ABSTRACT

A thorough knowledge of the anatomy of the aging face is essential to a safe and effective operation. Over time, the face undergoes changes in skill and subcutaneous tissues evidenced by rhytides and thinning. There are also change in the tone and Character official muscles Changes in fat structures in the face cause aesthetic changes that can be addressed surgically. Knowledge of the anatomy of the face and neck will aid in under-standing the changes that occur with aging and will allow for a more complete strategy in rejuvenating the aging face.

KEYWORDS: Aging face, face lift, anatomy, rhytides, rhytidectomy

Knowledge of the anatomy of the aging face is essential to the surgeon. Not only does it create a safer operation, but also understanding the anatomic structures and changes helps the surgeon develop an approach that will produce long lasting results. The goal of this article is to educate the reader about the basic facial anatomic structures and to describe some changes that occur with aging. The goal of this article is to educate the reader about the basic facial anatomic structures and to describe some change that occurs with aging.

SKIN AND SUBCUTANEOUS TISSUE

The skin is subdivided into the thinner, more superficial epidermis and tile more fibrous dermis. The epidermis is stratified squamous epithelium, which varies greatly in depth, ranging from the thickness of the scalp to the delicate skill Of the eyelid, which, at 0.04 mm, is the thinnest skin on the body The dermis, composed primarily of connective tissue, also contains nerves, blood vessels, muscles, lymphatics, sweat glands, and pilosebaceous glands The more superficial and thinner dermis is termed the papillary dermis! The deeper and thicker dermis is tile reticular dermis. The dermis is composed primarily o£ collagen.

The dermis contains a superficial vascular plexus and a deep vascular plexus. The superficial plexus, also known as the sub epidermal or sub papillary plexus, runs in the papillary dermis just beneath the epidermis, where it sends an arcade of capillary loops into each dermal papilla. The deep plexus, or dermal plexus, surrounds the skill appendages in the reticular dermis and is composed of larger vessels (Fig. 1)

Subcutaneous fat varies greatly in thickness and texture among individuals and in different regions of tile face. It is thickest in tile concavities of the cheeks, temples, and neck Lobules of subcutaneous fat are divided by fibrous septae, which contain vessels, nerves, and lymphatics. These septae represent a fibro fatty layer of subcutaneous tissue, which, in some areas of the face, connects to the fibro muscular layer of the superficial musculoaponeurotic system (SMAS). Thc fibromuscular layer consists of fibrous tissue, which envelops the muscles of facial expression. The nonexistent iii the midcheek, and are of intermediate strength over the parotid, temples, and neck .The fibrous connections between the skin and deeper structures are important, particularly in face lift surgery.