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Alhithlool AW, Al Qurashi AA, Halawani IR, Alkhonizy SW, AlBattal NZ, Alkhwildi LA, Alhindi N, Albalawi TA, Neel OF, Mortada H. Top 50 Highly Cited Publications in Facelift Surgery: A 50-Year Bibliometric Analysis Review. Aesthetic Plast Surg 2024; 48:312-323. [PMID: 38129354 DOI: 10.1007/s00266-023-03752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023). METHODS The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed. RESULTS The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author. CONCLUSION Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences at the National, Guards, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Division of Plastic Surgery, Department of Surgery, McGill University, Montreal, Canada
| | | | | | - Nouf Z AlBattal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lama A Alkhwildi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Nawaf Alhindi
- College of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | - Omar Fouda Neel
- Division of Plastic Surgery, Department of Surgery, McGill University, Montreal, Canada
- Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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Lindsey JT, Lee JJ, Phan HTP, Lindsey JT. Defining the Cervical Line in Face-Lift Surgery: A Three-Dimensional Study of the Cervical and Marginal Mandibular Branches of the Facial Nerve. Plast Reconstr Surg 2023; 152:977-985. [PMID: 36881027 DOI: 10.1097/prs.0000000000010369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Continuous sub-superficial musculoaponeurotic system (SMAS) dissection in the cheek with subplatysmal dissection in the neck is an important feature of many face-lift techniques, yet the neural anatomy in this area remains unclear, and recommendations regarding continuous dissection of these adjacent areas vary widely. The purpose of this study was to define the vulnerability of the facial nerve branches in this transitional area from the face-lift surgeon's perspective and to specifically identify the location of the cervical branch penetration through the deep cervical fascia. METHODS Ten fresh and five preserved cadaveric facial halves were dissected under 4× loupe magnification. The skin was reflected, followed by elevation of a SMAS-platysma flap, with identification of the location of cervical branch penetration through the deep cervical fascia. The cervical and marginal mandibular branches were then dissected retrograde through the deep cervical fascia to the cervicofacial trunk to confirm identifications. RESULTS Cervical and marginal mandibular branch anatomy was found to be similar to that of the other facial nerve branches, all of which initially course deep to the deep fascia in their postparotid course. The emergence of the terminal branch or branches of the cervical branch through the deep cervical fascia was consistently at or distal to a line from a point 5 cm below the mandibular angle on the anterior border of the sternocleidomastoid muscle to the point where the facial vessels course over the mandibular border (cervical line). CONCLUSIONS Continuous dissection of the SMAS in the cheek, with subplatysmal dissection in the neck crossing over the mandibular border, is possible without jeopardizing the marginal mandibular or cervical branches if done proximal to the cervical line. This study serves as the anatomical justification for continuous SMAS-platysma dissection, and has implications for all types of SMAS flap manipulations.
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Affiliation(s)
- John T Lindsey
- From the Department of Surgery, Vassar Brothers Medical Center, Nuvance Health
| | | | | | - John T Lindsey
- Division of Plastic and Reconstructive Surgery, Tulane University
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M B Zachary C, Grushchak S, Newman J. Skin Anatomy and Analysis. Facial Plast Surg Clin North Am 2023; 31:433-442. [PMID: 37806677 DOI: 10.1016/j.fsc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
This article provides a comprehensive review and strong reference for facial and neck anatomy. An anatomic foundation is built for the dermatologic concepts, techniques, procedures, and surgeries detailed in noninvasive skin treatments. Superficial anatomic landmarks have been established that allow for more nuanced navigation and measurement of facial features. Throughout this article, we discuss key anatomic features of the face and neck, compare dermal thickness in various regions and ethnic anatomic differences, review insertion points of retaining ligaments of the superficial musculoaponeurotic system, and detail diagnostic tools including ultrasound and optical coherence tomography analysis of the skin.
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Affiliation(s)
- Cameron M B Zachary
- Department of Dermatology, University of California Irvine, 118 Med Surg 1, Building 810, Irvine, CA 92697, USA
| | - Solomiya Grushchak
- Department of Dermatology, University of California Irvine, 118 Med Surg 1, Building 810, Irvine, CA 92697, USA.
| | - James Newman
- Premier Plastic Surgery, 1795 El Camino Real, Suite 200, Palo Alto, CA 94306, USA
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Chen Q, Li P, Zhao Q, Tu T, Lu H, Zhang W. Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries. Front Neurol 2023; 14:1258759. [PMID: 38020669 PMCID: PMC10659089 DOI: 10.3389/fneur.2023.1258759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.
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Affiliation(s)
- Qiang Chen
- Department of Hand & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - QingFang Zhao
- Department of Plastic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian Tu
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Ugradar S, Kim JS, Massry G. A Review of Midface Aging. Ophthalmic Plast Reconstr Surg 2023; 39:123-131. [PMID: 36700849 DOI: 10.1097/iop.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To review and summarize studies on the anatomy and involutional changes of the midface. METHODS A PubMed search was performed searching for studies on the anatomy and involutional changes concerning the midface. RESULTS The anatomy of the midface is complex. Studies of involutional change vary in scientific quality and have conflicting results. However, it appears that among the more common changes, there is a decrease in the maxillary and pyriform angle, with changes to the orbital floor position. Further, there appears to be an inferior migration of the fat compartments of the midface during aging, exacerbating the hollow of the palpebromalar groove and causing a deepening of the nasojugal groove. Changes to the volume of the buccal extension of the buccal fat pad exacerbate these changes and contribute to the gestalt changes associated with facial aging. Here, we review the major characteristics of soft tissue and bony changes on the midface, with special reference to their anatomic relationships. CONCLUSIONS The major findings characterizing midface aging are related largely to the soft tissue. However, more robust studies are required to quantify these changes and to appraise their impact on the overall manifestation of aging.
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Affiliation(s)
- Shoaib Ugradar
- The Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Jane S Kim
- Department of Ophthalmology, Duke University, Durham, North Carolina, U.S.A
| | - Guy Massry
- Cedars-Sinai Medical Centre, Los Angeles, California, U.S.A
- Division of Oculoplastic Surgery Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Marten T, Elyassnia D. High SMAS Facelift: Combined Single Flap Lifting of the Midface, Cheek, and Jawline. Facial Plast Surg 2022; 38:593-612. [PMID: 36563671 DOI: 10.1055/s-0042-1757757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The traditional deep plane and "low" cheek superficial musculoaponeurotic system (SMAS) flaps elevated below the zygomatic arch suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Traditional deep plane and low designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and "midface" area. Planning the flap "higher," along the zygomatic arch, and extending the dissection medially in an "extended SMAS" fashion to release and mobilize midface tissue, overcomes this problem and allows a combined, simultaneous, single flap lifting of the jawline, cheek, and midface. An improved outcome is obtained in many patients and no separate midface lift procedure is needed.
