Anatomy of the Facial Glideplanes, Deep Plane Spaces and Ligaments: Implications for Surgical and Non-Surgical Lifting Procedures

Minelli, Lennert; Brown, Cameron P.; van der Lei, Berend; Mendelson, Bryan

doi:10.1097/prs.0000000000011078

Cited by 6 publications

(1 citation statement)

References 50 publications

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“…What was considered as a surgical layer 4 is actually a potential dissection plane within the superficial part of the deep fascia, which when dissected, opens up as the surgical spaces, a finding that will be elaborated on further in a separate article. 62…”

Section: Deep Fat Compartmentsmentioning

confidence: 99%

The Deep Fascia of the Head and Neck Revisited: Relationship with the Facial Nerve and Implications for Rhytidectomy

Minelli

Lei

Mendelson³

2023

Plastic &Amp; Reconstructive Surgery

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Background: The deep fascia is important in face-lift surgery, as it is relied on for protection of the facial nerve during surgical dissection. Lack of consistency with the term may be attributable to the term deep fascia having two different meanings. It is a specific type of connective tissue, classically thin, fibrous, and flat, whereas in the description of the layers of the face and neck, the deep fascia layer includes all the connective tissue deep to the superficial fascia layer. This cadaver study was undertaken to clarify the layered anatomy of the face and neck and its relationship with the facial nerve branches. Methods: Preliminary dissections and macrosectioning, followed by a conclusive series of standardized layered dissections, histologic analysis, and sheet plastination, were performed on 50 cadaver heads. Results: The deep fascia is thin in convex areas of the face and neck, and thicker in concave areas; it is interspersed with deep fat. The facial nerve branches, after emerging from the parotid gland, are embedded within the deep fascia, not deep to it. They transition from deep within the deep fascia at specific locations to course in the most superficial part of the deep fascia where they underlie their target superficial fascia muscles and are at risk from deep plane face-lift dissection. Conclusions: The deep fascia layer is a multilamellar fibrofatty layer of variable thickness, which includes the deep fat in which the facial nerve branches are embedded. In deep plane face-lift surgery, dissection must be performed in the most superficial level of this deep fascia layer.

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Section: Deep Fat Compartmentsmentioning

confidence: 99%

The Deep Fascia of the Head and Neck Revisited: Relationship with the Facial Nerve and Implications for Rhytidectomy

Minelli

Lei

Mendelson³

2023

Plastic &Amp; Reconstructive Surgery

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Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

Minelli¹,

Brown

Warren

et al. 2023

Aesthetic Surgery Journal

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Background A limitation of current facelift techniques is the early postoperative reappearance of anterior midcheek laxity associated with recurrence of the nasolabial fold (NLF). Objectives This study was undertaken to examine the regional anatomy of the anterior midcheek and NLF with a focus on explaining the early recurrence phenomenon and to explore the possibility of alternative surgical methods that prolong NLF correction. Methods Fifty cadaver heads were studied (16 embalmed, 34 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT. Mechanical testing of the melo fat pad (MFP) and skin was performed to gain insight on which structure is responsible for transmission of the lifting tension in a composite facelift procedure. Results Anatomical dissections, sheet plastination and micro-CT demonstrated the three-dimensional architecture and borders of the MFP. Histology of a lifted midcheek demonstrated that a composite MFP lift causes a change in connective tissue organization from a hanging-down pattern into a pulled upward pattern suggesting traction on the skin. Mechanical testing confirmed that, in a composite lift, despite the sutures being placed directly into the deep aspect of the MFP, the lifting tension distal to the suture is transmitted through the skin and not through the MFP. Conclusions As a composite midcheek lift is usually performed, it is the skin and not the MFP itself, that bears the load of the non-dissected tissues distal to the lifting suture. For this reason, early recurrence of the NLF occurs following skin relaxation in the postoperative period. Accordingly, specific surgical procedures for remodeling the MFP should be explored, possibly in combination with volume restoration of the fat and bone, for more lasting improvement of the NLF.

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The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation

Minelli¹,

Wilson

Bravo³

et al. 2023

Aesthetic Surgery Journal

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Background Despite the central role of the platysma in face and neck rejuvenation, much confusion exists regarding its surgical anatomy. Objectives This study was undertaken to clarify the regional anatomy of the platysma and its innervation pattern and to explain clinical phenomena, such as the origin of platysmal bands and their recurrence, and the etiology of lower lip dysfunction after neck lift procedures. Methods Fifty-five cadaver heads were studied (16 embalmed, 39 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology and sheet plastination. Results In addition to its origin and insertion, the platysma is attached to the skin and deep fascia across its entire superficial and deep surfaces. This composite system explains the age-related formation of static platysmal bands, recurrent platysma bands after complete platysma transection, and recurrent anterior neck laxity after no-release lifting. The facial part of the platysma is primarily innervated by the marginal mandibular branch of the facial nerve, while the submandibular platysma is innervated by the “first” cervical branches which terminate at the mandibular origin of the depressor labii inferioris. This pattern has implications for post-operative dysfunction of the lower lip, including pseudo-paralysis, and potential targeted surgical denervation. Conclusions This anatomical study, using layered dissections, large histology, and sheet-plastination, fully describes the anatomy of the platysma including its bony, fascial, and dermal attachments, as well as its segmental innervation including its nerve danger zones. It provides a sound anatomical basis for the further development of surgical techniques to rejuvenate the neck with prevention of recurrent platysmal banding.

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Anatomy of the Facial Glideplanes, Deep Plane Spaces and Ligaments: Implications for Surgical and Non-Surgical Lifting Procedures

Cited by 6 publications

References 50 publications

The Deep Fascia of the Head and Neck Revisited: Relationship with the Facial Nerve and Implications for Rhytidectomy

The Deep Fascia of the Head and Neck Revisited: Relationship with the Facial Nerve and Implications for Rhytidectomy

Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence

The Functional Anatomy and Innervation of the Platysma is Segmental: Implications for Lower Lip Dysfunction, Recurrent Platysmal Bands, and Surgical Rejuvenation

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