Aesthetic Plastic Surgery

, Volume 33, Issue 2, pp 147–152 | Cite as

An Anatomical and Analytical Study of the Modiolus: Enlightening Its Relevance to Plastic Surgery

  • Rola Abdullah Al-Hoqail
  • Eiman Mohamed Abdel Meguid
Original Article



This study was designed to evaluate the structures, muscles, and fasciae of which the modiolus is composed. It can aid in the understanding and, therefore, the utilization of plastic surgery for the aesthetic or reconstructive treatment of that region, especially the angle of the mouth.


Dissections of the midface were done on five different cadavers. They were of different races (3 males, 2 females). The anatomy of the modiolus was studied in detail. New anatomical observations were classified as type I through type VI.


The perifacial artery fascia contributed to the modiolus in four (80%) specimens and was not part of it in 1 (20%) specimen. The facial artery was anterior to it in one (20%) specimen, lateral in four (80%) specimens, and never medial to it. No significant relationship was observed between the perifacial artery fascia contribution to the modiolus and gender or race. Also, the location of the facial artery lateral or anterior to the modiolus was not significantly related to gender or race. In addition, the deep and superficial fasciae of the face converged not anterior to the masseter muscle but actually at the modiolus, which was different from observations made by others.


The modiolus is of critical importance in aesthetic and reconstructive plastic surgery of the face.


Anatomy of modiolus Fasciae of the face Face-lift Facial rejuvenation 


  1. 1.
    Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MW (1995) Gray’s anatomy, 38th edn. Churchill Livingstone, New York, pp 796–799Google Scholar
  2. 2.
    Zufferey JA (2002) Importance of the modiolus in plastic surgery. Plast Reconstr Surg 110(1):331–334PubMedCrossRefGoogle Scholar
  3. 3.
    Demiryurek D, Bayramoglu A, Erbil KM, Onderoglu S, Sargon MF, Aldur MM, Korkusuz P, Zazikoglu A (2003) Three-dimensional structure of the modiolus. A computerized reconstruction study. Saudi Med J 24(8):846–849PubMedGoogle Scholar
  4. 4.
    Hunter DE, Whitten P (1976) Encyclopedia of anthropology. Harper & Row Publishers, New York, pp 326–327Google Scholar
  5. 5.
    Parker JD, Schenker N, Ingram DD, Weed JA, Heck KE, Madans JH (2004) Bridging between two standards for collecting information on race and ethnicity: an application to Census 2000 and vital rates. Public Health Rep 119(2):192–205PubMedGoogle Scholar
  6. 6.
    Laws MB, Heckscher RA (2002) Racial and ethnic identification practices in public health data systems in New England. Public Health Rep 117(1):50–61PubMedGoogle Scholar
  7. 7.
    Copin H, Bremond-Gignac D, Cirilie K, Braun M, Kohler CH (2003) Histologic and anatomic correlation of the infra-orbital region. Morphologie 87(278–279):29–32PubMedGoogle Scholar
  8. 8.
    Jost G, Levet Y (1984) Parotid fascia and face lifting: a critical evaluation of the SMAS concept. Plast Reconstr Surg 74:42–51PubMedCrossRefGoogle Scholar
  9. 9.
    Dzubow LM (1986) The fasciae of the face: an anatomic and histologic analysis. J Am Acad Dermatol 14:502–507PubMedCrossRefGoogle Scholar
  10. 10.
    Onderoglu S (1999) Topographical relations of the facial artery in the region of the modiolus anguli oris. Okajimas Folia Anat Jpn 76(2–3):141–147PubMedGoogle Scholar
  11. 11.
    Oluwatosin OM, Oluwatosin OA (1998) Orofacial indices: a study in 240 Nigerian children. Afr J Med Sci 27(1–2):39–42Google Scholar
  12. 12.
    Pellisier P, Pistre V, Bustamante K, Baudet J (2000) The modiolus: comparative anatomy, embryological and physiological review. Ann Chir Plast Esthet 45(1):41–47Google Scholar
  13. 13.
    Zhao Z, Li S, Yan Y, Li Y, Yang M, Mu L, Huang W, Liu Y, Zhai H, Jin J (1999) New buccinator myomucosal island flap: anatomic study and clinical application. Plast Reconstr Surg 104(1):55–64PubMedCrossRefGoogle Scholar
  14. 14.
    Moschella F, Cordova A (1998) Platysma muscle cutaneous flap for large defects of the lower lip and mental region. Plast Reconstr Surg 101(7):1083–1089Google Scholar
  15. 15.
    Frindel F (2003) Sixteen keys for building a youthful smile. Orthod Fr 74(1):83–102PubMedGoogle Scholar
  16. 16.
    Psillakis JM (1994) Deep face-lifting techniques. Thieme Medical Publishers, Stuttgart, pp 1–9, 103–121Google Scholar
  17. 17.
    Tonnard PL, Verpaele AM (2004) The MACS-lift short-scar rhytidectomy, vol I. Quality Medical Publishing, St. Louis, MO, pp 1–53Google Scholar
  18. 18.
    Lemon ML, Goin JM (1993) Color atlas of SMAS rhytidectomy, operative techniques in plastic surgery. Thieme Medical Publishers, Stuttgart, pp 1–11Google Scholar
  19. 19.
    Tonnar PL, Verpaele AM (2007) Short-scar face lift operative strategies and techniques, vol II. Quality Medical Publishing, St. Louis, MO, pp 45–113Google Scholar
  20. 20.
    Barton FE (2008) Facial rejuvenation. Quality Medical Publishing, St. Louis, MO, pp 185–259Google Scholar
  21. 21.
    Burgess LPA, Goode RL (1994) Reanimation of the paralyzed face. Thieme Medical Publishers, Stuttgart, pp 37–51Google Scholar
  22. 22.
    Stuzin JM, Baker TJ, Gordon HL (1992) The relationship of the superficial and deep facial fasciae: relevance to rhytidectomy and aging. Plast Reconstr Surg 89:441–449PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2008

Authors and Affiliations

  • Rola Abdullah Al-Hoqail
    • 1
    • 2
  • Eiman Mohamed Abdel Meguid
    • 3
    • 4
  1. 1.Plastic Surgery Division, Department of SurgeryCollege of Medicine, King Faisal University (KFU)DammamSaudi Arabia
  2. 2.Al-KhobarSaudi Arabia
  3. 3.Anatomy DepartmentFaculty of Medicine, Alexandria UniversityAlexandriaEgypt
  4. 4.College of Medicine, King Faisal University (KFU)DammamSaudi Arabia

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