Lumbosacral Fat Pads

The deep layer (lamellar fat) constitutes blocked reserve fat, easy to gain and difficult to lose, metabolised only when there is starvation. It has a laminar pattern and a horizontal orientation, and is arranged as fat pads (localised fat pads, LFP), surrounded by a fascia that is sometimes well identified as a specific capsule and sometimes indistinct from the fascias of the muscles, differently located according to sex, race and genetic

Buccal Fat Pad Anatomy
Fig. 2. Typical 'Chesterfield sofa' look of the skin of the buttocks (hypertrophy of the superficial fat). a Moderate grade. b Severe grade
Adipocytes The Skin

Fig.4. Fat pad in the submental region of a young woman characteristics. Fat pads appear at puberty or shortly thereafter and are the most responsible for the body silhouette. Larger vessels pass along connective trabeculas, destined to the superficial skin vascular net. Adipocytes in deep fat are smaller than in the areolar layer, and horizontally elongated [7]. Pad adipocytes are two to four times more receptive to glucose than other fat cells; they are also very rich in alpha 2 receptors, which block lipolysis and are stimulated by catecholamines.

Only surgery can modify the shape of the silhouette, through a direct approach to LFPs, both by dermolipectomy operations and, mainly, by different techniques of liposuction.

Different locations of fat pads have been described.

Face - Fat distribution in the face contributes to the face traits. A fat pad is observed around the buccal area (Fig. 3). It can be divided into three lobes: anterior, intermediate and posterior. Four extensions derive from the posterior lobe: buccal, pterygoid, pterygopalatine and temporal [9]. In the nose, an interdomal fat pad is present, varying in size from 1.2 x 2.4 mm to 3.6 x 5.2 mm [10]. Fat pads are also identified in the periorbital, nasolabial (Fig. 3), submental (Fig. 4) and temporal regions.

Upper torso - Three major fat pads are described: two even in the scapular regions, one odd in the interscapular area [7].

Fig.4. Fat pad in the submental region of a young woman

Chest - Fusion of the superficial layer with the deep fascia on the ribs creates separate pockets responsible for the ripple effect (Fig. 5).

Arms - A posterior fat pad (subacromial) [11] and a deltoid fat pad have been described.

Abdomen - In the medial regions (supraumbilical, umbilical, infraumbilical), the fascia superficialis presents several layers separated by adipose tissue, while in the lateral regions localised adiposity is

Weight Loss Effect Face
Fig. 3. Face of a young woman, with fat pads around the Fig. 5. Ripple effect on the chest of a middle-aged woman mouth and in the nasolabial regions

very rare. A true LFP can be identified just in the lower half of the abdomen, limited between an ideal line that joins both iliac crests above the umbilicus and the superior border of the pubis (Fig. 6). The thicker zone of the abdomen corresponds to the projection of the rectus abdominalis muscle, where the large perforating vessels are situated.

Hips - An LFP may be found in the hips, limited by the 12th rib above, the muscles of the lumbar region posteriorly, the abdominal muscles anteriorly, and the iliac crest below.

Gluteal region and flank - The lumbo-gluteal adipose body (LGAB) has been identified in this area [12-14]. It is a symmetrical structure, shaped as a triangular pyramid, with a subcutaneous posterior base and an intermuscular anterior apex, which

Men Pubic Fatpad
Fig. 6. Well-identified fat pad in the lower half of the abdomen in a thin young woman

partially borders three regions: the inferior part of the lumbar region, the superior part of the gluteal region and the posterior part of the flank. It extends from the second lumbar to the second sacral vertebral body and between the anterior superior iliac spines, so corresponding to the lumbar trigone (Fig. 7). Inside the LGAB, two/three layers can be identified, separated by parallel fibrous septa: the more superficial layers are composed of smaller lobules, and the deeper layers of larger lobules.

Buttocks - Important LFPs in this region exist only in blacks, Brazilian mulatas, Asiatics and certain Slavic types. Owing to the adherence of the deep fascial layer to the underlying muscles, these fat pads do not tend to drop while standing (Fig. 8), sometimes giving the buttocks a particularly pleasant shape. Enormous buttock fat pads have been described in some African tribes. Pretrochanteric area - This can be subdivided into four regions: the iliofemoral bulge, the middle femoral region, the anterior femoral region and the posterior extension, directed towards the infragluteal fold (Fig. 9). A large accumulation of fat in the iliofemoral area is typical among gynoid Caucasians.

Thigh - An LFP is present in both the upper and the lower third of the internal surface; the upper one

Surface Marking Gluteal
Fig. 7. Lumbo-gluteal adipose body in a female teenager
Lumbo Gluteal Fat
Fig. 8. Fat pads of the buttocks, with typical tendency to stay up

extends from the inguinal crease to the middle third of the thigh and can reach dimensions large enough to impair a good deambulation. In the middle third the lamellar layer is almost absent (Fig. 10).

Knees - Between the inferior portion of the thigh and the superior portion of the leg there is a fat pad with an anteromedial extension, which curves inferiorly around the medial and inferior segment of the patella like a hook (infrapatellar fat pad) (Fig. 11).

Legs - An oval unilocular fat pad has been identified, vertically oriented from the lateral aspect of the ankle towards the head of the fibula: the lateral inframalleolar fat pad. The sural nerve and the short saphenous vein run over its external surface [15,16] (Fig. 12).

Inside Thigh Fat
Fig. 10. Typical profile of the inner thighs: localised fat pads are present just in the upper and lower third

Fig. 11. Infrapatellar fat pads in a teenage girl m

Buccal Fat Pad Anatomy

Fig. 12. Lateral inframalleolar fat pads, giving a clumsy aspect to the legs of a young woman

According to the sex (hormonal factors), we observe that the majority of LFPs in women and gynoid types are located around the pelvis and in the lower half of the body (rhizomelic silhouette),while in men and android morphotypes, LFPs are observed mostly in the trunk and the upper half of the body.

According to the ethnic origin, four types are described, depending on the prevalent distribution and thickness of the LFPs:

1. Latin, with a typical 'violin' shape (rolls on the hips and trochanteric fat) (Fig. 13a, b)

Fig. 12. Lateral inframalleolar fat pads, giving a clumsy aspect to the legs of a young woman

Fig. 13. Typical 'violin' shape. a Front view. b Back view

2. AngloSaxon and Nordic, with a typical 'life preserver' shape (hips and abdominal rolls), which resembles the 'Michelin man' shape in the fatter individuals.

3. Asiatic, with a typical 'kimono' shape (rolls mainly on the waist, chest, arms) (Fig. 14)

4. Black, where steatopygia is the most distinctive character (fat on the buttocks) (Fig. 15). All the fat deposits described are composed of white adipocytes. Brown adipocytes are scattered among the white ones and constitute well-identified masses (as in the well-known buffalo hump on the back of the neck) only under pathological conditions (lipodystrophies).

Oval Shaped Areola Men
Fig. 14. Typical 'kimono' shape in a young man
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Responses

  • Marja
    What are slavic fat pads?
    6 years ago
  • iolanda
    Why do i have lumbosacral fat pad?
    6 years ago
  • ilario
    What is a sacral fat pad?
    4 years ago
  • veli-pekka repo
    Where fat anatomy legs?
    4 years ago
  • Deborah
    What causes lumbosgcral fat pad?
    4 years ago
  • arja
    How to reduce sacral fat pad?
    3 years ago
  • ren sch
    How padding thick thighs?
    8 months ago
  • Amalia
    How to get rid of fat pad on lower back?
    7 months ago

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