Basic Consideration for Facial Aging: Analyses of the Superficial Musculoaponeurotic System Based on Anatomy

Abstract

Background The superficial musucloaponeurotic system (SMAS) is an important structure to understand for face-lift surgeries. However, the detailed distribution and imaging findings of the SMAS have not been established yet. Objectives The aim of this study is to establish the accurate distribution and CT imaging findings of the SMAS based on cadaveric studies. Methods This study was designed in a three-step procedure. First: Seven cadaver faces were used to understand the distribution and histology of the SMAS. Second: The SMAS’s findings from the cadaveric studies were compared to the CT images. Third: CT images were enrolled for the SMAS interpretation. Results In seven cadaveric studies, the SMAS was observed as a subcutaneous fibro-membranous structure extending from the galea aponeurotica to the platysma muscle, and laterally connected to the parotid fascia. On the medial side, it also connects with major and minor zygomatic muscles. The SMAS consisted of muscular fibers, collagen fibers and elastic fibers, histologically. Eighteen CT images (all females; age range, 21-82 years) showed the thin linear structures corresponding to the fibro-membranous structures in the cadaveric studies. CT density of the SMAS was similar with the muscle’s, and the SMAS was able to be recognized in all 18 subjects. Conclusions The SMAS is a definite anatomical structure that can be demonstrated as a thin membranous structure on CT. This clinical application could be applicable to the development the cosmetic surgical procedures.

Objective analysis of the effectiveness of facial massage using breakthrough computed tomographic technology: A preliminary pilot study

“…One of the advantages of the workstation is that the same point can be precisely indicated on 3DCT and all multiplanar reformatted axial and sagittal images by utilizing spiral CT coordinates. Moreover, in addition to the facial 3D state, the anatomical relationship between the facial appearance and the subcutaneous structures can be accurately displayed with this approach 7,8,11 . A further innovation of our study was to use stationary facial bones, which were not changed by massage, as the landmarks for creating images for comparison before and after facial massage.…”

“…As shown in Figure 4, the SMAS is the fascia sandwiched between the superficial and deep layers of the adipose tissue, and is recognized as a linear structure on CT. 7,8 On reconstructed axial CT images, the widest horizontal distance between the right and left margins of the SMAS cheek at the same level as that used for the pre-massage evaluation was created using the stationary facial bone as the basis for measurements, and the post-massage cheek thickness was measured using the same method as that used for the pre-facial massage measurement. Change rate of the cheek thickness (%) = (cheek thickness post-massage/cheek thickness pre-massage) × 100 was defined as the SMAS-width (Figure 4A).…”

“…Highly accurate and detailed three‐dimensional (3D) CT images can be constructed using advanced spiral CT known as the multidetector‐row CT (MDCT) technique for capturing high‐resolution images and a workstation for processing and analyzing a large volume of images 7–9 . Moreover, spiral CT examination is a highly objective examination.…”

Anatomic and diagnostic considerations of facial mobility for understanding the effectiveness of facial massage: A pilot study

“…In particular, multidetector row CT scan data can easily display stereoscopic anatomical information of the face by creating detailed 3-D CT images. 3,11,[14][15][16] Furthermore, upright CT has also been developed recently, which can scan patients in the upright position. 17,18 This upright CT technology has profound significance in obtaining anatomical information from the living body with vector information in downward gravity.…”

Planning of methods of surgical correction of soft tissues of the face and neck

“…нической ситуации. Вместе с тем, основываясь на анатомических исследованиях, является очевидным, что необходима дифференциация анатомических структур деформаций мягких тканей в области лица и шеи[12].N.V. Alfen и cоавт.…”