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Affiliation(s)
- Timothy Marten
- Marten Clinic of Plastic Surgery, San Francisco, California
| | - Dino Elyassnia
- Marten Clinic of Plastic Surgery, San Francisco, California
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Uppal S. Essential Surgical Anatomy for Facelift. Facial Plast Surg 2022; 38:546-574. [PMID: 36563670 DOI: 10.1055/s-0042-1756463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
It is crucial for a facelift surgeon to have a comprehensive understanding of ageing-related changes on the volume, elasticity, and relative position of various facial tissues and layers. These changes lead to an alteration in the surface topography, contour, and ultimately shape of the face. The depressions and sagging of tissues created as a result of ageing then has a bearing on one's perceived age. This article describes the various layers of the face and neck affected by ageing. The fat compartments, superficial musculoaponeurotic system (SMAS), potential facial spaces, facial ligaments, and facial nerve are discussed in detail. Safe and effective execution of facelift requires a thorough understanding of the intricate relationship between the various layers of face and neck, in particular the path of facial nerve, as it negotiates between these layers. The emphasis of this article is on integrating this knowledge to generate practical tips for safe dissection, effective tissue movement, and repositioning during various type of facelift procedures.
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Affiliation(s)
- Sandeep Uppal
- Department of Otolaryngology, Head and Neck Surgery, Khoo Teck Puat Hospital, Singapore
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Abstract
BACKGROUND Reoperative face lift can be technically more demanding than primary face lift because of altered anatomy and scarred tissue plane. This study was carried out to analyze the outcome of reoperative face lift using sub-superficial musculoaponeurotic system (SMAS) techniques, including facial nerve injury. METHODS Seventy reoperative face lifts using sub-SMAS techniques were studied. Data analysis includes the patients' demographic information, the interval between the previous face lift and the reoperative face lift, intraoperative findings of the SMAS-platysma anatomy, complications, and rate of revision. A separate group of 180 primary face lifts using sub-SMAS techniques during the same period was analyzed for the incidence of facial nerve injury only. RESULTS Intraoperative findings in the reoperative group consist of anatomical changes in the SMAS-platysma in 82.9 percent of the cases, including increased fibrosis, changes in thickness, limited movement, and increased adhesion on the undersurface. Sub-SMAS dissection was completed in 137 hemifaces. Complication consists of seroma (1.4 percent), delayed healing (1.4 percent), and temporary facial nerve injury (7.1 percent), which was not correlated with increased fibrosis or adhesion under the SMAS-platysma. The rate of revision within 18 months was 11.4 percent. There was a 2.2 percent incidence of temporary facial nerve injury in the primary face-lift group. CONCLUSIONS Sub-SMAS techniques, with few exceptions, were successfully used in a series of reoperative face lifts. Temporary facial nerve injury was the most frequent complication. Satisfactory outcome was obtained in all the cases. The incidence of facial nerve injury was higher than in primary face lift using sub-SMAS techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Alghoul MS, Vaca EE. Creating Harmonious Arcs: The Importance of Brow Shape in Determining Upper Lid Aesthetics. Clin Plast Surg 2022; 49:389-397. [PMID: 35710154 DOI: 10.1016/j.cps.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brow lifting, when indicated, can significantly improve upper eyelid aesthetics. Brow lifting is a powerful maneuver to shape and lateralize the curvature of the brow arc and directly influences the upper eyelid fold height and the curvature of the upper eyelid crease. This article reviews the importance of upper periorbital aesthetic assessment because it lays the foundation to tailor the appropriate operative intervention. Highlighted are the authors' preferred approach to aesthetically shape the brow along with other complimentary upper eyelid aesthetic procedures including upper blepharoplasty, blepharoptosis repair, fat grafting, and upper periorbital fat shifting to optimize brow lifting outcomes.
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Affiliation(s)
- Mohammed S Alghoul
- Private Practice, Abdali Hospital, 12th floor, Al-Istethmar Street, Abdali Boulevar, Amman 11190, Jordan; Division of Plastic & Reconstructive Surgery, Northwestern Feinberg School of Medicine, 675 N Street Clair, Galter 250, IL 60611, Chicago.
| | - Elbert E Vaca
- Private Practice, 660 Glades Road, Suite 210, Boca Raton, FL 33431, USA
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Deep Plane Anatomy for the Facelift Surgeon. Facial Plast Surg Clin North Am 2022; 30:205-214. [DOI: 10.1016/j.fsc.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yang M, Gu Y, Wang D, Li J, Sun J, Lv Q, Qi Y, Han X, Qi Z, Ma GE. Liposuction of the Zygomatic Arch Area: A Novel Concept to Improve the Midface Contour. Aesthetic Plast Surg 2022; 46:1689-1697. [PMID: 35059815 DOI: 10.1007/s00266-021-02765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND An ovoid, slender face with a smooth contour is preferred in oriental esthetics. We developed a novel concept to achieve a slimmer and harmonious midface contour by liposuction of the projection area of the zygomatic arch. METHODS A cadaver study including anatomical dissection and histologic examination were conducted to better understand the soft tissue structure of the projection area of the zygomatic arch and the vital technique for liposuction. For the clinical evaluation, 49 patients with midface hypertrophy who underwent liposuction of the zygomatic arch area from January 2016 to June 2021 were retrospectively reviewed. RESULTS Cadaver study showed that abundant fatty tissue existed in the subcutaneous layer of the zygomatic arch area. The liposuction manipulation was precisely limited to the subcutaneous fat layer, and nerve branches were observed in the deeper loose areolar tissue plane. Of the 49 patients enrolled in this study (including 98 zygomatic arch areas), the median fat removal volume per zygomatic arch area was 3.0 (2.0, 5.0) mL. The subcutaneous fat thickness was significantly decreased postoperatively [median 9 (6, 10) mm vs. 1 (1, 2) mm per zygomatic arch area, P < 0.001]. All patients were satisfied with their postoperative outcomes. Only three patients underwent slight depression of the liposuction area during making facial expression after surgery and subsequently recovered. CONCLUSIONS Liposuction of the zygomatic arch area is effective in improving midface hypertrophy and achieving a harmonious facial contour with a low risk of complications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Elsayed SA, Hassan S, Hakam M, Mekhemer S, Mobarak F. Effect of two fascial incision options for access to the temporomandibular joint on facial nerve function: objective investigation. Int J Oral Maxillofac Surg 2021; 51:933-941. [PMID: 34972618 DOI: 10.1016/j.ijom.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
This study was performed to compare the effects on facial nerve (FN) function of the deep supra-temporalis muscle subfascial approach (DSFA) and traditional fascial approach (TFA) for access to the temporomandibular joint (TMJ), via qualitative and quantitative evaluations. Thirty patients requiring open TMJ surgery were randomly allocated to one of two groups: group A patients underwent the DSFA approach, while group B patients underwent the TFA approach. The TMJ was accessed via modified endaural incision with temporal extension. Clinical examinations, FN conduction tests, and electromyography (EMG) of the frontalis and orbicularis oculi muscles were used to assess FN function. A FN function deficit was noted in 50% of the whole sample population immediately after surgery, with no statistically significant difference between the groups (P = 0.082). Overall, 37.5% of the total study population experienced temporary loss of frontalis muscle activity, while zygomatic nerve injury was seen only in 25% of group A. Within 2-6 months, normal function returned in both groups. Nerve conduction studies showed no statistically significant difference between the groups in terms of nerve amplitude or latency after surgery. However, EMG of orbicularis oculi activity showed a significant difference between the groups after 6 months (P = 0.010). The results suggest that the traditional dissection approach is more protective of the FN, especially the zygomatic branch, than the deeper dissection technique.
