This diagram shows the layers of the face that you should think of when approaching a facelift. You have the skin, which is obviously visible. Directly underneath the skin is a layer of fat. This is the superficial layer of subcutaneous fat. Underneath that is the musculoaponeurotic system, which we will get more in-depth about. The deep space underneath that is like a loose areolar plane where the superficial system can glide and move relative to the deeper structures. It also has some retaining ligaments that we won't get into because that's a whole other discussion. The deepest layer is the periosteum, which is also continuous with the deep fascia directly on top of the bone. In this diagram, you can see how the layers of the face are concentrically arranged, meaning the layers of the face and forehead, through the midface and down to the neck, are essentially similar but have different names, which can be confusing. For example, if we were to follow the skin, subcutaneous tissue, and the temporal parietal fascia (the musculoaponeurotic layer in the temporal region), the temporal parietal fascia continues down into the midface as the SMAS (superficial musculoaponeurotic system). This continues all the way down to the platysma and its respective fascia. Now, let's get a little more in-depth into this with a different view. This is a view that, if you're looking straight on to somebody and then it is cut this way, is a coronal cut. Here’s the ear. I left out the skin and subcutaneous fat because that’s something where that’s consistent; we know about that. Just to simplify the diagram. The first thing we see is that this is the superficial fascia of the face. So the superficial fascia of the face is sometimes also directly referred to as the superficial musculoaponeurotic system. Basically, this is the superficial layer of the fascia of the face. It will run here, and then when it gets to a facial mimetic muscle like the orbicularis oculi, orbicularis oris, or zygomaticus major or minor, it will split into a superficial layer and a deep layer to invest that facial mimetic muscle. Then, it will rejoin itself and continue before it hits another muscle and continues throughout the face. So, the superficial fascial layer is basically starting in the neck as the platysma and its respective fascia. If you go more superior, or cephalad, it becomes the superficial musculoaponeurotic system in the midface. When you get up to the temporal region, it is now called the superficial temporal fascia. This is also sometimes called the temporal parietal fascia, which contributes to some of the confusion when you’re trying to learn this. So again, this is that SMAS or superficial facial fascial layer that is always going to be covering the branches of the facial nerve. The facial nerve will always be deep to the superficial temporal fascia, the superficial musculoaponeurotic system in the midface, and the platysma and its respective fascia in the neck when you’re talking about the cervical branch. The frontal branch will be deep to the TP fascia, or superficial temporal fascia, or temporal parietal fascia, whatever you want to call it. The zygomatic and buccal branches will be deep to the SMAS in the midface, and also the marginal mandibular and cervical branch will be deep to the platysma and its fascia as it transitions from the platysma to SMAS in the midface and lower midface. Deep to that, here’s our frontal branch, right? We’ll come back to the course of the facial nerve after we get through the different layers. The tricky part is where the periosteum of the forehead comes down, and let’s not forget that the superficial temporal fascia in the temporal region is also called the TP fascia. The superficial temporal fascia is named so in the temporal region, but over the forehead and the rest of the scalp, this layer of fascia is called the galea aponeurotica, which is basically the fascia of the frontalis or occipitofrontalis muscle. This is the superficial fascial system, which includes the facial mimetic muscles like the frontalis and platysma. If you go deep to that, you run into a very small superficial fat pad, sometimes just called a loose areolar plane, that covers the superficial layer of the deep temporal fascia. This is where people often get confused. The periosteum of the cranium extends down inferiorly, and in the temporal region, it becomes the deep temporal fascia. This deep fascial system, when it goes over bony prominences, is continuous with the periosteum. That’s a key point. The periosteum is now called the deep temporal fascia in the temporal area. We have the superficial temporal fascia and the deep temporal fascia. Sometimes, this is also called the temporalis fascia because it is the fascia right on top of the temporalis muscle. The deep temporal fascia continues down and splits into a superficial layer and a deep layer, named because the superficial layer