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Subcutaneous tissue, also known as the superficial fascia, is divided into three layers: apical, mantle, and the deeper layer The apical layer is located beneath the reticular dermis surrounding sweat glands and hair follicles It contains blood vessels, lymphatic vessels, and nerves It is also rich in carotenoids and tends to be yellow in gross appearance Damage to this layer can lead to hematoma, seroma, paresthesia, and full thickness skin necrosis The mantle layer is composed of columnar-shaped adipocytes and is absent from eyelids, nail beds, bridge of the nose, and penis It contributes to the ability to resist trauma by distributing pressure across a large field The deeper layer is located under the mantle layer and its shape depends on gender, genetics, anatomic area, and diet Adipocytes in this layer are arranged in lobules between septa as well as between fibrous planes This layer is suitable for liposuction Vertical extrusion and/or expansion of this layer can cause cellulite (Fig 3-1) Subcutaneous tissue is found throughout the body except for the eyelids, proximal nail fold, penis, scrotum, and the entire auricle of the external ear except the lobule In particular, subcutaneous tissue is prominent at the temples, cheeks, chin, nose, abdomen, buttocks, and thighs, as well as infraorbital areas and very thick at the palms and soles Age, gender, and lifestyle choices determine the distribution and density of adipose deposits For example, in newborns
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BOX 3-1 Functions of the Subcutaneous Tissue The largest repository of energy in the body Stores fat-soluble vitamins (A, D, E, K), including their derivatives such as retinoic acids Helps to shape the surface of the body, and form fat pads that act as shock absorbers Helps distribute force or stress to mitigate damage to underlying organs Protects against physical injury from excessive heat, cold, or mechanical factors Fills up spaces between other tissues and helps to keep organs in place Involved in thermoregulation by insulating the body from heat loss Functions as a secretory organ that releases many cytokines Plays a role in regulating androgen and estrogen levels3
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malar fat pad during the aging process This can lead to prominent flattening of the cheek/buccal area, sagging of the skin of the face, and prominent deep wrinkles, such as nasolabial folds and marionette lines or jowls
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Role of Lipids in the Human Body
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Lipids can be found in different areas of the skin, not only in subcutaneous tissue Lipids are constituents of phospholipids in the myelin sheaths of nerve tissue and cell membranes (lipid bilayers), play an important role in the skin barrier of the epidermis, and are essential for the production of steroids They are water-insoluble organic molecules because they are nonpolar However, after esterification (a condensation reaction between acid and alcohol), they are more water-soluble than their parent forms The most common lipids in the diet are triglycerides (triacylglycerol), which are composed of a glycerol subunit attached to three fatty acids (Fig 3-3) Lipids can be saturated or unsaturated Generally, an unsaturated fatty acid contains at least one double bond while saturated fatty acids do not Unsaturated fatty acids provide slightly less energy during metabolism than saturated fatty acids with the same number of carbon atoms In addition, saturated fatty acids are usually solids at room temperature
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CHAPTER 3 FAT AND THE SUBCUTANEOUS LAYER
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Apical layer Mantle layer
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Deeper layer Muscle
FIGURE 3-1 The three layers of the subcutaneous tissue
adipose tissue has a uniform thickness throughout the body, while in adults the tissue tends to disappear from some areas of the body and increase in other areas under the influence of hormones Adipose tissue is distributed differently in men and women Men tend to accumulate fat in an android or upper abdominal body distribution (apple shape) In contrast, women tend to accumulate fat in a gynoid or lower body distribution that predominantly involves the lower abdomen, hips, and thighs (pear shape) (Fig 3-2) In the elderly, hyper- or hypoaccumulation of fat occurs in various areas For example, infraorbital eye bags, buccal fat pad accumulation (chipmunk feature), wattle of the anterior neck, loose skin and fat accumulation in the posterior arm, increase in breast size of males, and an increase in abdomen, buttock and thigh fat are common Subcutaneous fat can also be lost in the