eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Facelift Anatomy: Multimedia

Author: S Valentine Fernandes, MBBS, MB, BS, BSc(Hons), MCPS, FRCSEd, FRACS, FACS, Conjoint Senior Clinical Lecturer, Department of Otorhinolaryngology, Newcastle University; Senior Consultant Surgeon, Department of Otorhinolaryngology-Head and Neck Surgery, John Hunter, Toronto Private and Kurri Hospitals, Australia
Contributor Information and Disclosures

Updated: May 20, 2008

Multimedia

Superficial musculoaponeurotic system (SMAS) laye...
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Media file 1: Superficial musculoaponeurotic system (SMAS) layer.
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Superficial musculoaponeurotic system (SMAS) laye...

Superficial musculoaponeurotic system (SMAS) layer.

Branches of the facial nerve (left side).
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Media file 2: Branches of the facial nerve (left side).
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Branches of the facial nerve (left side).

Branches of the facial nerve (left side).

Schematic representation of the frontal division ...
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Media file 3: Schematic representation of the frontal division of the temporal branches of the facial nerve around the zygoma region. The deep layer of the temporal fascia separates the superficial fat pad from the deep fat pad.
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Schematic representation of the frontal division ...

Schematic representation of the frontal division of the temporal branches of the facial nerve around the zygoma region. The deep layer of the temporal fascia separates the superficial fat pad from the deep fat pad.

Zygomaticus major muscle. The buccal branches of ...
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Media file 4: Zygomaticus major muscle. The buccal branches of the facial nerve and the parotid duct are visualized on the masseter muscle.
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Zygomaticus major muscle. The buccal branches of ...

Zygomaticus major muscle. The buccal branches of the facial nerve and the parotid duct are visualized on the masseter muscle.

A zygomatic branch of the facial nerve deep to th...
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Media file 5: A zygomatic branch of the facial nerve deep to the zygomaticus major muscle.
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A zygomatic branch of the facial nerve deep to th...

A zygomatic branch of the facial nerve deep to the zygomaticus major muscle.

Supratrochlear nerve branches penetrating through...
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Media file 6: Supratrochlear nerve branches penetrating through the corrugator muscle. The orbicularis oculi muscle has been reflected downward, and the periosteum has been incised superiorly.
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Supratrochlear nerve branches penetrating through...

Supratrochlear nerve branches penetrating through the corrugator muscle. The orbicularis oculi muscle has been reflected downward, and the periosteum has been incised superiorly.

Schematic representation of the buccal branch of ...
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Media file 7: Schematic representation of the buccal branch of the facial nerve.
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Schematic representation of the buccal branch of ...

Schematic representation of the buccal branch of the facial nerve.

Schematic representation of the marginal mandibul...
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Media file 8: Schematic representation of the marginal mandibular branch of the facial nerve.
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Schematic representation of the marginal mandibul...

Schematic representation of the marginal mandibular branch of the facial nerve.

The malar fat pad and nasolabial fold.
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Media file 9: The malar fat pad and nasolabial fold.
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The malar fat pad and nasolabial fold.

The malar fat pad and nasolabial fold.

The superficial temporal artery lies in the super...
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Media file 10: The superficial temporal artery lies in the superficial musculoaponeurotic system (SMAS) layer above the level of the zygoma.
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The superficial temporal artery lies in the super...

The superficial temporal artery lies in the superficial musculoaponeurotic system (SMAS) layer above the level of the zygoma.

Zygomatic and masseteric ligaments.
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Media file 11: Zygomatic and masseteric ligaments.
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Zygomatic and masseteric ligaments.

Zygomatic and masseteric ligaments.

In the dissection specimen shown in this image, t...
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Media file 12: In the dissection specimen shown in this image, the earlobe has been stitched upward.
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In the dissection specimen shown in this image, t...

In the dissection specimen shown in this image, the earlobe has been stitched upward.

Consider a shirt pocket full of sand. If an upwar...
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Media file 13: Consider a shirt pocket full of sand. If an upward pull is exerted on the part of the shirt that forms the back flap of the pocket, then the lower seam deepens. However, if this back flap contains a tear, the seam either is not affected or lightens when given a pull. In this analogy, the back flap of the pocket is the SMAS with the zygomaticus major muscle, the front flap is the skin, the sand is the malar fat pad, and the lower seam is the nasolabial fold.
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Consider a shirt pocket full of sand. If an upwar...