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Affiliation(s)
- S A Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University for Girls, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, Taibah University Dental College and Hospital, Almadinah Almunawwarah, Saudi Arabia.
| | - S Hassan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - M Hakam
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S Mekhemer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - F Mobarak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity. Plast Reconstr Surg 2021; 148:1357-1365. [PMID: 34705806 DOI: 10.1097/prs.0000000000008586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A commonly seen issue in facial palsy patients is brow ptosis caused by paralysis of the frontalis muscle powered by the frontal branch of the facial nerve. Predominantly, static methods are used for correction. Functional restoration concepts include the transfer of the deep temporal branch of the trigeminal nerve and cross-facial nerve grafts. Both techniques can neurotize the original mimic muscles in early cases or power muscle transplants in late cases. Because axonal capacity is particularly important in cross-facial nerve graft procedures, the authors investigated the microanatomical features of the frontal branch to provide the basis for its potential use and to ease intraoperative donor nerve selection. METHODS Nerve biopsy specimens from 106 fresh-frozen cadaver facial halves were obtained. Histologic processing and digitalization were followed by nerve morphometric analysis and semiautomated axon quantification. RESULTS The frontal branch showed a median of three fascicles (n = 100; range, one to nine fascicles). A mean axonal capacity of 1191 ± 668 axons (range, 186 to 3539 axons; n = 88) and an average cross-sectional diameter of 1.01 ± 0.26 mm (range, 0.43 to 1.74 mm; n = 67) were noted. In the linear regression model, diameter and axonal capacity demonstrated a positive relation (n = 57; r2 = 0.32; p < 0.001). Based on that equation, a nerve measuring 1 mm is expected to carry 1339 axons. CONCLUSION The authors' analysis on the microanatomy of the frontal branch could promote clinical use of cross-facial nerve graft procedures in frontalis muscle neurotization and free muscle transplantations.
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Safe Zone for Dissection in Frontotemporal Region to Avoid Injury to the Temporal Branch of Facial Nerve. J Craniofac Surg 2021; 32:2322-2325. [PMID: 34705381 DOI: 10.1097/scs.0000000000007668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The objective of this study is to provide a reliable roadmap for temporal branch of the facial nerve, in order to minimize, the risk of injury to the nerve during surgical dissections. A literature search was conducted on temporal branch of facial nerve. The date search range was 1950 to 2017. Databases searched included Medline, Web of science, Biosis, SciELO, Data Citation, and Zoologic Records. Data were collected on, author specialty, date of publication, and the relationship of the temporal branch of facial nerve to various landmarks in the frontotemporal region reported in human anatomic studies. Among the 48 studies reviewed, a total of 3477 anatomic dissections were performed in the craniofacial region. Temporal branch of facial nerve was located between 2.5 and 3 cm from lateral orbital rim. In relation to the zygomatic arch, it was found anywhere from the midpoint of the arch to 1 finger breath posterior to the arch. For the plane, it was most commonly described as being under the superficial temporal fascia (STF) or within the loose areolar tissue. Most anatomic dissections found 2 to 4 twigs of the temporal branch of facial nerve. In relation to the lateral canthus, it was found to be 2.85 +/- 0.69 cm superior and 2.54 +/- 0.43 cm lateral to the lateral canthus. Our study suggests consolidated data on surgical landmarks in order to ensure safe dissection in temporal region and prevent injury to the temporal branch of facial nerve.
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Abstract
The Asian facelift requires an adaptation of current techniques to achieve a desired aesthetic outcome. Cultural differences and differences in anthropomorphologic features alter a patient's vision of beauty and youthfulness. Rejuvenation of the aging Asian face mandates a set of strategies, including understanding cultural aspects of Asian patients, anatomy of Asian patients, and appropriate techniques based on these cultural and anatomic considerations. For stable application and results, the surgeon must understand surgical facial anatomy. If performed properly, facelifts can improve facial balance and can yield aesthetically more appealing results. The deep plane facelift technique presented is well suited for Asian patients.
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Affiliation(s)
- Taek Keun Kwon
- 18-6, Ihyeon-RO 29BEON-GIL, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
| | - Yun Hee Choi
- 18-6, Ihyeon-RO 29BEON-GIL, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
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Kucukguven A, Ulkir M, Bilgic Kucukguven M, Demiryurek MD, Vargel I. Defining a Preauricular Safe Zone: A Cadaveric Study of the Frontotemporal Branch of the Facial Nerve. Aesthet Surg J 2021; 41:398-407. [PMID: 32770215 DOI: 10.1093/asj/sjaa232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the preauricular region, the frontotemporal branch of the facial nerve is vulnerable to injury, which can result in facial palsy and poor cosmesis after surgical interventions. OBJECTIVES The purpose of this study was to describe variations in the branching patterns of the frontotemporal branch of the facial nerve and the relation between this branch and the surrounding anatomic landmarks. Based on our findings, we propose a Danger Zone and Safe Zones for preauricular interventions to avoid frontal branch injury. METHODS Twenty cadaveric half-heads, 10 freshly frozen and 10 embalmed, were dissected. The anatomy of the auriculotemporal nerve, facial nerve, and variations of its branching pattern in the preauricular region were investigated. RESULTS The mean [standard deviation] number of frontotemporal branches crossing the zygomatic arch was 2.05 [0.6]. Beginning from the X point at the apex of the intertragal notch, frontal branches ran over the zygomatic arch at a distance extending from 10 to 31 mm anterior to the tragus, which can be defined as the Danger Zone for frontal branches. Safe Zones A and B are triangular regions located behind and in front of the Danger Zone, respectively. CONCLUSIONS Mapping of these Safety and Danger Zones is a reliable and simple approach in preauricular interventions to avoid frontal branch injury because the facial nerve typically has multiple frontal branches. This approach provides practical information for surgeons rather than estimating the trajectory of a single frontal branch from Pitanuy's line.
