PEER-REVIEW | FACIAL CONTOURING | Anatomical recall
The cervicofacial area is divided into three planes: ■ Outside, the SACS ■ In contact with SACS, the superficial muscular aponeurotic system (SMAS)
■ On the ventral side of the SMAS, the second muscular layer and the vascularÐ nerve structures. The anatomical plane concerning the liposculpture
technique of the cervicofacial area is the SACS. Here the SACS, and the SMAS directly in contact with the SACS, are described, as well as the risk areas.
The superficial adipo-cutaneous system The SACS is an anatomical plane that includes the skin and the subjacent adipose tissue, and which covers the cervicofacial area. Trepsat3 observes that the layer of fat thickens as it travels further from the ear towards the malar and the cheek. It can therefore be easily understood how much one can gain when carrying out a degressive tunnelisation of this area, proceeding from the thickest adipose tissue to the thinnest. Trepsat2
thus observes
that in the upper part of the nasogenian grooves, the fat thickens at the level of the bulge, where it is concentrated,
Ôsometimes tubulised and organisedÕ when this bulge is large and old. Trespat also notes that when there is a sub-fat
separation (i.e. separation of the deep SACS plane and of the SMAS), this resulting created space is Ôextremely little
haemorrhage prone, since only very little perforating can be causedÕ .
The SACS is an anatomical
The superficial muscular aponeurotic system Immediately in contact with the deep plane of the SACS, the SMAS is an anatomicosurgical structure strictly derived from the primitive platysma and depending on the fascia corporalis superficialis. It presents no osseous insertion and is a continuous subcutaneous fibromuscular leaf. The muscular part composing the
plane that includes the skin and the subjacent adipose tissue, and which covers the cervicofacial area.
SMAS is made up of the
platysma muscle and the risorius muscle. The fascia corporalis superficialis lengthens the muscular structure towards the zygomatic arch. The SMAS does not spread as far as the nasogenian grooves and the upper lip. Arterial vascularisation of the skin is
ensured by the facial artery and its branches that form a vascular network under the
platysma and the parotido-masseterin SMAS. The facial artery penetrates deeply within the area underneath the maxilla and spreads over the gland, thus following a first curve with inferior concavity. It then inflects and embraces the lower edge of the mandible near the anterior edge of the masseter (chin pulse) following a second curve (under the maxilla) with superior concavity. The chin pulse is an important anatomical mark as the superior mandibular branch of the facial nerve crosses the facial artery (risk area).
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January/February 2013 |
prime-journal.com
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