Skip to main content
SpringerLink
Log in

Anatomie im Kopf-Hals-Bereich

Plastisch-chirurgisch relevante Grundlagen

Anatomy of the head and neck region

Relevant principles in plastic surgery

  • Leitthema
  • Published:
Journal für Ästhetische Chirurgie Aims and scope

Zusammenfassung

Zur chirurgischen Intervention im Gesichtsbereich gehören profunde Kenntnisse der Anatomie. Das Gesicht kann nach dem SCALP-Prinzip in 5 Schichten aufgeteilt werden. Eine Besonderheit des Gesichts ist die Existenz des superfiziellen muskuloaponeurotisches Systems (SMAS), das die Dermis mit den darunter liegenden mimischen Muskeln verbindet und die Grundlage für die exakte Übertragung von Gesichtsausdrücken bildet. Es besteht aus einem Netzwerk an Kollagenfasern, elastischen Fasern, Myo- und Adipozyten. Das muskuloaponeurotische System trennt die oberflächlichen von den tiefen Fettkompartimenten, die das Gleiten der Gesichtsmuskeln ermöglichen. Nebeneinander lokalisierte Fettkompartimente werden durch sog. „retaining ligaments“ separiert. Die Lokalisation und das Volumen dieser Kompartimente ändern sich im Alter. Der Gesichtsschädel ist als knöchernes Grundgerüst für die Gesichtsweichteile ebenfalls den Alterungsprozessen durch Knochenresorption unterworfen. Die 7 „danger zones“ – potenzielle Gefahrenzonen – beschreiben potenzielle Nervenschädigungsareale, die bei chirurgischen Eingriffen berücksichtigt werden müssen.

Abstract

For surgical interventions in the facial area profound knowledge of anatomy is essential. The facial soft tissue can be divided according to the SCALP principle into five basic layers. A unique feature is the superficial musculoaponeurotic system (SMAS), which connects the dermis to the underlying facial muscles and is seen as a basic prerequisite for the precise transmission of facial expressions. It contains a network of collagen fibers, elastic fibers, myocytes and adipocytes. The SMAS separates the superficial from the deep fat compartments which allows gliding of the facial muscles. Boundaries between adjacent fat compartments are separated by so-called retaining ligaments. The localization and volume of these compartments alters with aging. The facial skeleton as the bony scaffold of the facial soft tissues provides projection to the overlaying tissues and is also affected by significant resorption during aging. The seven danger zones describe areas of potential nerve damage that need to be considered in surgical interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. De la Cuadra-Blanco C, Peces-Peña MD, Carvallo-de Moraes LO, Herrera-Lara ME, Mérida-Velasco JR (2013) Development of the Platysma Muscle and the Superficial Musculoaponeurotic System (Human Specimens at 8–17 Weeks of Development). Scient World J 8 (Article ID 716962)

  2. Furnas DW (1989) The retaining ligaments of the cheek. Plast Reconstr Surg 83:11

    Article  CAS  PubMed  Google Scholar 

  3. Gassner HG, Rafi i A, Young A, Murakami C, Moe K, Larrabee WF (2008) Surgical anatomy of the face. Implications for modern face-lift techniques. Arch Facial Plast Surg 10(1):9–19

    Article  PubMed  Google Scholar 

  4. Ghassemi A, Prescher A, Riediger D, Axer H (2003) Anatomy of the SMAS revisited. Aesthetic Plast Surg 27(4):258–264

    Article  PubMed  Google Scholar 

  5. Har-Shai Y, Bodner SR, Egozy-Golan D, Lindenbaum ES, Ben-Izhak O, Mitz V, Hirshowitz B (1996) Mechanical properties and microstructure of the superficial musculoaponeurotic system. Plast Reconstr Surg 98:59–70

    Article  CAS  PubMed  Google Scholar 

  6. Har-Shai Y, Bodner SR, Egozy-Golan D, Lindenbaum ES, Ben-Izhak O, Mitz V, Hirshowitz B (1997) Viscoelastic properties of the superficial musculoaponeurotic system (SMAS): a microscopic and mechanical study. Aesthetic Plast Surg 21:219–224

    Article  CAS  PubMed  Google Scholar 

  7. Macchi V, Tiengo C, X Porzionato A et al (2009) Histotopographic study of the fibroadipose connective cheek system. Cells Tissues Orgns 191(1):47–56

    Article  Google Scholar 

  8. Marten TJ (1997) Facelift. Plannung and technique. Clin Plast Surg 24(2):269–308

    CAS  PubMed  Google Scholar 

  9. Mendelson BC (2007) Advances in the understanding of the surgical anatomy of the face. In: Eisenmann-Klein M, Neuhann-Lorenz C (Hrsg) Innovations in plastic and aesthetic surgery. Springer Verlag, New York, S 141–145

