Surgical Anatomy of the Ligamentous Attachments in the Superoposterior Scalp Region.

BACKGROUND: Hairline-lowering surgery has become increasingly popular in recent years, but little investigation into the surgical anatomy of the scalp has been performed. OBJECTIVES: The aim of this study was to describe findings based on clinical observation and anatomic study of ligamentous attachments in the superoposterior region of the scalp. METHODS: Six fresh cadaveric heads were dissected to identify connective tissue structures in the superoposterior scalp region. The areas of interest were along the sagittal suture towards the lambda, the obelion, and around the lambdoid suture. The location and dimensions of identified connective tissue attachments were documented with reference to described skeletal landmarks. RESULTS: Three distinct structures could be identified: (1) a cylindrical structure that sits at the posterior end of the sagittal suture with the parietal foramina in its base. This ligamentous structure extends from the pericranium into the galea, causes dimpling in the skin, and contains emissary veins. As this fulfills the criteria for an osseocutaneous retaining ligament, the term "cranial retaining ligament" is proposed. (2) Anterior to this ligament a connective tissue thickening was identified running along the sagittal suture and blending into the ligament, for which the term "sagittal adhesion" is proposed. (3) Another adhesion was identified just superior to the lambdoid suture, posterior to the retaining ligament, for which the term "supralambdoid adhesion" is proposed. CONCLUSIONS: Identification and better understanding of ligamentous structures in the superoposterior scalp allows for a safer and more effective advancement of the scalp in hairline-lowering surgery, which is a benefit to both patients and surgeons.

Introduction of the Lip Classification of Tubercles: A Novel Approach to Minimally Invasive Aesthetic Lip Treatments.

Background: Lip enhancement procedures involving dermal fillers are one of the most sought after nonsurgical aesthetic treatments. However, current trends are associated with unnatural results and involve increased risks of complications and compromise to normal function. It appears that lips may be classified according to the presentation of their tubercles and this may be used to guide minimally invasive techniques which aim to preserve individual lip shapes and normal function. Objectives: To test the reliability of a classification system based on lip tubercle morphology, named the Lip Classification of Tubercles (LCT). Methods: To test the reliability of the LCT, a total of 214 high-definition photographs of patients' lips with no previous histories of lip treatments were classified independently by 4 experienced aesthetic practitioners on 2 separate occasions 3 months apart; the second followed a more detailed explanation of the classification. Results: When inter-rater reliability was calculated for the first attempt, the results were 36% and 43% for upper and lower lips, respectively. The second attempt following an education process resulted in 79% for both lips. When 1 practitioner was considered the standard, the average score for the remaining 3 showed some individual variation but improved significantly from 58% to 85%. Conclusions: The LCT is a reliable way to classify lip types based on the morphology of tubercles.