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Affiliation(s)
- Arda Kucukguven
- Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara, Turkey
| | - Mehmet Ulkir
- Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Meric Bilgic Kucukguven
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | | | - Ibrahim Vargel
- Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara, Turkey
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Trussler AP. Commentary on: Basic Consideration for Facial Aging: Analyses of the Superficial Musculoaponeurotic System (SMAS) Based on Anatomy. Aesthet Surg J 2021; 41:NP124-NP126. [PMID: 33346338 DOI: 10.1093/asj/sjaa293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pankratz J, Baer J, Mayer C, Rana V, Stephens R, Segars L, Surek CC. Depth Transitions of the Frontal Branch of the Facial Nerve: Implications in SMAS rhytidectomy. JPRAS Open 2020; 26:101-108. [PMID: 33251317 PMCID: PMC7680882 DOI: 10.1016/j.jpra.2019.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022] Open
Abstract
Background Anatomy of the frontal branch of the facial nerve relative to the zygomatic arch and the superficial musculoaponeurotic system (SMAS) has been well described. The variability centers on the location where the frontal branch traverses from a deeper to more superficial plane in the SMAS. The goal of this study is to examine the depth transition of the frontal branch of the facial nerve relative to the zygomatic arch with hopes of pinpointing a caution zone for dissection to avoid nerve injury. Methods The frontal branch of the facial nerve was dissected in 36 hemifacial fresh cadaver specimens. Pitanguy's line, the zygomatic arch, and temporal crest were marked. Measurements were taken from the zygomatic arch to the location where the frontal branch pierced the temporoparietal fascia. Locations of the superficial temporal artery (STA), the frontal branch cross relative to the lateral orbital rim and frontalis muscle were also measured. Results In 94.4% (n = 36) of the specimens, the frontal branch was found to transition to an intra-SMAS plane approximately 9.6 mm above the zygomatic arch. In all specimens, the frontal branch transitioned to an intra-SMAS plane approximately 12.2 mm posterior to Pitanguy's line. Conclusions This study describes a surgical "caution zone" centered on a point 9.6 mm above the arch and 12.2 mm posterior to Pitanguy's line, and related to the anterior branch of the STA. We hope this anatomical detail will help to decrease the likelihood of intraoperative injury to the frontal branch of the facial nerve.
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Affiliation(s)
- Joseph Pankratz
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Jacob Baer
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Catherine Mayer
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Viren Rana
- Department of Anatomy, Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106 US
| | - Robert Stephens
- Professor of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106 US
| | - Larry Segars
- College of Biosciences, Kansas City University of Medicine and Biosciences, Kansas City, MO 64106 US
| | - Christopher C Surek
- Surek Plastic Surgery, Clinical Assistant Professor, Department of Plastic Surgery, University of Kansas Health System, Assistant Professor of Anatomy, Kansas City University of Medicine and Biosciences US
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Amano K, Naito M, Matsuo M. Morphological study of human facial fascia and subcutaneous tissue structure by region through SEM observation. Tissue Cell 2020; 67:101437. [PMID: 32942164 DOI: 10.1016/j.tice.2020.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/17/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Abstract
Fascia of the facial area is contiguous between fat tissues of the subcutaneous and connective tissue layers and does not envelope the muscle surface like other parts of the human body. This structure is called the superficial musculoaponeurotic system (SMAS), which is accepted as an international anatomical terminology. This special structure is commonly used to pull facial muscles during plastic surgeries such as a face lift. Most reports regarding the facial subcutaneous tissue structure including SMAS are in the field of plastic surgery, and only a few studies from a morphological perspective has been reported. Since the facial fascia does not envelope the muscular surface layer which is different from the deep fascia found on the general skeletal muscle surface, a clear definition of this structure has not been established yet. The purpose of this study was to clearly identify the basic morphological structure of the subcutaneous tissue layer containing the SMAS three-dimensionally through a scanning electron microscope using dissected specimen rather than living subjects. Moreover, this study explores structural differences among seven aging facial areas; thereby further clarifying the properties of the structure and add clinical significance and considerations.
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Affiliation(s)
- Kaori Amano
- Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan.
| | - Michiko Naito
- Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, 30-1 Oyaguchi, Kamicho, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Masato Matsuo
- Department of Oral Science, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan
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El-Rabbany M, Alhumaid J, Dalmao O, Cuddy K. Odontogenic necrotizing soft tissue infection of the scalp: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Quek SYP, Gomes-Zagury J, Subramanian G. Twin Block in Myogenous Orofacial Pain: Applied Anatomy, Technique Update, and Safety. Anesth Prog 2020; 67:103-106. [PMID: 32633773 DOI: 10.2344/anpr-67-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022] Open
Abstract
The twin block, introduced in 2014, has proven to be more advantageous for the management of myogenous orofacial pain than the masseteric nerve block, which was introduced in 2009. The twin block is an extraoral nerve block injection which passes through the temporal fossa to anesthetize both the masseteric and the deep temporal nerves as they exit the infratemporal fossa at the infratemporal crest. Similar to the masseteric nerve block, the twin block has demonstrated efficacy with expeditious and sustained relief of myogenous face pain originating from the masseter muscle. Furthermore, in a 6-month prospective treatment study, that has been accepted for publication, the twin block has been demonstrated as comparable to trigger point injections in the management of chronic myofascial pain of masseteric origin. The twin block's ability to mitigate myogenous pain from both the masseter and temporalis muscles and its ease of administration are the key advantages over the masseteric nerve block. Since its inception, we have refined the technique for administering the twin block and our clinical experience corroborates its safety and efficacy. This review describes the refined technique and its safety in the context of the region's applied anatomy.