    Google Scholar 

  10. Mendelson BC (2009) Facelift anatomy, SMAS, retaining ligaments and facial spaces. In: Aston J, Steinbrech DS, Walden JL (Hrsg) Aesth plast surg. Saunders Elsevier, London, S 53–72

  11. Mendelson B, Wong CH (2012) Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plast Surg 36(4):753–760

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mendelson B, Wong CH (2013) Anatomy of the aging face. In: Neligan PC (ed) Plastic surgery, 3rd edn. Elsevier Saunders, Philadelphia, S 78–92

  13. Mendelson BC, Freeman ME, Wu W, Huggins RJ (2008) Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg 32(2):185–195

    Article  PubMed  Google Scholar 

  14. Mendelson BC, Muzaffar AR, Adams WP (2002) Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 110(3):885–896

    Article  PubMed  Google Scholar 

  15. Mitz V, Peyronie M (1976) The superficial musculo aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 58(1):80–88

    Article  CAS  PubMed  Google Scholar 

  16. Moss CJ, Mendelson BC, Taylor GI (2000) Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 105:1475–1490

    CAS  PubMed  Google Scholar 

  17. Özdemir R, Kilinç H, Unlü RE, Uysal AC, Sensöz O, Baran CN (2002) Anatomicohistologic study of the retaining ligaments of the face and use in face lift: retaining ligament correction and SMAS plication. Plast Reconstr Surg 110(4):1134–1147

    Article  PubMed  Google Scholar 

  18. Pessa JE, Slice DE, Hanz KR, Broadbent TH Jr, Rohrich RJ (2008) Aging and the shape of the mandible. Plast Reconstr Surg 121:196–200

    Article  CAS  PubMed  Google Scholar 

  19. Prendergast PM (2012) Anatomy of the face and neck. In: Shiffman MA, Di Guiseppe A (Hrsg) Cosmetic Surgery. Springer-Verlag, Heidelberg. doi:10.1007/978-3-642-21837-8_2

  20. Radlanski R, Wesker K (2011) Das Gesicht: Bildatlas klinische Anatomie. KVM-Verlag, Berlin

    Google Scholar 

  21. Ramirez OM (2014) Multidimensional evaluation and surgical approaches to neck rejuvenation. Clin Plast Surg 41(1):99–107

    Article  PubMed  Google Scholar 

  22. Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119(7):2219–2227

    Article  CAS  PubMed  Google Scholar 

  23. Rohrich R, Arbique GM, Wong C, Brown S, Pessa JE (2009) The anatomy of suborbicularis fat: implications for periorbital rejuvenation. Plast Reconstr Surg 124(3):946–951

    Article  CAS  PubMed  Google Scholar 

  24. Rohrich RJ, Hollier LH Jr, Janis JE, Kim J (2004) Rhinoplasty with advancing age. Plast Reconstr Surg 114:1936–1944

    Article  PubMed  Google Scholar 

  25. Rossell-Perry P, Paredes-Leandro P (2013) Anatomic study of the retaining ligaments of the face and applications for facial rejuvenation. Aesthetic Plast Surg 37:504–512

    Article  PubMed  Google Scholar 

  26. Saulis AS, Lautenschlager EP, Mustoe TA, Forrest CR (2002) Biomechanical and viscoelastic properties of skin, SMAS, and composite flaps as they pertain to rhytidectomy. Plast Reconstr Surg 110(2):590–598

    Article  PubMed  Google Scholar 

  27. Seckel BR (1994) Facial Danger Zones: avoiding nerve injury in facial plastic surgery. Churchill Livingstone Press, 52P

  28. Shaw RB, Katzel EB, Koltz PF, Yaremchuk MJ, Girotto JA, Kahn DM, Langstein HN (2011) Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg 127(1):374

    Article  CAS  PubMed  Google Scholar 

  29. Skoog T (1974) Plastic surgery: new methods and refinements. Saunders, Philadelphia

    Google Scholar 

  30. Stuzin JM (2006) Restoring facial shape in face lifting: the role of skeletal support in facial analysis and midface soft-tissue repositioning. Plast Reconstr Surg 119:362–376

    Article  Google Scholar 

  31. Stuzin JM, Baker TJ, Gordon HL (1992) The relationship of the superfi cial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 89(3):441–449

    Article  CAS  PubMed  Google Scholar 

  32. Zide BM (2006) ROOF and beyond (superolateral zone). Surgical anatomy around the orbit. The system of zones. Lippincott Williams & Wilkins, Philadelphia, S 57

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    N. Pallua &  Verena-Constanze Buchinger-Kähler

Authors
  1. N. Pallua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Verena-Constanze Buchinger-Kähler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Pallua.

Ethics declarations

Interessenkonflikt

N. Pallua und V.-C. Buchinger-Kähler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pallua, N., Buchinger-Kähler, VC. Anatomie im Kopf-Hals-Bereich. J Ästhet Chir 8, 157–163 (2015). https://doi.org/10.1007/s12631-015-0021-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12631-015-0021-4

Schlüsselwörter

Keywords

Search

Navigation