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Facial Anatomy

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Anatomy of the facial soft tissues

Five layers of critical anatomy:

1.

Skin
Subcutaneous fat
Supereficial Musculoaponeurotic system
(SMAS)/ muscle layer.
Deep Fascia
Facial n.

2.
3.
4.
5.

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Subcutaneous Soft Tissue

Homogenous fascial fatty layer.

Malar Fat Pad: Triangular in shape

Beneath is the SMAS.

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SMAS
Superficial musculoaponeurotic system

A tissue plane that is composed of fibrous or

muscular tissue, lies in direct continuity with the
platysma, and lacks direct bone insertion.

SMAS
History

Henry Gray, 1859

Skoog, 1974- Plication and flap suspension in facelift.
Mitz and Peyronie, 1976- Detailed anatomic description of
the SMAS in the parotid and cheek area :
1.The SMAS was continuous with the frontalis m.
2. Continuous with the platysma m. inferiorly.
3. Motor n. run deep to the SMAS.
4. Sensory n. are superficial.

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Jost and Levet, 1984 The SMAS is the

remnant of the primitive
platysma muscle; true
platysma, risorius,
triangularis, auricular
posterior.
The SMAS over the parotid forms the parotid
fascia.
A second layer of facial muscles located deep to the
SMAS , oriented vertically and attached to the skull
and facial bones; The sphincter colli profundus:
frontalis, periorbital, zygomaticus, and quadratus
labii inferioris.

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Parotid region
Mitz and Peyronie, 1976:
The SMAS anterior to the tragus is particularly
dense.
Jost and Levet, 1984:
Impossible to separate the SMAS from the deep
parotid fascia.

Zygomatic and Temporal regions

Mitz and Peyronie, 1976: The SMAS tightly

adhered to the zygoma.
The fascial layer in the temple, the
temporoparietalis fascia, is continuous with the
posterior portion of the frontalis m.
Jost and Levet, 1984: The SMAS ends at the level
of the zygoma, and does not join the frontalis m.

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Stuzin: Three fascial layers in the temporal

area: Temporoparietal fascia, Superficial
layer of deep temporal fascia, and the deep
layer of of the DTF.

Nasolabial fold

Mitz and Peyronie, 1976: The NLF as a cutaneous

depression where the SMAS ends.
Pensler, 1985: The superficial fascia in the upper
lip is continuous with the cheek SMAS through
the NLF.
Barton, 1992: The SMAS in the anterior cheek is
the nesting fascia for the muscles of the upper lip;
Lateral traction on the SMAS would have little
effect on the medial cheek skin.

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Yousif, 1994: Traction on the SMAS

deepens the NLF; traction on the fascialfatty layer lessens the fold.

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SMAS

S.Aston: It is fibrous, muscular, or fatty,

depending on the location in the face:
A single, heterogenous layer: GaleaFrontalis- Temporoparital fascia- SMASOrbicularis oculi- Orbicularis orisPlatysma.

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Retaining ligaments of the

cheek
Furnas: Described 4 ls., that support the soft
tissue of the face:
Zygomatic (McGregors patch), Mandibular
retaining ligaments in the cheek: from the
periosteum to affix the skin.
Anterior Platyma- cutaneous l.,
Platysma- Auricular l.

Stuzin:
2 types of retaining ll:
1. Osteocutaneous ll.:Zyg, Man. l.l.
2. Fascial connections: Parotid- cut.l, Massetericcut.l.

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The zygomatic ll., Stuzin: Fixate the malar

pad to the underlying zygomatic
eminence in the youthful face.
Masseteric Cutaneous ls., Stuzin, Baker,
and Gordon:

Fibroelastic septi that extends between the

superficial and deep facial fascia along the
anterior margin of the masseter m.
Provides support to the SMAS- platysma in
the midface.

Mimetic Muscles

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1. Depressor anguli oris, Zygomaticus minor,

Orbicularis oculi.

2. Depressor labii inferioris, risorius,

platysma, zygomaticus major, levator labii
superioris alaeque nasi.

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3. Orbicularis oris, levator labii superioris.

4. Mentalis, levator anguli oris, Buccinator.

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The innervation of the ms.

of the first 3 layers is from
their deep surface.
The deepest group is
innervated from the
superficial surface.

The platysma muscle

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The platysma m.

Size: 8*12 cm
Origin: Fascia over the upper parts of the
pectoralis major and deltoid.
Insertion: Skin and subcutaneous tissue of the
lower face.
Has no bony insertions!

Pattern of circulation: type II:

Dominant pedicle: submental a.
Minor a: suprasternal a.

Nerve supply:
Motor: cervical branch, VII.
Sensory: transverse cervical n.

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The platysma m.

Vistnes and Souther, 1979:

61%- Decussated from the level of the
hyoid
39%- No decussation- Turket globbler
deformity.

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Cardoso de Castro, 1980: Three different

conformations:

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Parotid- Masseteric fascia

A thin, areolar layer that lies immediately

on the surface of the facial n., anterior to the
parotid gland.
Analogous layers:
Neck- Cervical fascia.
Temporal region- Innominate fascia.
Scalp- Subgaleal fascia.

Facial n.
Facial danger zones

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Facial danger zone 1

Greater auricular n.- Mckinney and

Katrana: 6.5 cm below external auditory
meatus
Posterior to SMAS

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Facial danger zone 2

Frontal branch of VII

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A line from 0.5 cm below

the tragus to 1.5
above the lateral
end of eyebrow.

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Facial danger zone 3

marginal mandibular branch

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Dingman and Grabb: The mandibular n.

passes above the mandibular border- 81%posterior to the facial a.

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Facial danger zone 4

Zygomatic and Buccal
brances

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Facial danger zone 5

Supraorbital and Supratrochlear nn.

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Facial danger zone 6

Infraorbital n.

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Facial danger zone 7

Mental n.

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