Adapting Injection Techniques to Different Regions
Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh in Adapting Dermal Fillers in Clinical Practice, 2022
Because of the problem of forehead vasculature, injection – whether with cannula or needles – should preferably not proceed in the superficial fat compartment. Frontalis muscle is a very dynamic structure and usually does not cover completely the entire forehead. Superficial injection above the muscle and underlying the very thin layer of skin can be very unforgiving; any unevenness will be easily visible. Injection within in the frontalis muscle is possible but not preferred. Intramuscular filler injection is not the usual practice; muscles move and have a specific pattern of distribution. The deep fat compartment is a choice to accommodate fillers but for the forehead it is very limited in amount. Using cannula in the forehead area has to contend with many loose septal structures in order to reach different corners (Figure 4.4). Because of the wavy bony structure and the rigid character of a cannula, injecting directly with cannula dissection could not easily remain within a single layer (Figure 6.12). Hydrodissection with saline (using the harmless liquid to prepare the subgaleal space) could evenly loosen these septa and facilitate an even distribution of fillers (see Section 4.3).
Aesthetic
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
The frontalis muscle forms a continuous layer with the galea. It inserts into the supraorbital dermis and interdigitates with the orbicularis oculi, whilst the posterior part of the galea passes deep to the muscle and inserts into the periosteum at the supraorbital rim. Other brow muscles include the following: The corrugator supercilii with its oblique head (supraorbital rim to medial eyebrow dermis and thus acts as a brow depressor forming the oblique glabellar lines) and transverse head (from medial supraorbital rim to middle-third eyebrow dermis, thus moving the brow medially and forming vertical glabellar lines).The depressor supercilii runs from the medial supraorbital rim to the medial brow dermis, thus depressing the brow and forming oblique lines.The procerus runs from the medial supraorbital rim to the dermis of the medial brow, thus depressing the brow forming the nasal root lines that are oblique and horizontal.Orbicularis oculi, orbital part – the medial part causes medial brow depression whilst the lateral portion causes lateral brow depression and crow’s feet.
Anatomy of the Forehead and Periocular Region
Neil S. Sadick in Illustrated Manual of Injectable Fillers, 2020
The frontalis muscle serves as the sole brow elevator. It is a paired thin muscle and rhomboidal in form. There are no true bony attachments. It is enveloped by the galea aponeurotica. Inferiorly the frontalis muscle inserts into the forehead skin blending with fibers from the orbicularis oculi, procerus, and corrugator muscles. Superiorly it continues as the galea aponeurotica transitioning posteriorly into the occipitalis. The frontalis muscle raises the eyebrow and draws the scalp forward giving the expression of surprise. This vertical lift promotes the formation of transverse rhytides in the forehead skin. These rhytides become more well-defined at rest as elongation of the forehead progresses. The corrugator is a pyramidal muscle that originates from the medial end of the superciliary arch, travels superiorly and laterally inserting into the subcutaneous tissue close to the pupillary line. The action of the corrugator is to draw the eyebrows medially and inferiorly, creating the oblique and vertical folds in the glabella known as the “elevens.” The procerus muscle lies medial to the corrugators in the midline of the forehead with an origin along the nasal bones and insertion into the skin of the glabella. The contraction of the procerus muscle draws the eyebrows inferiorly and creates horizontal wrinkles in the glabella.
The spectrum of orbital dermoid cysts and their surgical management
Published in Orbit, 2020
Jasmina Bajric, Gerald J. Harris
Dermoid cysts are the most common orbital tumors of childhood.1,2 They are benign choristomas that arise from sequestration of ectoderm along the lines of embryonic fusion of mesodermal processes destined to be bone.3 They can stem from any of the suture lines within the osseous orbit, and the frontozygomatic suture is the most common point of origin.3–6 With desquamation of their epidermal lining and secretion of their dermal glandular elements, the cysts enlarge over time. Although the number of suture lines in the orbit is limited, the patterns of cyst expansion relative to adjacent and overlying anatomic structures are varied. These impact the potential morbidity of dissection and resection. For example, with superior expansion, the frontalis muscle insertion and/or frontal branches of the facial nerve may be interposed between the skin surface and the cyst’s osseous base.
Relationship between ocular dominance and brow position in patients with blepharoptosis
Published in Orbit, 2018
Andrew W. Thorne, Rao V Chundury, Julian D Perry, Daniel B Rootman
In the same way that handedness and eye dominance correlate poorly,10 an individual’s facial performance or preference bias (‘facial handedness’) may also correlate poorly with eye dominance. Anatomically, it has been shown that there is commonly a difference in the size of the frontalis muscle, which could indicate an intrinsic bias.11 This could produce discordance between ipsilateral eyelid ptosis and brow position. Further, eye dominance can be subject to switching12 and measurement errors,13 which could account for some of the variation found in this study. Last, it is possible that brow elevation accomplished its hypothetical teleological goal by stabilizing the MRD1 in many patients, which would mask a correlation between lower MRD1 and a higher brow. These theories are all yet unsubstantiated and require further research.
Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Yucheng Qiu, Rui Jin, Xue Dong, Yirui Shen, Feixue Ding, Zhizhong Deng, Xianyu Zhou, Youcong Ning, Jun Yang, Fei Liu
This technique has several advantages over previous approaches. The structures of the eyebrows were not dissected to expose the frontalis muscle during this surgery, inducing less tissue injury than in frontalis suspension. In addition, the eyelid opening is not powered by the frontalis, which reduces the appearance of forehead furrows [21,28]. In patients with severe blepharoptosis, there may not be enough levator to be removed because the ratio between the levator resection amount and the eyelid elevation is 5:1. With the combined suspension of CFS, the amount of levator muscle removed is greatly reduced, and the modified technique can provide stronger power to ameliorate ptosis, compared with simple CFS suspension or levator shortening surgery.
Related Knowledge Centers
- Facial Nerve
- Fascia
- Occipitalis Muscle
- Occipitofrontalis Muscle
- Skull
- Supraorbital Artery
- Skeletal Muscle
- Forehead
- Supratrochlear Artery
- Procerus Muscle