Consider a shirt pocket full of sand. If an upward pull is exerted on the part of the shirt that forms the back flap of the pocket, then the lower seam deepens. However, if this back flap contains a tear, the seam either is not affected or lightens when given a pull. In this analogy, the back flap of the pocket is the SMAS with the zygomaticus major muscle, the front flap is the skin, the sand is the malar fat pad, and the lower seam is the nasolabial fold.

More on Facelift Anatomy

References
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References

  1. Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. Jul 1976;58(1):80-8. [Medline].

  2. Skoog T. The aging face. In: Plastic Surgery: New Methods and Refinements. Philadelphia, PA: WB Saunders Co; 1974.

  3. Hamra ST. Composite rhytidectomy. Plast Reconstr Surg. Jul 1992;90(1):1-13. [Medline].

  4. Barton FE Jr. Rhytidectomy and the nasolabial fold. Plast Reconstr Surg. Oct 1992;90(4):601-7. [Medline].

  5. Driuk NF, Khar'kov AL. [The method of lifting and fixation of superficial musculo-aponeurotical system in rejuvenation operations on the face]. Klin Khir. Sep 2006;(9):53-4. [Medline].

  6. Freilinger G, Gruber H, Happak W, Pechmann U. Surgical anatomy of the mimic muscle system and the facial nerve: importance for reconstructive and aesthetic surgery. Plast Reconstr Surg. Nov 1987;80(5):686-90. [Medline].

  7. Fuente del Campo A. Face lift without preauricular scars. Plast Reconstr Surg. Sep 1993;92(4):642-53; discussion 654-61. [Medline].

  8. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. Jan 1989;83(1):11-6. [Medline].

  9. Gassner HG, Rafii A, Young A, Murakami C, Moe KS, Larrabee WF Jr. Surgical anatomy of the face: implications for modern face-lift techniques. Arch Facial Plast Surg. Jan-Feb 2008;10(1):9-19. [Medline].

  10. Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg. Mar 2008;32(2):185-95. [Medline].

  11. Mowlavi A, Majzoub RK, Cooney DS, Wilhelmi BJ, Guyuron B. Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy. Plast Reconstr Surg. May 2007;119(6):1891-5; discussion 1896. [Medline].

  12. Nouraei SA, Al-Yaghchi C, Ahmed J, Kirkpatrick N, Mansuri S, Singh A, et al. An anatomical comparison of Blair and facelift incisions for parotid surgery. Clin Otolaryngol. Dec 2006;31(6):531-4. [Medline].

  13. Pessa JE, Garza PA, Love VM, Zadoo VP, Garza JR. The anatomy of the labiomandibular fold. Plast Reconstr Surg. Feb 1998;101(2):482-6. [Medline].

  14. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. Jun 2007;119(7):2219-27; discussion 2228-31. [Medline].

  15. Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg. Jan 1989;83(1):1-10. [Medline].

  16. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. Mar 1992;89(3):441-9; discussion 450-1. [Medline].

  17. Whetzel TP, Mathes SJ. Arterial anatomy of the face: an analysis of vascular territories and perforating cutaneous vessels. Plast Reconstr Surg. Apr 1992;89(4):591-603; discussion 604-5. [Medline].

  18. Yousif NJ, Gosain A, Matloub HS, et al. The nasolabial fold: an anatomic and histologic reappraisal. Plast Reconstr Surg. Jan 1994;93(1):60-9. [Medline].

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Further Reading

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Keywords

facelift anatomy, face lift, face-lift, anatomy of the face, face anatomy, facial anatomy, facial nerve injury, great auricular nerve damage, superficial musculoaponeurotic system, SMAS, facial plastic surgery anatomy, facial surgery anatomy

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Contributor Information and Disclosures

Author

S Valentine Fernandes, MBBS, MB, BS, BSc(Hons), MCPS, FRCSEd, FRACS, FACS, Conjoint Senior Clinical Lecturer, Department of Otorhinolaryngology, Newcastle University; Senior Consultant Surgeon, Department of Otorhinolaryngology-Head and Neck Surgery, John Hunter, Toronto Private and Kurri Hospitals, Australia
S Valentine Fernandes, MBBS, MB, BS, BSc(Hons), MCPS, FRCSEd, FRACS, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Keith A LaFerriere, MD, Clinical Professor, Fellowship Director, Department of Surgery, Division of Otolaryngology, University of Missouri at Columbia
Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

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