Understanding the anatomy of aging can be a useful tool to see what areas of your face may or may not need improvement.
Eyebrow position is usually considered the key landmark in determining the aesthetic configuration of the upper third of the face. The medial end of the eyebrow should have a club-head configuration and should be in line with a vertical line drawn through the ala of the nose. It arches superolaterally above the supraorbital rim to its apex between vertical lines drawn from the lateral limbus and lateral canthus.
What are some of the important terms to know in facelift anatomy?
Nasolabial crease (sulcus)- facial line b/t upper lip and cheek
Nasolabial fold- bulging fat pad and skin lateral to NLC, caused by attenuation of the zygomatic retaining ligaments causing malar soft tissues to migrate downward along zygomaticus creating a bulge along NLC
Malar fat pad- triangular fat pad with base along NLC and in younger people with apex at zygoma
Modiolus – corner of the mouth
Marionette lines- inferior extensions of the nasolabial crease below the mouth, otherwise known as NLC below commissure
Witch’s chin deformity- a droopy chin from aging, otherwise known as ptosis of the integumentary and muscular tissues of the mentum
Jowls- ovoid masses of fibrofatty tissues subcutaneous tissue immediately adjacent and lateral to inferior extremity of the nasolabial crease
Knowing several structures on the surface of the face will help improve understanding of the aging terminology.
1- Eye-Cheek Junction- This is a critical area in evaluating the aging face. Ideally this area is a smooth transition from the eye to the cheek.
2- Tragus- Part of the ear which is located on the face. In facelift surgery, an incision can be made behind this part of the ear (retrotragal) or in front of this part (pretragal)
3- Zygomatic Insertion Point- Location of the origin of zygomaticus major muscle determined by P Miller, S Smith, AR Shah (yes that is Dr. Shah). Serves also as a useful point to help identify platysma muscle location within the face.
4- Malar fat pad- Location of fat pad in face
5- Nasolabial fold- A fold which may become more prominent with aging. Note, that every person has a nasolabial fold and that its elimination will look unnatural
6- White part of the lip- As we age this part of the lip looks longer and the red lips become thinner.
7- Mandibular angle- Good bone structure may help lead to improved jawline and neckline
8- Marionette line- Lines along inferior lip which may become more prominent with aging.
9- Jowl- The jowl below the jawline can be improved with liposuction, the part above the jaw in the face is generally not recommended for liposuction.
10- Chin projection- A more prominent chin can help with providing more definition to the neck
11- Submandibular glands- In some patients, these glands may be prominent on the side view of the neck. They are generally not recommended to be removed for aesthetic purposes as they provide almost 80% of saliva.
12- Hyoid bone- A critical bone in the neck which helps determine how much of an L can be created in the neck.
13- Sternocleidomastoid muscle- A neck muscle who is typically much more prominent in men and should not be removed for aesthetic purposes.
There are differences between our faces and necks which will limit how much improvement we can see in a facelift. Much of this difference has to do with innate structures in our neck such as the chin and a bone in our neck called the hyoid bone. You can feel this part of your neck because if you stick your tongue out the bottom of the tongue will move this portion of the neck forward.
Figure Legend demonstrates how a patient’s neck with a smaller hyoid to chin distance (A to B) will have a more limited neck result than a patient with a larger hyoid to chin distance (A to B)
Dr. Shah’s practice is located in Chicago, Illinois in the gold coast area in the landmark Watertown building. His practice is one of the only facial plastic practices with a large contingent of international clientele mixed in with a growing base of Chicago and Chicagoland patients.