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Figure 3 illustrates the superficial fat layers that
change during the aging process.
A. Superior orbital fat, B. Inferior orbital fat, C.
Lateral orbital fat, D. Medial cheek fat, E. Nasolabial
fat, F. Lateral temporal-cheek fat, and G. Buccal exten-
sion or buccal fat. Figure 4 shows the deep orbital fat
compartments that change due to the effects of aging
including A.Sub-orbicularis oculi fat (medial part), B.
Sub-orbicularis oculi fat (lateral part), C. Deep medial
cheek fat (medial part), D. Deep medial cheek fat (lat-
eral part), and E. Buccal extension of the buccal fat.
Farkas et al. continues their observations when
they state that “There is unquestionably a powerful
genetic component to facial aging, which in turn plays
a significant role in overall skin appearance over time.
This is likely the most powerful intrinsic factor of the
appearance of skin aging.” 1
Dr. Val Lambros—writing for the Department of
Plastic Surgery at the University of California, Irvine—
observes that aging also causes a “distinct change” in
the shape of the upper eyelid from a normal medially
biased peak, which over time becomes situated in a
more central location. 3 Figure 3. Superficial fat layers
A comparison of Figures 1 and 2 illustrates some
of the observations made by the above-referenced
physicians and show dramatic changes in the overall
appearance of the patient over the course of ten years.
By 2018, the patient’s skin appears to have much more
laxity; there is an overall hollowing in the appearance
of the cheeks and jowls; and an increase of the pres-
ence of wrinkles in his face. The nasal labial folds are
deeper and there are much larger “bags” under the
eye sockets. In Figures 1 and 2, the patient is wearing
the ocular prosthesis (OD) that was made for him in
2008. In 2008, the prosthesis was properly supported
by the lower lid; the prosthesis properly fit the socket/
supported the upper lid; and the appearance of the su-
perior sulcus was mirrored, in an acceptable manner,
compared with the companion eye. Ten years later,
that same ocular prosthesis no longer fit properly and
was cosmetically unacceptable.

Figure 4. Deep orbital fat
compartments change due to aging.

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