Anatomical study and aging analysis of the labiomandibular fold / 中华整形外科杂志

Objective@#To discuss the formation mechanism of the aging characteristics of the labiomandibular fold in the lower face, through anatomical and histological study of the labiomandibular fold area.@*Methods@#①The methylene blue dye was injected into the jowl fat compartment and the labiomandibular fat compartment which were located in one side of the face of adult fresh cadaveric heads(5 male, 3 female), the labiomandibular fold area was the uncolored region which between the two colored fat compartments. ②Combining with the observation by eyes, symmetrical region of theobjective ly marked labiomandibular fold on the other side of the face in the same head was selected to dissect with microsurgery technique under microscope. The locations, characteristics and adjacent relationships of the anatomical structures of the labiomandibular fold were observed carefully. During the experiment, some related tissues were measured by vernier caliper and recorded by the text and image. ③The symmetrical region of the marked labiomandibular fold with the methylene blue dye (step①) was cut, dehydrated, imbedded in paraffin and serially sliced in cross-section with the thickness of 10 μm. After that, the sections were used to perform HE stain and Masson stain.@*Results@#The labiomandibular fold is the area of the face which located in the surface of the depressor anguli oris muscle and extends from the mouth corner to the mandibular border. The superior boundary of the labiomandibular fold is formed by the cutaneous insertion of the depressor anguli oris muscle around the mouth corner. The inferior boundary is the mandibular ligament. The lateral and medial area of the labiomandibular fold are the jowl fat compartment and the labiomandibular fat compartment respectively. However, the adipose tissue of the jowl fat compartment is bigger, thicker, looser and lighter in color. Theresult of the histologic evaluation are consistent with the findings of the gross anatomy.@*Conclusions@#According to the characteristics of the labiomandibular fold, there are many aspects of reasons for the emergence of the labiomandibular fold, such as the relaxation of the facial retaining ligaments associated with the labiomandibular fold and the descensus of the lateral soft tissue of the labiomandibular fold with age. In addition, the differences in structure and morphology between the medial and lateral fat compartments of the labiomandibular fold also play a vital role.

The anatomic study and clinical application of the premasseter space / 中华整形外科杂志

Objective@#Through the anatomy study of the premasseter space, further improved the anatomic knowledge of the premasseter space and explored its application in rhytidectomy, in order to reduce the risk of facial nerve injury. To further improve the anatomic knowledge of the premasseter space and to determine its application in rhytidectomy.@*Methods@#The anatomy of the premasseter region was investigated in 12 fresh cadaver (24 hemi-faces) dissections; 810 patients of SMAS rhytidectomy procedures were observed.@*Results@#①There were several soft tissue spaces superficial to the masseter muscle, and the boundaries were strengthened by retaining ligaments. Adjacent spaces were separated by numerous weak fiber membranes connecting the SMAS and masseter fascia. ②The space was further divided into two parts; one part was located under the platysma and another part was under the aponeurosis of SMAS. The former part was easier to identify and dissect.③The relaxation, expansion, and sliding of the space is an important reason in the face sags with aging, which is referred to as the layered ptosis theory.@*Conclusions@#The soft tissue space superficial to the masseter muscle have two different characteristics. The different nature of the two parts of the space can easily mislead dissection to the wrong layer, which is the important anatomical factors for the risk of facial nerve damage in rhytidectomy. The layered ptosis theory seem to better explain the process of aging.The primary treatment of aged face was facial space dissection and tighten.

