Our face has different structural layers, which are named from superficial to deep as follows:
The first layer is the skin, the second – in this case relevant layer for facial liposuction – is the subcutaneous fat tissue with retinacula cutis (fibrous connective tissue). The third layer is called superficial musculoaponeurotic system (SMAS). The fourth layer consists of deep adipose tissue (buccal fat), which cannot be removed by liposuction. The deepest tissue layer, called preist or deep fascia, brings up the rear.
The fat compartments are located in the second and fourth layers.
In the course of lipedema, we have observed for some time that many patients report an increase in volume in the second and rarely in the fourth tissue layer. This phenomenon can occur both before liposuction and during it.
The second tissue layer, the subcutaneous fat tissue, behaves similarly to the painful fat deposits on the arms and legs: hypertrophy (proliferation) and hyperplasia (enlargement) of the fat tissue occurs. Consequently, fat volume may increase in the face and even in the neck area. Lipolytic resistance of fat deposits occurs. This means that the adipocytes (fat cells) become “metabolically blind” as the extracellular structures now formed consisting of bound water and protein force the cells to inactivate their AQP7 channels to avoid membrane rupture. The fat now coated with water, gel (hyaluronan) and protein cannot be lost through exercise and dieting.
Whether this redistribution is lipedema fat cannot yet be conclusively answered, this still needs to be researched. However, there is already a tendency for more and more patients to come to us with painful fat accumulation in the face and neck area.