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Affiliation(s)
- Samuel Y P Quek
- Professor, Rutgers School of Dental Medicine, Department of Diagnostic Sciences, Division of Oral Medicine, Rutgers School of Dental Medicine, Newark, New Jersey
| | - Julyana Gomes-Zagury
- Adjunct Professor, Rutgers School of Dental Medicine, Department of Diagnostic Sciences, Division of Orofacial Pain, Newark, New Jersey
| | - Gayathri Subramanian
- Assistant Professor, Rutgers School of Dental Medicine, Department of Diagnostic Sciences, Division of Oral Medicine, Newark, New Jersey
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Green Sanderson K, Conti A, Colussi M, Connolly C. A Simple Clinical Application for Locating the Frontotemporal Branch of the Facial Nerve Using the Zygomatic Arch and the Tragus. Aesthet Surg J 2020; 40:NP223-NP227. [PMID: 31254463 DOI: 10.1093/asj/sjz186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The seventh cranial nerve (CN VII), also known as the facial nerve, is an anatomically intricate structure the branches of which serve several physiologic functions. CN VII innervates the muscles of facial expression which are crucial for eye protection, oral competence, and social interaction. The temporal branch, clinically referred to as the frontotemporal branch (FTB), is the most superior of the 5 branches and is at risk during cutaneous surgery of the parotid gland and in the temporal region. Several methods for delineating the FTB trajectory exist, the most widely known being Pitanguy's Line, which is defined as running from 0.5 cm below the tragus to 1.5 cm above the lateral eyebrow. However, variations in eyebrow location, often affected by modern-day cosmetic trends, complicate the accuracy of this approach. OBJECTIVES The aim of this study was to develop a surgical landmark to identify FTB location without relying on soft tissue structures. METHODS To minimize variation, we chose landmarks that were both consistent and easy to locate based on simple surface anatomy. Twenty-one cadaver hemifaces were dissected in order to locate the FTB in relation to the inferior border of the zygomatic arch and the apex of the tragus. RESULTS We found that the mean ± SEM distance from the apex of the tragus to the point where the FTB crossed the inferior border of the zygomatic arch was 3.21 ± 0.05 cm. CONCLUSIONS Through the use of this measurement, we aim to avoid the pitfalls of previous techniques by providing a widely applicable clinical tool based on landmarks easily found on any patient. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Kit Green Sanderson
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alyssa Conti
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mariah Colussi
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cara Connolly
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Swanson E. Clinical Evaluation of 225 Sub-SMAS Facelifts with No Temporal Incision. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2640. [PMID: 32309087 PMCID: PMC7159970 DOI: 10.1097/gox.0000000000002640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite their name, "short scar" procedures leave scars in the temples and the postauricular scar often requires extension. Redraping the orbicularis muscle for periorbital rejuvenation increases the risk of facial nerve injury. This retrospective cohort study was undertaken to clinically evaluate a surgical approach that eliminates the temporal incision. METHODS A sub-superficial musculoaponeurotic system (SMAS) facelift was used, incorporating a triple-vector platysmaplasty and fat injection for periorbital rejuvenation. From 2009 to 2019, 225 consecutive outpatients underwent a sub-SMAS facelift with a triple-vector (superior, lateral, medial) platysmaplasty, either alone or in combination with fat injection, laser resurfacing, blepharoplasties, endoscopic forehead lift, and other cosmetic procedures. Release of the retaining ligaments optimized SMAS mobilization. A temporal incision was not used. Fat (mean volume 32 ml) was injected into the undissected subcutaneous tissue plane. The mean follow-up time was 28 months. RESULTS The most frequent complication was a neuropraxia (7.6%), usually affecting a frontal nerve branch, and always temporary. Two deep venous thromboses were detected by ultrasound surveillance. No significant correlation was detected between complications and age, sex, body mass index, smoking history, or a previous facelift. Sixteen patients (7%) returned for a secondary facelift (mean interval, 3.5 years). CONCLUSIONS A sub-SMAS facelift and triple-vector platysmaplasty with fat injection combine effective neckline rejuvenation with facial volume restoration. Avoiding a temporal incision eliminates a telltale scar. Orbicularis preservation avoids additional dissection, possibly reducing the risk of neuropraxia. Fat injection provides a net increase in facial volume. Long-term measurement studies are recommended.
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Hashem AM, Couto RA, Duraes EFR, Çakmakoğlu Ç, Swanson M, Surek C, Zins JE. Facelift Part I: History, Anatomy, and Clinical Assessment. Aesthet Surg J 2020; 40:1-18. [PMID: 30843042 DOI: 10.1093/asj/sjy326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, the authors aim to thoroughly describe the critical surgical anatomy of the facial layers, the retaining ligamentous attachments of the face, and the complex three-dimensional course of the pertinent nerves. This is supplemented with clarifying anatomic dissections and artwork figures whenever possible to enable easy, sound, and safe navigation during surgery. The historic milestones that led the evolution of cervicofacial rejuvenation to the art we know today are summarized at the beginning, and the pearls of the relevant facial analysis that permit accurate clinical judgment and hence individualized treatment strategies are highlighted at the end. The facelift operation remains the cornerstone of face and neck rejuvenation. Despite the emergence of numerous less invasive modalities, surgery continues to be the most powerful and more durable technique to modify facial appearance. All other procedures designed to ameliorate facial aging are either built around or serve as adjuncts to this formidable craft.
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | | | - Marco Swanson
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Chris Surek
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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Micucci SB, Cheng SS, Song T, Rasgon B. The Role of the Parotid-Mastoid Fascia in Identification of the Facial Nerve Trunk During Parotidectomy. EAR, NOSE & THROAT JOURNAL 2019; 100:504-508. [PMID: 31581824 DOI: 10.1177/0145561319877998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aim to describe the parotid fascia as a landmark that can help identify the immediately underlying facial nerve trunk. METHODS Dissection of the parotid fascia and identification of the facial nerve trunk were carried out on 8 fresh cadaveric parotid glands. The attachments and arrangement of the parotid gland and its fascia were evaluated and histologically assessed, with special attention to the fascia overlying the facial nerve trunk. RESULTS The parotid fascia envelops the posterior aspect of the parotid gland in an open-book fashion. Posteriorly, it connects to the anterior and medial aspect of the mastoid tip. Posterosuperiorly, it attaches to the inferior aspect of the tragal pointer. Directly medial to the fascia lies the facial nerve trunk. CONCLUSION The parotid fascia, particularly the parotid-mastoid segment overlying the facial nerve trunk, can be utilized as an additional landmark of depth to help identify the facial nerve trunk during a parotidectomy in conjunction with other commonly used standard anatomic landmarks. The parotid fascia sling spans from the mastoid and tragal pointer to the parotid gland and can be easily palpated intraoperatively. Once the fascia is removed, the facial nerve trunk is identified.
