The Anatomy of the Skin and Fascial Layers of the Face in Aesthetic Surgery

Ruess, William; Owsley, John Q.

doi:10.1016/s0094-1298(20)31494-2

Cited by 38 publications

(11 citation statements)

References 9 publications

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“…The majority of studies concerning this fascia have done so in the context of facelift surgery and focus primarily on the parotid fascia, as it approximates the superficial musculoaponeurotic system (SMAS) layer, rather than its relationship with the facial nerve trunk. 6,[12][13][14][15][16] The findings in these studies have been varied. In 1976, Mitz and Peyronie first described the parotid fascia as discrete and deep to the SMAS.…”

Section: Discussionmentioning

confidence: 99%

“…The parotid fascia refers to the investing layer or superficial layer of the deep cervical fascia of the neck that envelops the parotid gland. 6 It covers both the deep and the superficial part of the gland. The superficial layer of the deep cervical fascia divides posterior to the angle of the mandible and anterior to the sternocleidomastoid muscle to form a capsule around the parotid gland.…”

Section: Introductionmentioning

confidence: 99%

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The Role of the Parotid-Mastoid Fascia in Identification of the Facial Nerve Trunk During Parotidectomy

et al. 2019

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of the Parotid-Mastoid Fascia in Identification of the Facial Nerve Trunk During Parotidectomy

et al. 2019

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“…In the subcutaneous layer, the adipose tissue (fat lobules) is divided by multiple fibrous septae (retinacula cutis) running from the SMAS to the overlying dermis. These interlacing septae (39,40,43,45,46,55,56) are often perpendicular to the skin (as in the cheek area), but are sometimes oblique or parallel to it (as in the parotid area). This fibroadipose organization of the subcutis is found in most of the face and neck regions.…”

Section: Part 1: the Theory -Analysis Of Facial Tissue Mobility Anatomentioning

confidence: 99%

“…The most common type of separation is by an areolar plane. This areolar plane (43)(44)(45)55,56), composed of a network of celluloadipose tissue, exists in areas such as the cheek (between the SMAS and the parotidomassetric fascia overlying the masseter muscle, and between the SMAS and the fat pad, or corpus adiposum buccae) and in the region of the neck (between the platysma and the underlying strap muscles).…”

Section: Part 1: the Theory -Analysis Of Facial Tissue Mobility Anatomentioning

confidence: 99%

“…In the case of the subskin layer, this network is made of dense fibrous septae (39,40,43,45,46,55,56), mostly perpendicular to the skin, which connect it to the SMAS. In the case of the sub-SMAS layer, this network is composed of a much looser areolar tissue (43)(44)(45)55,56) connecting the SMAS to the deep structures. In Figure 1A, for practicality and simplicity purposes, the septae of the subplanes are schematically represented by vertical lines to better demonstrate their dynamics.…”

Section: Part 1: the Theory -Analysis Of Facial Tissue Mobility Anatomentioning

confidence: 99%

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‘Optimum Mobility’ Facelift. Part 1 – the Theory

Fanous

2006

Canadian Journal of Plastic Surgery

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Traditional rhytidectomy techniques, such as the cutaneous lift, the superficial musculoaponeurotic system lift, the deep plane lift and the subperiosteal lift, are mostly differentiated by their different planes of dissection. As well, many of these techniques consider the complete mobilization of tissues a prerequisite for obtaining a satisfactory result.However, is it true that the result of a rhytidectomy is linked to the choice of the dissection plane? Also, is it true that the adequacy of the surgical mobilization of tissues is vital to the outcome? The present paper discusses the above questions and introduces a factor that is believed to be crucial to the planning and success of a rhytidectomy: facial tissue mobility. The analysis of this mobility is presented and leads to the development of three theories: 'intrinsic mobility', 'surgically induced mobility' and 'optimum mobility points'. These theories form the foundation of a rhytidectomy technique termed 'optimum mobility' facelift.

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