Anatomy in Aesthetic Medicine

• Layers of the Face

  • Skin
  • Subcutaneous layer
  • Superficial musculoaponeurotic system (SMAS)
  • Retaining ligaments and spaces
  • Periosteum and Deep fascia

  
• Epidermis

  Provides barrier functions, made up of keratinocytes
• Dermis

  Provides strength and elasticity, contains fibroblasts that synthesize collagen and elastin
• Collagen

  Provides support matrix of the skin, resistance to traction
• Elastin

  Maintains skin elasticity
• Matrix

  Glycosaminoglycans + Proteoglycans, enable the circulation of water and dissolved molecules
• Fat

  Stores energy, connects dermis to muscles and bones, provides insulation
• Superficial fat compartments

  • Forehead fat
  • Lateral orbital fat
  • Palpebral portion of orbicularis oculi m
  • Malar fat
  • Nasolabial fat
  • Prejowl fat

  
• Deep fat compartments

  • Suborbicularis oculi fat (SOOF)
  • Retro-orbicularis oculi fat (ROOF)
  • Buccal fat
  • Deep medial cheek fat

  
• Superficial muscular aponeurotic system (SMAS)

  Continuous fibromuscular layer extending from the platysma to the galea aponeurotica
• Facial expression muscles

  • Originate from the facial bone or fascia and attach to the facial skin
  • Muscle contracts toward the origin to produce facial expressions and creases
  • All wrinkles or furrows are created perpendicularly to the muscle vectors

  
• Muscles of the forehead region

  • Frontalis
  • Depressor supercilli
  • Orbicularis oculi
  • Corrugator supercilli
• Frontalis muscle

  Elevates the brow
• Procerus muscle

  Depresses the brow
• Depressor supercilii muscle

  Depresses the brow
• Orbicularis oculi muscle

  Mediates eye closure
• Corrugator supercilii muscle

  Draws the brows medially
• Muscles of the lid closure

  • Orbicularis oculi (orbital part)
  • Corrugator supercilii
  • Procerus
  • Depressor supercilii
• Spock eyebrows

  When botulinum toxin is injected only at the central part of the upper forehead, leaving the sides untouched, the central brow drops and the outer brow appears lifted
• Ptosis

  When botulinum toxin migrates to the muscle that raises the eyelid (levator palpebrae superioris muscle)
• Muscles of the nose region

  • Nasalis (transverse)
  • Nasalis (alar)
  • Depressor septi nasi
  • Depressor alar nasi
• Nasalis (transverse) muscle

  Compresses and decreases the size of the naris
• Nasalis (alar) muscle

  Enlarges the size of the naris
• Depressor septi nasi muscle

  Pulls the nose tip inferiorly to enlarge the size of the naris
• Nasal dilator muscles

  • Nasalis (alar portion)
  • Depressor Septi Nasi
• Nasal compressor muscles

  • Nasalis (transverse portion)
  • Compressor narium minor
• Perioral muscles

  • Orbicularis oris
  • Levator angular oris
  • Zygomaticus major
  • Buccinator
  • Risorius
  • Depressor angular oris (DAO)
  • Platysma
• Orbicularis oris muscle

  Mediates lip closure
• Levator angular oris muscle

  Elevates the mouth angle
• Zygomaticus major muscle

  Elevates the mouth angle
• Buccinator muscle

  Presses the lips and cheeks against the teeth
• Risorius muscle

  Pulls the lips laterally
• Depressor angular oris (DAO) muscle

  Depresses and laterally moves the mouth angle
• Platysma muscle

  Depresses the lower lip
• Upper lip elevators

  • Levator labii superioris alaque nasi m.
  • Levator labii superioris m.
  • Zygomaticus minor m
• Levator labii superioris alaque nasi muscle

  Dilates the nostril and elevates the upper lip
• Levator labii superioris muscle

  Elevates the upper lip
• Zygomaticus minor muscle

  Elevates and laterally moves the mouth angle
• Lower lip muscles

  • Depressor labii inferioris
  • Mentalis
  • Platysma
• Depressor labii inferioris muscle

  Depresses the lower lip