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Affiliation(s)
- Steven B Micucci
- Department of Head and Neck Surgery-Otolaryngology, 23537Kaiser Permanente Medical Center, Oakland, CA, USA
| | - Siri Sunderi Cheng
- 22837Contra Costa Health Services, Martinez Health Center, Martinez, CA, USA
| | - Tara Song
- Department of Head and Neck Surgery-Otolaryngology, 164194Kaiser Permanente Panorama City Medical Center, Panorama City, CA, USA
| | - Barry Rasgon
- Department of Head and Neck Surgery-Otolaryngology, 23537Kaiser Permanente Medical Center, Oakland, CA, USA
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Kim YS, Lee KW, Kim JS, Gil YC, Tanvaa T, Shin DH, Kim HJ. Regional thickness of facial skin and superficial fat: Application to the minimally invasive procedures. Clin Anat 2019; 32:1008-1018. [PMID: 30629772 DOI: 10.1002/ca.23331] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Abstract
Various recently introduced minimally invasive treatment modalities are now widely used for enhancing the aging face. In a special, filler is used to increase the volume of tissue, and so understanding the regional thickness and distribution of the facial superficial fat is essential for optimizing minimally invasive procedures. The aim of this study was to establish the overall facial skin and superficial fat thicknesses using a three-dimensional (3D) scanning system. From 53 adult Korean and Thai embalmed adult cadavers, the undissected and serially-dissected facial specimens were scanned and reconstructed. The facial skin and superficial fat thicknesses on seven facial regions were calculated from the superimposed images. The facial skin tended to become thicker in the order of the radix and dorsum, and the temple, supraorbital, forehead, perioral, cheek, and infraorbital areas. The skin was thinnest at radix and dorsum (1.51 ± 0.55 mm), and thickest in infraorbital region (1.97 ± 0.84 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The superficial fat was thinnest at the radix and dorsum (1.61 ± 1.07 mm), and thickest in the perioral region (5.14 ± 3.31 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The present findings indicate that 3D scanning system can yield crucial anatomical information about depths of the facial skin and superficial fat layers for utilization in various clinical procedures. Clin. Anat. 32:1008-1018, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- You-Soo Kim
- Department of Anatomy, Institute of Forensic Science, Seoul National University College of Medicine, Seoul, South Korea.,YSBio Co. Ltd., Seoul, South Korea
| | - Kang-Woo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Soo Kim
- YSBio Co. Ltd., Seoul, South Korea.,Dr. Youth Clinic, Seoul, South Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University School of Medicine, Cheongju, South Korea
| | - Tansatit Tanvaa
- Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dong Hoon Shin
- Department of Anatomy, Institute of Forensic Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Materials Science & Engineering, College of Engineering, Yonsei University Seoul, Seoul, South Korea
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The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle. Aesthetic Plast Surg 2018; 42:471-478. [PMID: 29302733 DOI: 10.1007/s00266-017-1056-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM. METHODS One hundred twenty-one Asian patients underwent this facelift procedure. Of those, the distances between the posterior margin of tragus and the lateral margin of the OOM and the center of the origin of the ZMM were measured in 20 patients. RESULTS The mean age of the initial 121 patients was 50.9 years. In all cases, improvement was seen in soft tissue sagging of the midface and lower face. There was no functional impairment of the OOM. In 20 patients of them, the lateral margin of the OOM and the center of the origin of the ZMM were located at mean distances of 50.6 (range 48-53 mm) and 61.0 mm (range 60-65 mm) from the posterior margin of the tragus. CONCLUSIONS The SMAS flap with the OOM is sufficiently strong enough so that it can maintain the pulling force and also helps to securely fix it. The authors hope that these anatomical findings would be useful when performing it and aid in the understanding of the relationship between the muscles in the malar area. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses. J Craniofac Surg 2017; 28:2151-2154. [DOI: 10.1097/scs.0000000000003975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The temporal region has imprecise limits in the young patient. During the aging process, it becomes individualized with the appearance of a temporal fossa, the temporal, orbital and zygomatic bone margins, the ptosis of the lateral part of the brow and the appearance of the wrinkles of the crow's foot. As this area frame the look, it should be taken into consideration during the clinical examination as well as the facial and cervical stages. The rejuvenation techniques are numerous, nuanced and gradual. As long as the eyebrow ptosis is not evident and the distance of the eyebrows unaltered, the volumizing techniques and the botulinum toxin can respond effectively and harmoniously to the patients' demand. Then the surgical techniques of temporal and brow liftings must be considered and coupled with the techniques of lipostructure that are more and more practiced. It should be noted that the demand for temporal rejuvenation is increasing and precedes the demand of cervicofacial rejuvenation. This underlines the importance of this region both in terms of preventing or at least slowing down the process than in terms of curing the stigma of aging.
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Meybodi AT, Lawton MT, El-Sayed I, Davies J, Tabani H, Feng X, Benet A. The Infrazygomatic Segment of the Superficial Temporal Artery: Anatomy and Technique for Harvesting a Better Interposition Graft. Oper Neurosurg (Hagerstown) 2017; 13:517-521. [PMID: 28838108 DOI: 10.1093/ons/opx013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 01/14/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The superficial temporal artery (STA) is underutilized as an interposition graft because current techniques expose and harvest STA above the level of the zygoma. This technique yields a diminutive arterial segment in both length and diameter, which limits its use for extracranial-intracranial bypass. OBJECTIVE To introduce a safe and efficient technique for harvesting of the infrazygomatic segment of the STA. METHODS Scalp layers, STA, and the facial nerve were studied in 18 specimens. The length of the STA segment harvested below the superior border of the zygomatic arch was measured. Safety of this technique was assessed by measuring the distance between the facial nerve and the STA. RESULTS The galea and subgaleal fat pad were the only anatomical planes found between the facial nerve and the STA below the zygomatic arch. A dense subcutaneous band of galea contained the STA and allowed proximal dissection of the artery without exposing the facial nerve. The average length of the artery harvested between the zygomatic arch and the parotid gland was 20 mm. CONCLUSION Subcutaneous dissection within the galea below the level of the zygomatic arch and preservation of the dense subcutaneous band surrounding the STA avoids transecting the facial nerve branches while providing increased STA exposure. This anatomical knowledge may increase the use of STA as an interposition graft in cerebrovascular bypass procedures and reduce the need to harvest grafts through additional incisions at remote sites.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California
| | - Ivan El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California.,Department of Otolaryngology and Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Jason Davies
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Halima Tabani
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California
| | - Xuequan Feng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California
| | - Arnau Benet
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California