Three-dimensional visualization of lid/cheek junction / 中华医学美学美容杂志

Objective To explore the methodology of reconstruction of a three-dimensional model of lid/cheek junction through continuous paraffin sections and stained lid/cheek junction three-dimensional visualization,and to further explore the feasibility and reliability to provide anatomical basis for clinical teaching of plastic and reconstructive surgery.Methods The full size of lid/cheek junction was cut from the specimens,the size of 25 mm× 15 mm× 10 mm,and then embedded in paraffin,and sectioned in thickness of 15 μm for 200 slices;the experimental HE staining and Masson staining were conducted,Sony camera photos using Adobe Photoshop CS 5.1 image processing software for image registration and 3D-Docter software image segmentation were used to give different colors for establishment of complete three-dimensional model.Results Histologically the LOT of the fascia area,the existence of reconstruction and the LOT model were confirmed.It showed the histological characteristics:the Masson stain displayed red,blue and white tissues in color;fascia tissue staining infered intertexture of elastic fibers and collagen fibers in LOT.LOT was the bottom edge of the triangle toward the orbital base with length of 26 mm,31 mm in high,0.8 mm in thick,and area of approximately 4.03 cm2 in size.Layers of skin,orbicularis oculi muscle,orbicularis retaining ligament,middle temporal fascia,periosteum and LOT were visible in the 3D model.By the three-dimensional model of lid/cheek junction,adjacent relationship could be rotated to any angle.Conclusions This initial establishment of a three-dimensional model of the lid/cheek junction confirms that the histological characteristics of lid/cheek junction and the feasibility of the fine structure of soft tissue within the three-dimensional model can be used as a new method for further research.

Anatomical studying of the tear trough area / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the mechanism of the aging deformity of tear trough through the anatomic study of the tear trough region.</p><p><b>METHODS</b>13 adult cadaveric heads (26 sides), including 9 male heads (18 sides) and 4 female heads (8 sides), aged 22-78 years old, were used. Anatomic study was performed around the orbital, especially tear trough region, with microsurgery instrument under microscope( x 10 times). The lower orbicularis retaining ligament was dissected and exposed. The anatomic location was recorded and photographed.</p><p><b>RESULTS</b>(1) The anatomic layers of the tear trough region contains skin, subcutaneous tissue, orbicularis oculi muscle, periosteal membrane. There is no subcutaneous fat above the tear trough, while it exists below the tear trough, called malar fat pad. (2) There is a natural boundary between the septal and the orbital portions of the orbicularis oculi muscle of lower eyelid at surface of the orbital bone. The natural boundary, projected on the body surface corresponds to tear trough. The width of boundary is (2.06 +/- 0.15) mm on the vertical line through inner canthus and (3.25 +/- 0.12) mm on the vertical line through the lateral margin of the ala. The septal portion and the orbital portion of the orbicularis oculi muscle began to merge in (16.56 +/- 0.51) mm to inner canthus. (3) There is ligament attachment in the medial, upper and lower orbital and no ligament attachment in the lateral orbital. Orbicularis retaining ligament of lower eyelid is divided into two layers. (4) The medial of the upper layer of the orbicularis retaining ligament in lower eyelid originates from orbital margin and from preorbital walls laterally in (16.10 +/- 0.43) mm to the medial of lateral orbital margin, through orbicularis oculi muscle and ends at the skin. The lower layer of the orbicularis retaining ligament of lower eyelid originates from preorbital walls through orbicularis oculi muscle and its superficial fat, then ends at the skin.</p><p><b>CONCLUSIONS</b>The length of tear trough is (16.56 +/- 0.51) mm, the width of tear trough is (2.06 +/- 0.15) mm and (3.25 +/- 0.12) mm on the vertical line through inner canthus and the lateral margin of the ala nasi respectively. The main reason of the aging deformity of tear trough attributes to the increased distance between the upper and lower layers of the orbicularis retaining ligament in lower eyelid, which is caused by loose of the orbicularis retaining ligament and its underlying fat atrophy or decline.</p>

