| FACIAL CONTOURING | PEER-REVIEW A tunnelisation that does
not run strictly parallel to the cutaneous plane would damage the subjacent vascular and nerve elements.
The auricular branch of superficial cervical plexus This crosses the back edge of the sternocleidomastoid muscle, goes along the SMAS and becomes superficial in the under-auricular area. Damage of the trunk provokes a definitive anaesthesia of the ear lobule.
The facial vein crosses the inferoexternal margin of the under-maxillary gland It rarely doubles up with the superficial cervical aponeurosis, where it can be damaged.
Figure 3 76-year-old patient (A) before and (B) 1-year post-treatment The facial artery then returns back up the face
where it makes its way between the superficial and deep planes of the facial hypodermic muscles. Its path is sinuous; it goes past and outside the corners of the lips (labial corner pulse) then straightens along the nasogenian groove, where it takes the name of angular artery before anastomosing with the nasal artery at the inside of the eye, and connecting with the ophthalmic nerve. The transverse facial artery, parallel to the lower edge of the zygomatic arch, anastomoses to the angular artery after having distributed a few perforations for the SMAS, the orbicularis, and the skin. The vascularisation of the skin and fat is ensured at
two levels: at the main level with perforations going through the SMAS; and through direct arteries for the skin and fat .
Anatomical dangers Continuity zone between the superficial and deep malar fat tissue A tunnelisation that does not run strictly parallel to the cutaneous plane would damage the subjacent vascular and nerve elements.
Type three decussation of the platysma muscle presents the same danger The retroplatysmal fat is a lymphatic draining area with the under-chin and under-maxilla lymphatic network. Therefore, there is a risk of lymphorrhea.
The posterior auricular branch of the facial nerve This can be damaged as a result of retro-auricular tunnelisation, provoking an occipital muscle paralysis and a forward sagging of the scalp, thus pulled by the forehead muscles.
Figure 4 55-year-old patient (A) before and (B) 6 months post-treatment
prime-journal.com | January/February 2013 ❚ 43
The post-parotid branches of the facial nerve These branches travel between the masseter and the SMAS, where the parotid exists in a cellular fascia. There are many anastomoses that allow reserve supplies should one of these branches become cut. Only the extreme branches (mandibular and temporal) are particularly vulnerable. The upper branch of the mandibular precociously crosses the lower edge of the mandible, and superficially crosses the facial artery.
Indications for cervicofacial liposculpture With an aesthetic view in mind, these indications apply to making the face both more beautiful and youthful. In the young adult, whose skin is firm and elastic, the restoration of a normal cervical chin contour through liposuction must follow the criteria
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92