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The Deep Temporal Nerve Transfer: An Anatomical Feasibility Study and Implications for Upper Facial Reanimation. Plast Reconstr Surg 2017; 138:498e-505e. [PMID: 27556625 DOI: 10.1097/prs.0000000000002482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial paralysis has a profound impact on the brow, and currently static procedures are the mainstay of treatment. The deep temporal branches of the trigeminal nerve, given their proximity to the brow, may serve as possible donor nerves for both potential innervation of a free muscle transfer in patients with prolonged facial palsy or nerve transfers in acute or subacute palsy. As such, the authors present the detailed surgical anatomy of the deep temporal nerve, assessing feasibility for both functional muscle and nerve transfers, including a proposed surgical technique. METHODS Thirty cadaver hemifaces were dissected to establish deep temporal nerve anatomy and perform axonal analysis. RESULTS Two (53 percent) or three (47 percent) divisions of the deep temporal nerve were noted, with the most consistent division being the middle division (30 of 30 specimens). This division was consistently found approximately 4.1 cm (range, 3.7 to 4.5 cm) anterior to the tragus at the level of the zygomatic arch. For each 1 cm cranial to the arch, the nerve courses approximately 1 mm posteriorly. The number of axons in the proposed temporal branch is 1469 as it emerges from behind the zygomatic arch, 889 at 1 cm, 682 at 2 cm, 534 at 3 cm, 355 at 4 cm, 377 at 5 cm, and 256 at 6 cm. CONCLUSION Given its anatomical consistency, and expendability, the middle division of the deep temporal nerve is a viable donor nerve for dynamic upper facial reanimation with either nerve transfer or functional muscle transfer, depending on the length of facial palsy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Aesthetic Eyebrow Reconstruction with an Expanded Scalp Island Flap Pedicled by the Superficial Temporal Artery. Aesthetic Plast Surg 2017; 41:563-567. [PMID: 28280893 DOI: 10.1007/s00266-016-0736-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This case study demonstrates a new operative method of eyebrow reconstruction, in which the hair density of the reconstructed eyebrow is controlled by the surgeon and is more similar to that of the uninjured side, resulting in a more natural facial expression and greater aesthetic value for our patients. MATERIALS AND METHODS The operation was divided into two stages: Stage 1: Implantation of a soft tissue expander into the corresponding subgaleal position of the parietal branch of the superficial temporal artery on the injured side, followed by dilation of the expander until the density of the hair on the expanded scalp reached a suitable value and was lower than that of the uninjured eyebrow. Stage 2: Harvesting of the scalp island flap pedicled by the superficial temporal artery, the end of which was attached to the expanded scalp, followed by the downward movement of the flap to the defect site of the eyebrow via a subcutaneous tunnel, resulting in new eyebrow formation. RESULTS In eight cases who were monitored for 4-16 months of follow-up, almost all of the reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations; the transplanted hairs were highly similar to those of the original eyebrows. All participants remained healthy after the operation, which was indicated by sufficient blood supply to the expanded flap and normal growth of a new eyebrow without postoperative complications. CONCLUSION Our study demonstrated the excellent performance of an innovative procedure in which a expanded scalp island flap pedicled by the superficial temporal artery was used in the construction of a new eyebrow. It can be performed very safely and reliably to ensure expected results. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Kang HG, Youn KH, Kim IB, Nam YS. Bilayered Structure of the Superficial Facial Fascia. Aesthet Surg J 2017; 37:627-636. [PMID: 28333197 DOI: 10.1093/asj/sjx001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The superficial facial fascia comprises the superficial musculoaponeurotic system (SMAS) and the temporoparietal fascia (TPF) and is regarded as a continuous monolayer. However, some evidence indicates that the superficial facial fascia consists of 2 layers in specific areas. Objectives The authors evaluated the superficial facial fascia for bilayered regions. Methods Twenty fresh cadavers (40 hemifaces) were dissected to observe the superficial facial fascia. Twelve cadavers were dissected to assess tensile strengths of the superficial and deep layers of the SMAS. Specimens were obtained from 2 cadavers for histologic analysis. Results The SMAS and TPF were separable into superficial and deep layers, with intervening areolar tissue. The deep TPF was continuous with the deep SMAS inferiorly and the subgalea anteriorly. The superficial orbicularis oculi was invested by the superficial SMAS, whereas the deep orbicularis and the platysma were invested by the deep SMAS. Thus, 2 key structures addressed in facial rejuvenation are positioned in different surgical planes. Conclusions Study results support the belief that the superficial facial fascia comprises 2 layers, with the superficial orbicularis oculi and platysma invested by different layers. These findings have implications for facial rejuvenation techniques that involve management of the SMAS and TPF.
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Affiliation(s)
- Hyun Gu Kang
- Department of Plastic and Reconstructive Surgery, Naju Community Health Center, Naju, South Korea
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwan-Hyun Youn
- Division in Biomedical Art, Department of Visual Arts, Incheon Catholic University Graduate School, Incheon, South Korea
| | - In-Beom Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea
| | - Yong Seok Nam
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea
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Yanan W, Yanli H, Dilxat D, Weilong L, Hui L, Yi W, Lei L. [Complications of supratemporalis approach with scalp coronal incision for orbital-zygomatic fracture]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2017; 35:73-76. [PMID: 28326731 DOI: 10.7518/hxkq.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to examine the complications of supratemporalis approach with scalp coronal incision for the treatment of orbital-zygomatic fractures. METHODS A total of 206 patients with orbital-zygomatic fractures were treated with scalp coronal incision through the supratemporalis approach. The effects and complications of the treatment were analyzed. RESULTS The degree of fracture of the 206 patients was successfully reduced. The facial morphologies and functions were improved. No facial nerve injury was observed in all of the cases. However, the following complications were noted: fossa introcession in 1 case, forehead scalp pain or paresthesia in 11 cases, incision infection in 1 case, subcutaneous hematoma in 1 case, incision scar in 5 cases, and alopecia in 3 cases. CONCLUSIONS The supratemporalis approach prevents facial nerve injury and does not increase the frequency of other complications. Therefore, this approach can be applied as a routine and safe procedure in clinical settings.
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Affiliation(s)
- Wang Yanan
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;Dept. of Stomatology, The Third People's Hospital of Shizuishan, Shizuishan 753400, China
| | - Huang Yanli
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;The Third Affiliated Hospital, Xinxiang Medical College, Xinxiang 453000, China
| | - Dilnur Dilxat
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liu Weilong
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li Hui
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wang Yi
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liu Lei
- State Key Laboratory of Oral Diseases, Dept. of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Postoperative temporal hollowing: Is there a surgical approach that prevents this complication? A systematic review and anatomic illustration. J Plast Reconstr Aesthet Surg 2016; 70:401-415. [PMID: 27894915 DOI: 10.1016/j.bjps.2016.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Temporal hollowing is a common complication following surgical dissection in the temporal region. Our objectives were to: (1) review and clarify the temporal soft tissue relationships - supplemented by cadaveric dissection - to better understand surgical approach variations and elucidate potential etiologies of postoperative hollowing; (2) identify if there is any evidence to support a surgical approach that prevents hollowing through a systematic review. METHODS Cadaveric dissection was performed on six hemi-heads. A systematic review of the literature was undertaken to identify surgical approaches with a decreased risk of postoperative hollowing. RESULTS A total of 1212 articles were reviewed; 19 of these met final inclusion criteria. Level I and II evidence supports against the use of a dissection plane beneath the superficial layer of the deep temporal fascia or through the intermediate temporal fat pad. Level II evidence supports preservation of the temporalis muscle origin - no evidence is available to support other temporalis resuspension techniques. For intracranial exposure, refraining from temporal fat pad dissection (Level I Evidence) and use of decreased access approaches such as the minipterional craniotomy (Level I Evidence) appear to minimize temporal soft tissue atrophy. CONCLUSIONS This study highlights the significance of preservation of the temporal soft tissue components to prevent hollowing. Preserving the temporalis origin and avoiding dissection between the leaflets of the deep temporal fascia or through the intermediate temporal fat pad appear to minimize this complication.