inserts and is continuous with the periosteum on the superficial part of the zygomatic arch, while the deep layer is continuous with the periosteum on the deep surface of the zygomatic arch. Between these layers is the middle temporal fat pad. Continuing down, the deep temporal fascia's superficial layer becomes continuous with the parotidomasseteric fascia in the midface, eventually becoming the deep cervical fascia. The deep cervical fascia is also the parotidomasseteric fascia, and the superficial leaflet of the deep temporal fascia fuses together, becoming the deep temporal fascia before eventually becoming the periosteum. Hopefully, we are all clear so far. You have a superficial layer of fascia composed of the galea aponeurotica, the superficial temporal fascia, the superficial musculoaponeurotic system, which is also continuous with the platysma and its fascia. The deeper layer, continuous with the periosteum at bony prominences, is the deep temporal fascia, which splits into superficial and deep layers, continuous with the periosteum of the zygomatic arch, and the superficial leaflet is continuous with the parotidomasseteric fascia in the midface and lower midface. It's important to note that the facial nerve, particularly the frontal branch, is most susceptible to injury above the zygomatic arch. Initially, it is deep and covered by the parotidomasseteric fascia, but recent studies show that one to three centimeters above the zygomatic arch, the frontal branch is still protected by the superficial fat pad. Depending on the study and diagram, the frontal branch may still be deep and protected by the superficial layer of the deep temporal fascia before piercing through the superficial fat pad or loose areolar plane. When approaching the zygomatic arch, you want to stay deep to the temporalis muscle and the deep layer of the deep temporal fascia to avoid the frontal branch. The deep temporal fascia, sometimes called the temporalis fascia, is directly on top of the temporalis muscle. Understanding the course of the frontal branch, which follows Pitanguy's line (0.5 cm below the tragus to 1.5 cm above the lateral brow), is crucial. This video aims to clarify the different facial layers for better understanding during facelifts and similar procedures.
This diagram shows the layers of the face that you should think of when approaching a facelift. You have the skin, which is obviously visible. Directly underneath the skin is a layer of fat. This is the superficial layer of subcutaneous fat. Underneath that is the musculoaponeurotic system, which we will get more in-depth about. The deep space underneath that is like a loose areolar plane where the superficial system can glide and move relative to the deeper structures. It also has some retaining ligaments that we won't get into because that's a whole other discussion. The deepest layer is the periosteum, which is also continuous with the deep fascia directly on top of the bone.
In this diagram, you can see how the layers of the face are concentrically arranged, meaning the layers of the face and forehead, through the midface and down to the neck, are essentially similar but have different names, which can be confusing. For example, if we were to follow the skin, subcutaneous tissue, and the temporal parietal fascia (the musculoaponeurotic layer in the temporal region), the temporal parietal fascia continues down into the midface as the SMAS (superficial musculoaponeurotic system). This continues all the way down to the platysma and its respective fascia.
Now, let's get a little more in-depth into this with a different view. This is a view that, if you're looking straight on to somebody and then it is cut this way, is a coronal cut. Here’s the ear. I left out the skin and subcutaneous fat because that’s something where that’s consistent; we know about that. Just to simplify the diagram.
The first thing we see is that this is the superficial fascia of the face. So the superficial fascia of the face is sometimes also directly referred to as the superficial musculoaponeurotic system. Basically, this is the superficial layer of the fascia of the face. It will run here, and then when it gets to a facial mimetic muscle like the orbicularis oculi, orbicularis oris, or zygomaticus major or minor, it will split into a superficial layer and a deep layer to invest that facial mimetic muscle. Then, it will rejoin itself and continue before it hits another muscle and continues throughout the face.
So, the superficial fascial layer is basically starting in the neck as the platysma and its respective fascia. If you go more superior, or cephalad, it becomes the superficial musculoaponeurotic system in the midface. When you get up to the temporal region, it is now called the superficial temporal fascia. This is also sometimes called the temporal parietal fascia, which contributes to some of the confusion when you’re trying to learn this.
