Histological, SEM and three-dimensional analysis of the midfacial SMAS — New morphological insights

Sandulescu, T.; Buechner, Howard A.; Rauscher, D.; Naumova, Ella A.; Arnold, Wolfgang H.

doi:10.1016/j.aanat.2018.11.004

Cited by 29 publications

(26 citation statements)

References 30 publications

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“…Previous studies investigated the phenotype of the NLF, describing its shape and angle, which could be concave, straight, or convex (Rubin et al ; Zufferey ; Pessa et al ). Our most recent published study analyzed the three‐dimensional aspect of the SMAS bordering the NLF and concluded, similar to the results of the present study, that the NLF defined the transition area between two SMAS morphologies: Type I in the cheek area and Type II in the perioral area (Sandulescu et al , , ). Furthermore, in the present study, there were no morphological differences in SMAS architecture between the straight and convex NLF phenotypes as described by Pessa and colleagues (Pessa et al ).…”

Section: Discussionsupporting

confidence: 87%

“…Analysis of the subcutaneous tissue demonstrated three different SMAS morphological types: Type I in the cheek and forehead region, Type II in the perioral region medial to the NLF and MF, and Type III covering the upper and lower eyelid regions caudal to the UEF and cranial to the IOF. The existence of Type I SMAS covering the perioral region and Type II SMAS covering the midfacial and the forehead areas was demonstrated in early studies by Ghassemi et al () and corroborated by our latest studies (Ghassemi et al ; Sandulescu et al , , ). A previous study described Type III SMAS in the lower eyelid area cranial to the IOF (Sandulescu et al ).…”

Section: Discussionsupporting

confidence: 78%

“…The NLF is macroscopically situated on the cheek region starting from the tip of the ala of the nose and ending at the corner of the mouth, marking the transition to the perioral area (Lemperle et al ;Sandulescu et al , , ). As one of the most investigated facial folds, the NLF was mentioned in earlier studies under various labels such as “melolabial fold” (Bagal et al ; Gassner et al ) or “nasomandibular fold” (Robbins et al ).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, there are various interchangeable terms for wrin, including “wrinkle,” “crease,” “furrow,” “line,” and “fold,” describing the same cutaneous formations (Mallouris et al ; Hadi and Wilkinson ). Recent studies have demonstrated that the superficial musculoaponeurotic system (SMAS) defined a subcutaneous spreading musculoaponeurotic‐adipose layer covering the face with regional morphological differences probably related to nasolabial fold (NLF) development (Sandulescu et al , , ). Despite these histomorphological findings, the lack of uniform terminology has caused three different nomenclatures, “naso‐labial crease,” “naso‐labial groove,” and “naso‐labial fold,” to be used for the area marking the border between the cheek and the perioral area (Dunn and Harrison ; Hadi and Wilkinson ; Sandulescu et al , , ).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the lack of set nomenclature and the inconsistent application of the various terms leads to misinterpretation (Dunn and Harrison ). Therefore, as with SMAS description, a standardized facial crease nomenclature is necessary for effective scientific communications among clinicians, the scholarly community and researchers (Ghassemi et al ; Hadi and Wilkinson ; Sandulescu et al , , ).…”

Section: Introductionmentioning

confidence: 99%

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Facial fold and crease development: A new morphological approach and classification

et al. 2019

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Facial folds and creases are established descriptive anatomical terms for structures of which the morphological characteristics and origins are not clearly defined. The aim of this study was to perform a morphological investigation of the nasolabial fold (NLF), mandibular fold (MF), deep transverse forehead (DTFC), infraorbital fold (IOF) and upper eyelid fold (UEF), correlating their phenotypes to differences in the superficial musculoaponeurotic system (SMAS), noting morphological differences and similarities. Full-graft tissue blocks of skin, subcutaneous tissue, and mimic muscles collected postmortem were studied histologically. Serial histological sections were stained with Azan. Location-and composition-specific morphological differences were determined. Histological serial section digitalization and threedimensional reconstruction of the tissue blocks were performed. Three different types of SMAS architecture were identified. Type I SMAS consisted of parallelaligned fibrous septa connecting the mimic muscles to the skin that covered the cheek, infraorbital and supraorbital, and forehead areas. Type II SMAS morphology appeared as a condensed Type I SMAS architecture with stronger fibrous septa and smaller fatty tissue compartments covering the lower and upper lip areas. Type III SMAS consisted of loose connective tissue covering the lower and upper eyelid regions. NLF, MF, IOF, and UEF are habitual primary folds induced by morphological changes in the underlying SMAS architecture. The secondary, accidental creases (DTFC) are cutaneous depressions derived from interacting dermal-skeletalmuscular changes without SMAS structure changes. The upper and lower eyelid wrinkles were tertiary, age-related undulating skin redundancy formations. Clin. Anat. 32:573-584, 2019.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Facial fold and crease development: A new morphological approach and classification

et al. 2019

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Three sublayers in the SMAS: Observations of facial soft tissue using the stretched tissue dissection method focusing on the SMAS

et al. 2022

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The characteristics of the superficial musculoaponeurotic system (SMAS), including the morphology of each part and the connection between tissues, remain controversial. The purpose of this study is to clarify the anatomy of the SMAS using our new dissection method. In this study, six hemi-sides of heads from formalin-preserved cadavers were used. Three were used for creating a horizontal section and three were used for creating the section along the axial line perpendicular to the surface of the skin, resulting in a gradual change from the coronal section at the lateral to the sagittal section at the median. The resected head was cut into slices with widths of 7 mm. The stretched tissue dissection method was performed by fixing a tissue slice to a board and pulling the skin outward to stretch the soft tissue. Blunt dissection was then performed under a microscope. The SMAS comprises three layers: superficial, intermediate, and deep. The superficial layer is a thin membrane directly connecting to the septa in the subcutaneous fat. The deep layer is the connective tissue in contact with the sub-SMAS structure. The layer surrounded by the superficial and deep layer of the SMAS is the intermediate layer, containing connective tissue, adipose tissue, and facial muscles. The detailed findings of the SMAS obtained using this method resolve theoretical discrepancies and provide important insight for the field of facial surgery.

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Funktionelle Morphologie der Gesichtshaut

Arnold

Sandulescu

2019

MKG-Chirurg

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Die gesamte Körperoberfläche wird von der Haut bedeckt, wobei sich deren Struktur regionen-, alters-und geschlechtsspezifisch unterscheidet und nach der Funktion richtet. Die Kenntnis der strukturellen und funktionellen Unterschiede ist im klinischen Alltag für die Narbenbildung während der Wundheilung und somit für das ästhetische Ergebnis entscheidend. Die allgemeinen Funktionen der Haut sind 4 Schutz vor mechanischen, chemischtoxischen, thermischen und mikrobi

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Histological, SEM and three-dimensional analysis of the midfacial SMAS — New morphological insights

Cited by 29 publications

References 30 publications

Facial fold and crease development: A new morphological approach and classification

Facial fold and crease development: A new morphological approach and classification

Three sublayers in the SMAS: Observations of facial soft tissue using the stretched tissue dissection method focusing on the SMAS

Funktionelle Morphologie der Gesichtshaut

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