Anatomical foundation of smiling and mid-lower facial rejuvenation / 中华医学美学美容杂志

Objective To investigate the forming mechanism of smile anatomically,and to analyze the changes of aging characteristics of mid-lower face.Methods Ten (with 20 sides) adult fresh cadaveric heads were fixed by formalin,and then nasolabial fold morphology was observed under 10X operating magnifying glass,and compared with alteration of the middle and lower face aging features under the state of smiling and static according to observation from 50 doctors' and out-patients' photos.Results The nasolabial fold was the boundary between fatty and fat-free zone in the middle face,the lateral side of which was malar fat pad.The nasolabial fold was the linear area,which was formed by the insertions of seven mimetic muscles on the skin.When smiling,the nasolabial fold and cheek groove,got deep and extended,cheek stripe became obvious.While smiling,malar fat pad shifted up,and tear trough became deformity..64％ disappeared and 36％ getting shallow and appearance improved; orbit-malar fold showed 100％ horizontal part disappeared,74 ％ vertical part became shallow and improved,and 26％ stayed stable; mid-cheek fold showed 78％ dissovled,22％ getting shallow and improved; Labiomandibular fold showed 100％ Ⅲ degree disappeared,100％ Ⅱ degree dissovled,74％ Ⅰ degree disappeared,and 26％ getting shallow and ameliorated; submaxilla line showed 18％ getting smooth and 82％ remained.Conclusions Smiling is produced by movement of mimetric muscles,and its orgin is from nasolabial fold.A smile could make malar fat pad upwards to mask some aging characteristics of middle and lower face,which is helpful to form a younger face.

Anatomy of aging characteristics of orbit-malar-fold / 中华医学美学美容杂志

Objective To identify the anatomical basis for aging orbit-malar fold forming orbitmalar groove and its underlying mechanism.Methods Thirteen cadavers (26 hemifaces) were dissected in this study (9 male and 4 female heads).All specimens were fixed in 10％ formalin,with age ranges from 22 to 78 years.The lateral orbital region was dissected in layers by mieroinsrument using 10 X loupe magnification,especially at the palpebral and the lateral orbital part,and then the anatomy layer was described; the lateral orbital thickening (LOT) was performed carefully to evaluate whether there were multiple anatomical contributions to anatomy.Anatomic observations were systematically recorded,sketched,and photographically documented.Results The lateral orbital layers included skin,subcutaneous adipose tissue,orbicularis oculi muscle,middle temporal fascia,and periosteum.The lateral orbital thickening was a triangular condensation of fascia,which extended over the lateral orbital rim onto the adjacent medial tem~ral fascia,the lateral orbital thickening was measured (9.28 ±0.45) mm in transverse width from Vertex triangle to lateral canchal,the inner part of the LOT sanwiched between orbibularis and obital septum,which consisted of upper lid and lower lid part,the lower lid part presented transverse V shape,the top part of the transverse V was adhesive to fascial tissue over tarsal plate.The distance to lateral canthus angular was 21.69-37.21 mm,and the under part was adhesive to low orbital rim the low arm distance to lateral canthus angular was (13.55 ±0.52) mm.Vertex of.V to lateral canthus angular vertical distance was (11.35±0.27) mm.Conclusions The reason why aging orbit-malar fold forms orbital-malar groove is the atrophy of the subcutaneous adipose tissue and the middle temporal fascia fat.

Anatomical features of nasolabial fold / 中华医学美学美容杂志

Objective To investigate the anatomic characteristics of the nasolabial fold and to give an accurate description and definition of it in order to to provide theoretical basis for plastic, cosmetic and maxillofacial surgery. Methods Ten (20 sides) adult fresh bodies with vascular perfusion of formalin fixed after morphological observation under a 10 × magnifying len. Results Nasolabial fold was a border between fat-rich zone and non-fat zone in the midfacial region. The nasolabial fold derived from nasal alar skin point in the transverse portion of nasalis, and ended at the outer skin point of zygomaticus major muscle in the mouth. From the anatomy point of view, the nasolabial fold was divided into three segments: the upper, the middle and the under. The upper segment ( Ⅰ ) was the transverse portion of nasalis, (20. 38± 0. 74) mm in length; the middle section ( Ⅱ ): levator labii superioris,(17.13 ± 0.57) mm in length; the under segment (Ⅲ ): modiolus, (20. 81 ±0. 70) mm in length. The nasolabial fold was a connecting region where seven mimetic muscles inserted into the skin point. Superficial musculoapneurotic system (SMAS) and the nasolabial fold were composed of seven mimetic muscles belonging to the same layer. Conclusions The nasolabial fold is a region where the seven mimetic muscles insert into the skin point for connection, and regardless of age, it is an eternal existence. The nasolabial fold is different from the nasolabial wrinkle formed with facial aging and the nasolabial ridges formed by facial mimetic muscles changes.