Methods  Twenty-eight patients with facial aging who received autologous fat transplantation in buccal fat pad in the plastic surgery Hospital of Chinese Academy of Medical Sciences from January 2017 to December 2020 were selected, all of them were healthy women, aged from 28 to 51 years old. The fat was obtained from the patient's abdomen, and the autologous fat purified by cotton pad was transplanted into the patient's buccal fat pad through a blunt needle. The patients were followed up from 3 to 36 months after operation. Routine digital photography was performed before and after operation. The tangent angle (the angle between the lateral canthus-oral angle and the highest point of the zygomatic part of ogee line and the lowest point of the middle face in ogee line at 45 °oblique position of the patient's face) was measured before and after operation. At the same time, the improvement of ogee line was evaluated by observing the photos before and after operation. To obtain the data of satisfaction (excellent, good, moderate and poor) of aging improvement in the middle of the face of doctors, patients and third parties. The data obtained were statistically analyzed and described.

Results  A total of 28 healthy female patients with facial aging were treated with autologous fat transplantation in the buccal fat pad, with an average age of 35.8 ±5.3 years. The dose of unilateral buccal fat pad fat transplantation was between 1.2~5.5ml, with an average of 2.8 ±1.3ml. The patients were followed up for 3 to 36 months, with an average follow-up time of 6 ±11.2 months. None of the 28 patients had infection, induration or uneven complications, and 6 patients developed postoperative bruising and were cured 10 days later. The Ogee line of all patients was softer than that before operation, and the tangent angle was 6.6±1.9°before operation and 3.9±1.4°after operation, with an average reduction of 2.7°, which was confirmed by paired t test(p < 0.01). The excellent and good rate of doctor-patient satisfaction was 75%, 85.71% and 89.29% respectively, which was confirmed by Kendall synergy coefficient W test (p < 0.01).

Conclusion  Autologous fat transplantation in buccal fat pad can effectively improve the aging caused by volume loss in the middle of the face. shaping a young and soft facial curve (Ogee line), it is an effective method for the treatment of mid-facial aging.