So again, this is that SMAS or superficial facial fascial layer that is always going to be covering the branches of the facial nerve. The facial nerve will always be deep to the superficial temporal fascia, the superficial musculoaponeurotic system in the midface, and the platysma and its respective fascia in the neck when you’re talking about the cervical branch. The frontal branch will be deep to the TP fascia, or superficial temporal fascia, or temporal parietal fascia, whatever you want to call it. The zygomatic and buccal branches will be deep to the SMAS in the midface, and also the marginal mandibular and cervical branch will be deep to the platysma and its fascia as it transitions from the platysma to SMAS in the midface and lower midface.
Deep to that, here’s our frontal branch, right? We’ll come back to the course of the facial nerve after we get through the different layers. The tricky part is where the periosteum of the forehead comes down, and let’s not forget that the superficial temporal fascia in the temporal region is also called the TP fascia. The superficial temporal fascia is named so in the temporal region, but over the forehead and the rest of the scalp, this layer of fascia is called the galea aponeurotica, which is basically the fascia of the frontalis or occipitofrontalis muscle. This is the superficial fascial system, which includes the facial mimetic muscles like the frontalis and platysma.
If you go deep to that, you run into a very small superficial fat pad, sometimes just called a loose areolar plane, that covers the superficial layer of the deep temporal fascia. This is where people often get confused. The periosteum of the cranium extends down inferiorly, and in the temporal region, it becomes the deep temporal fascia. This deep fascial system, when it goes over bony prominences, is continuous with the periosteum. That’s a key point. The periosteum is now called the deep temporal fascia in the temporal area. We have the superficial temporal fascia and the deep temporal fascia. Sometimes, this is also called the temporalis fascia because it is the fascia right on top of the temporalis muscle. The deep temporal fascia continues down and splits into a superficial layer and a deep layer, named because the superficial layer inserts and is continuous with the periosteum on the superficial part of the zygomatic arch, while the deep layer is continuous with the periosteum on the deep surface of the zygomatic arch. Between these layers is the middle temporal fat pad.
Continuing down, the deep temporal fascia's superficial layer becomes continuous with the parotidomasseteric fascia in the midface, eventually becoming the deep cervical fascia. The deep cervical fascia is also the parotidomasseteric fascia, and the superficial leaflet of the deep temporal fascia fuses together, becoming the deep temporal fascia before eventually becoming the periosteum.
Hopefully, we are all clear so far. You have a superficial layer of fascia composed of the galea aponeurotica, the superficial temporal fascia, the superficial musculoaponeurotic system, which is also continuous with the platysma and its fascia. The deeper layer, continuous with the periosteum at bony prominences, is the deep temporal fascia, which splits into superficial and deep layers, continuous with the periosteum of the zygomatic arch, and the superficial leaflet is continuous with the parotidomasseteric fascia in the midface and lower midface.
It's important to note that the facial nerve, particularly the frontal branch, is most susceptible to injury above the zygomatic arch. Initially, it is deep and covered by the parotidomasseteric fascia, but recent studies show that one to three centimeters above the zygomatic arch, the frontal branch is still protected by the superficial fat pad. Depending on the study and diagram, the frontal branch may still be deep and protected by the superficial layer of the deep temporal fascia before piercing through the superficial fat pad or loose areolar plane.
When approaching the zygomatic arch, you want to stay deep to the temporalis muscle and the deep layer of the deep temporal fascia to avoid the frontal branch. The deep temporal fascia, sometimes called the temporalis fascia, is directly on top of the temporalis muscle. Understanding the course of the frontal branch, which follows Pitanguy's line (0.5 cm below the tragus to 1.5 cm above the lateral brow), is crucial. This video aims to clarify the different facial layers for better understanding during facelifts and similar procedures.
Excellent presentation thank you
Nice and good explanation
Excellent
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Thank you that was a very useful lecture
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❤❤❤
Gianfra ' parla come magni
Wats going on 😢