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Reduction malarplasty using a zygomatic arch-lifting technique. J Plast Reconstr Aesthet Surg 2016; 69:809-818. [DOI: 10.1016/j.bjps.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 11/22/2022]
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Abstract
Periorbital rejuvenation requires a careful understanding of the interplay between the eyelids, brow, forehead, and midface. Reversing periorbital signs of aging requires a correction of volume loss, soft tissue ptosis, and skin changes. Many surgical and nonsurgical techniques exist to treat the aging periorbital region; however, careful consideration of the patient's complaints and existing anatomy is critical to achieving a safe and esthetically pleasing outcome.
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Affiliation(s)
- John J Chi
- Division of Facial Plastic & Reconstructive Surgery, Washington University Facial Plastic Surgery Center, Washington University in St. Louis-School of Medicine, 1020 North Mason Road, Medical Building 3, Suite 205, St Louis, MO 63141, USA.
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Mendelson BC, Farhadieh RD. Facelift. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wong CH, Mendelson BC. Facial anatomy and ageing. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ryu MH, Moon VA. High superficial musculoaponeurotic system facelift with finger-assisted facial spaces dissection for Asian patients. Aesthet Surg J 2015; 35:1-8. [PMID: 25568228 DOI: 10.1093/asj/sju021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few facelift methods are designed specifically for Asian patients. Because of their characteristic thick skin and flat, wide facial geometry, satisfactory facelift results can be difficult to achieve in these patients. OBJECTIVES The authors evaluated outcomes achieved with a high superficial musculoaponeurotic system (high-SMAS) facelift with finger-assisted facial spaces dissection to rejuvenate the aging Asian face. METHODS Fifty-three patients underwent this facelift procedure. The indication for surgery was typical sagging of the face associated with aging; the relative contraindications were previous facelift and severe facial atrophy. RESULTS Mean patient age was 50.7 years. Patients received follow-up for a mean of 19 months. In all cases, improvement was seen in soft-tissue sagging of the midface and lower face. One patient experienced unilateral temporal nerve injury, 3 experienced hematoma, and 2 had wound dehiscence. CONCLUSIONS Understanding surgical anatomy including facial layers, spaces, and retaining ligaments is crucial for stable application of facelift techniques in Asian patients. Because of the small number of patients evaluated in this study and the limited follow-up period, more research is needed to define suitable facelift methods for these patients.
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Affiliation(s)
- Min-Hee Ryu
- Dr Ryu is a plastic surgeon in private practice in Seoul, South Korea. Dr Moon is an assistant professor, Division of Plastic, Reconstructive and Hand Surgery, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, New York
| | - Victor A Moon
- Dr Ryu is a plastic surgeon in private practice in Seoul, South Korea. Dr Moon is an assistant professor, Division of Plastic, Reconstructive and Hand Surgery, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York, New York
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de Bonnecaze G, Chaput B, Filleron T, Al Hawat A, Vergez S, Chaynes P. The frontal branch of the facial nerve: can we define a safety zone? Surg Radiol Anat 2014; 37:499-506. [DOI: 10.1007/s00276-014-1386-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/10/2014] [Indexed: 11/28/2022]
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Development of the platysma muscle and the superficial musculoaponeurotic system (human specimens at 8-17 weeks of development). ScientificWorldJournal 2013; 2013:716962. [PMID: 24396304 PMCID: PMC3874947 DOI: 10.1155/2013/716962] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/19/2013] [Indexed: 11/26/2022] Open
Abstract
There is controversy regarding the description of the different regions of the face of the superficial musculoaponeurotic system (SMAS) and its relationship with the superficial mimetic muscles. The purpose of this study is to analyze the development of the platysma muscle and the SMAS in human specimens at 8–17 weeks of development using an optical microscope. Furthermore, we propose to study the relationship of the anlage of the SMAS and the neighbouring superficial mimetic muscles. The facial musculature derives from the mesenchyme of the second arch and migrates towards the different regions of the face while forming premuscular laminae. During the 8th week of development, the cervical, infraorbital, mandibular, and temporal laminae are observed to be on the same plane. The platysma muscle derives from the cervical lamina and its mandibular extension enclosing the lower part of the parotid region and the cheek, while the SMAS derives from the upper region. During the period of development analyzed in this study, we have observed no continuity between the anlage of the SMAS and that of the superficial layer of the temporal fascia and the zygomaticus major muscle. Nor have we observed any structure similar to the SMAS in the labial region.
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Alghoul M, Codner MA. Retaining ligaments of the face: review of anatomy and clinical applications. Aesthet Surg J 2013; 33:769-82. [PMID: 23855010 DOI: 10.1177/1090820x13495405] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The retaining ligaments of the face are important in understanding concepts of facial aging and rejuvenation. They are located in constant anatomic locations where they separate facial spaces and compartments. Their superficial extensions form subcutaneous septa that separate facial fat compartments. Their main significance relates to their surgical release in order to achieve the desired aesthetic outcome. Furthermore, they have a sentinel role in their anatomic relationship to facial nerve branches. When performing facial aesthetic surgery, plastic surgeons should select a plane of dissection, release the appropriate ligaments depending on the desired aesthetic goals, and avoid nerve injury by using the ligaments as anatomic landmarks. Descriptions of the retaining ligaments are variable in the literature; due to different interpretations of anatomy, several classifications, locations, and nomenclature systems have been proposed. This article will review and clarify the anatomy of the retaining ligaments of the face, including the cheek, mandible, temporal, and periorbital areas.
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Affiliation(s)
- Mohammed Alghoul
- Division of Plastic Surgery at Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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New Perspectives on the Surgical Anatomy and Nomenclature of the Temporal Region. Plast Reconstr Surg 2013; 131:510-522. [DOI: 10.1097/prs.0b013e31827c6ed6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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