Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
Laboratory of Cell and Tissue Biology, Keio University School of Medicine, Tokyo, Japan.
Clin Anat. 2024 Apr;37(3):321-328. doi: 10.1002/ca.24118. Epub 2023 Sep 21.
Deeply etched forehead creases indicate aging. Various treatments such as filler injections, fat grafting, and facelift surgery are used to remove them. However, knowledge of the anatomical structures associated with subcutaneous tissue changes and the superficial musculoaponeurotic system is lacking, and there is no consensus about the appropriate treatment. We have investigated the subcutaneous structures involved in forehead creases; this will help to establish selection criteria for improved treatment. The forehead sections of five unfixed adult Asian cadavers were obtained. Tissues containing forehead creases were removed from the periosteum and were examined using gross observation, radiography, histology, and nano-computed tomography. All methods revealed that the dermis in the skin crease area, namely the fold visible from the body surface, was bound to the frontalis muscle by a three-dimensional fibrous structure between the fatty septa. This structure was dense near the skin folds and sparse and thin in other areas. In particular, it was tightly bound to the dermis immediately below the crease, with collagen fibers traversing toward the epidermis. In addition, there were fewer skin appendages near the crease than in the normal area, or they were absent altogether; the epidermis was thicker, and the dermal papillae were more developed. It is thought that the density and firmness of the fibrous fatty septal structures between the dermis-frontalis muscle and the specific structures of the epidermis and dermis immediately below the crease account for the characteristic plastic forehead creases.
深刻的额纹表明衰老。各种治疗方法，如填充物注射、脂肪移植和面部提升手术，都被用于去除这些皱纹。然而，人们对与皮下组织变化和浅表肌肉腱膜系统相关的解剖结构缺乏了解，也没有关于合适治疗方法的共识。我们研究了涉及额纹的皮下结构；这将有助于建立更好的治疗选择标准。我们从五个未经固定的成年亚洲尸体的额部分获取组织。从骨膜上取下包含额纹的组织，通过肉眼观察、放射照相、组织学和纳米计算机断层扫描对其进行检查。所有方法都表明，在皮肤皱纹区域（即从体表可见的褶皱）的真皮与额肌之间存在由脂肪隔之间的三维纤维结构连接。该结构在皮肤褶皱附近密集，在其他区域稀疏且薄。特别是，它与褶皱下方的真皮紧密结合，胶原纤维向表皮穿过。此外，在褶皱附近的皮肤附属物比正常区域少，或者根本没有；表皮较厚，真皮乳头更发达。人们认为，真皮-额肌之间的纤维脂肪隔结构的密度和坚固性以及褶皱下方的表皮和真皮的特定结构是形成特征性的塑性额纹的原因。
