Novel Clinical Anatomic Consideration of the Superficial and Deep Layers of the Deep Temporal Fascia

Abstract

he deep temporal fascia (DTF) is a dense aponeurotic layer that covers the temporalis muscle, which is found on the lateral side of the head. 1 It originates from the superior temporal line and descends as a single layer. Approximately at the level of the superior orbital rim, the DTF is divided into superficial and deep layers reaching the lateral and medial borders of the upper surface of the zygomatic arch, respectively. 1,2 Clinically, the DTF provides anchoring during thread lifting, which is a minimally invasive face-lifting procedure. [3][4][5] Surgical midface-and forehead-lifting procedures assisted by endoscopy are usually performed through dual-plane or whole-layer lifting. 6 However, for many surgeons, the anatomy of the perizygomatic arch remains unclear and challenging; most surgeons perform only a subcutaneous layer thread lift. 6 The invasive face-lift procedure has advantages such as the quality and longevity of improvement 7 ; however, it has several potential complications, such as a long postoperative recovery time, scarring, and hematoma. 8,9 Thus, minimally invasive facial rejuvenation Background: The deep temporal fascia provides anchoring during thread lifting, which is a minimally invasive face-lifting procedure. However, anatomical studies involving the deep temporal fascia in addition to effective and safe thread-lifting procedures are scarce. The authors clarified the anatomy of the superficial layer of the deep temporal fascia and its surrounding structure using ultrasonography, histologic sections, and cadaveric dissection to propose an effective thread-lifting procedure guideline. Methods: The authors included 20 healthy young participants from the Republic of Korea. Real-time, two-dimensional, B-mode ultrasonography was performed. Longitudinal scanning was performed along three vertical lines: the line passing through the jugale, the anterior margin of the condylar process of the mandible, and the midpoint between the jugale and anterior margin of the condylar process. Histologic samples from three fresh adult cadavers were harvested from 2.5 cm above and below the zygomatic arch. Eighteen fresh adult hemifaces of cadavers from the Republic of Korea (six men and three women, aged 67.3 ± 7.2 years) were used to confirm the morphology of the deep temporal fascia. Results: The superficial layer of the deep temporal fascia crossed the zygomatic arch and was connected to the origin of the zygomaticus major muscle at the line passing through the jugale. The superficial layer continued inferiorly to the parotidomasseteric fascia at the line passing through the midpoint and condylar process of the mandible. Conclusion:This study yielded the novel anatomy of the superficial layer of the deep temporal fascia, and this anatomical structure may be used for an ideal thread-lifting procedure.

Skin & SMAS layer remodeling technique (SSRT): Achieving both volume and lifting effects with filler treatments

“…Interestingly, a cadaver study illustrated that, when supine, the areas anterior to the ears and along the jawline exhibit increased tautness and definition, avoiding the accumulation of loose tissues that could otherwise create a bulging appearance along the lower facial contours (Figure 4). 25–27 …”

Development and growth of the temporal fascia: a histological study using human fetuses

“…In a morphometrical and histological study, Morales-Avalos et al [ 6 ] demonstrated the advantages of the DLTF for graft use in terms of its fiber arrangement. Surprisingly, in living humans, an excellent ultrasound technique is able to demonstrate details of the multilaminar STFL and its individual variation [ 7 ].…”