Analysis of Age-Related Changes in Asian Facial Skeletons Using 3D Vector Mathematics on Picture Archiving and Communication System Computed Tomography

J Deutsche Derma Gesell

Lachman

2019

Summary Objective There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy. Material and Methods The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy. Results The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the retinacula cutis (composed of fibrous connective tissue); layer 3: superficial musculo‐aponeurotic system (SMAS); layer 4: deep fat; and layer 5: periosteum or deep fascia. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues. Conclusions The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures.

Section: Deep and Superficial Fat Compartments Of The Foreheadmentioning

confidence: 99%

Section: Tiefe Und Oberflächliche Fettkompartimente Der Stirnunclassified

Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery

J Deutsche Derma Gesell

Lachman

2019

“…Der Volumenverlust ergibt sich aus den altersbedingten Veränderungen des Stirnbeins, von denen in ähnlicher Weise auch die Mittelgesichtsknochen betroffen sind . Da das bedeckende Weichteilgewebe dünner ist als im Mittelgesicht und sich das Fettgewebe von oberflächlichen in abdominale oder ektopische Lokalisationen umverteilt (Leber, Knochenmark) , kann es an der Stirn zu einer Aushöhlung kommen.…”

Section: Tiefe Und Oberflächliche Fettkompartimente Der Stirnunclassified

Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie

J Deutsche Derma Gesell

Lachman

2019

Zusammenfassung Ziel In den letzten zehn Jahren hat sich unser Verständnis der Gesichtsanatomie gewandelt. Neuere minimalinvasive Eingriffe zur Gesichtsverjüngung erfordern bessere anatomische Kenntnisse. Material und Methoden In dieser narrativen Übersichtsarbeit wird die aktuelle Literatur mit den Erfahrungen der Autoren zusammengefasst und analysiert. Sie resümiert den aktuellen Wissenstand zu oberflächlichen und tiefen fazialen Fettkompartimenten und deren Bedeutung für minimalinvasive Eingriffe am Gesicht. Ein schematisches Modell zum besseren Verständnis der komplexen Anatomie des Gesichts wurde erstellt. Ergebnisse Das Gesicht ist aus den folgenden fünf Schichten aufgebaut: Schicht 1: Haut; Schicht 2: subkutanes Fettgewebe mit Retinacula cutis (aus fibrösem Bindegewebe), Schicht 3: superfizielles muskuloaponeurotisches System (SMAS), Schicht 4: tiefes Fettgewebe und Schicht 5: Periost oder tiefe Faszie. Dieser Aufbau unterscheidet sich je nach Region, insbesondere, wenn die Ligamente in das Modell einbezogen werden. Die fazialen Fettkompartimente sind in den Schichten 2 und 4 lokalisiert. Jede Schicht hat einzigartige Merkmale und spezielle räumliche Beziehungen zu den umgebenden Geweben. Schlussfolgerungen Das neue Konzept des geschichteten Aufbaus erklärt die räumlichen Beziehungen und das funktionale Zusammenwirken der Weichteilgewebe im Gesicht. Die Kenntnis der Schichten sowie der genauen Lage der oberflächlichen und tiefen Fettkompartimente des Gesichts und ihrer Begrenzungen ist entscheidend für die sichere und effektive Durchführung minimalinvasiver Eingriffe am Gesicht.

“…It is currently accepted that the facial skeleton undergoes lifelong and continuous changes and that these changes affect the appearance of the face and its expressions. 3,42,43 An early study summarized the changes occurring in the facial skeleton and set the basis for our current understanding of facial changes during aging as follows 44 : lateral translation of the orbits; protrusion of the glabella; expansion of the supraorbital ridges; increase in the depth and lateral expansion of the cheeks; increase in length, width, and vertical dimensions of the nose; and increase in vertical height in the occlusal region associated with increased chin prominence. 43 Based on these changes, the Lambros theory of clockwise rotation of the viscerocranium (when viewed from the right) was postulated.…”

Section: Age-related Changes Facial Bonesmentioning

confidence: 99%

“…42 Another study carried out in an Asian population found similar results; however, the orbital and maxillary angles showed less changes and the pyriform angle showed more prominent changes compared to studies conducted in Caucasian populations. 3 The resulting changes of the facial skeleton not only are causative for the overall facial shape but also affect the position, that is, the origin of ligaments and the overlying fat compartments. A decrease of the maxillary angle might be causative for the expansion of the inferior orbital rim and thus of an anterior positioning of the orbital septum.…”

Section: Age-related Changes Facial Bonesmentioning

confidence: 99%

The Anatomy of the Aging Face: A Review

Fratila

Schenck³

et al. 2016

Facial plast Surg

173

The anatomy of the human face has received intensive attention during the last decade, as procedures of facial rejuvenation are being performed with increasing frequency and in numerous varieties. Several new anatomic structures have been identified, which help to understand one of the most complex areas of the human body (►Fig. 1). A plethora of invasive and noninvasive procedures have been introduced to reduce the signs of aging and to restore the youthful appearance of the face. As each of the different procedures is based on the underlying facial anatomy, the understanding of its three-dimensional composition and layered concept is crucial for safe, natural, and long-lasting applications. 1The trend in facial rejuvenative procedures points toward a more natural look compared with the previous empiric approaches, which resulted in a "pulled back" look.2 Today's rejuvenative options try to restore the natural balance between the different facial structures and facial layers and thus to give back to face what is lost during aging processes. 1Aging is the result of the interplay of changes occurring in the facial skeleton, facial ligaments, facial muscles, facial adipose tissue, and skin. These changes befall each mentioned structure at a different pace, start in each individual at a different age, and differ between ethnic background.3 Therefore, it is hard to estimate which structure is mainly causative Keywords ► facial bones ► fat compartments ► facial muscles ► facial ligaments ► aging AbstractRejuvenative procedures of the face are increasing in numbers, and a plethora of different therapeutic options are available today. Every procedure should aim for the patient's safety first and then for natural and long-lasting results. The face is one of the most complex regions in the human body and research continuously reveals new insights into the complex interplay of the different participating structures. Bone, ligaments, muscles, fat, and skin are the key players in the layered arrangement of the face. Aging occurs in all involved facial structures but the onset and the speed of age-related changes differ between each specific structure, between each individual, and between different ethnic groups. Therefore, knowledge of age-related anatomy is crucial for a physician's work when trying to restore a youthful face. This review focuses on the current understanding of the anatomy of the human face and tries to elucidate the morphological changes during aging of bone, ligaments, muscles, and fat, and their role in rejuvenative procedures.