Snider Chelsea C, Amalfi Ashley N, Hutchinson Lauren E, Sommer Nicole Z
Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street, 3rd Floor, Springfield, IL, 62702, USA.
Department of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Aesthetic Plast Surg. 2017 Oct;41(5):1083-1090. doi: 10.1007/s00266-017-0889-9. Epub 2017 May 15.
The prominent nasolabial fold is a distinct feature of the aging midface. As minimally invasive procedures have become mainstream, chemodenervation is a preferred method for treating dynamic facial rhytids. We therefore sought to identify relevant nasolabial fold and midfacial muscular anatomy to determine the ideal location of neuromodulation to improve the aesthetics of the midface and nasolabial fold without altering the upper lip and smile.
Twelve hemifacial cadaveric dissections were performed to identify midface muscle origin, insertion, width, vector of pull, and neighboring structures. Attention was focused on the levator labii superioris alaeque nasi (LLSAN), levator labii superioris (LLS), nasalis, and orbicularis oculi. Measurements were obtained based on surface landmarks including the medial canthus for future neurotoxin injection.
The LLSAN inserts into the medial nasolabial fold and alar base, while the LLS inserts into the middle third of the nasolabial fold. The broadest portion of the superior LLSAN was on average 8.4 mm inferior and 4.6 mm medial to the medial canthus. A separate muscle obliquely oriented between the orbicularis oculi and LLSAN was identified and found to insert into the malar fat pad. This "malar levator" was present in all specimens and has implications on medial periorbital rhytids and the tear trough deformity.
This study further defines midfacial and nasolabial fold muscular anatomy and provides new insights into the use of neuromodulators for these areas without affecting upper lip position. The malar levator muscle appears to be a separate midfacial muscle with independent action.
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明显的鼻唇沟是面部中份老化的一个显著特征。随着微创手术成为主流，化学去神经支配是治疗动态面部皱纹的首选方法。因此，我们试图确定相关的鼻唇沟和面部中份肌肉解剖结构，以确定神经调节的理想位置，从而在不改变上唇和笑容的情况下改善面部中份和鼻唇沟的美观。
进行了12例半侧面部尸体解剖，以确定面部中份肌肉的起点、止点、宽度、牵拉方向和相邻结构。重点关注提上唇鼻翼肌、提上唇肌、鼻肌和眼轮匝肌。基于包括内眦在内的表面标志进行测量，以便未来进行神经毒素注射。
提上唇鼻翼肌插入鼻唇沟内侧和鼻翼基部，而提上唇肌插入鼻唇沟中三分之一处。提上唇鼻翼肌上部最宽处平均在内眦下方8.4毫米、内侧4.6毫米处。在眼轮匝肌和提上唇鼻翼肌之间发现了一条斜向的独立肌肉，它插入颧脂肪垫。这条“颧提肌”在所有标本中均存在，对眶周内侧皱纹和泪沟畸形有影响。
本研究进一步明确了面部中份和鼻唇沟的肌肉解剖结构，并为在不影响上唇位置的情况下在这些区域使用神经调节剂提供了新的见解。颧提肌似乎是一块具有独立作用的面部中份独立肌肉。
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