Facial Anatomy & Its Impact On Our Appearance As We Age

More Than Skin Deep: Understanding Your Facial Anatomy Before Undergoing Cosmetic Surgery or Treatments

Dr David Sharp

Specialist Plastic Surgeon + Registered Medical Practitioner

Article written by Director and Journalist Liz Washington B.Journ, and medically reviewed by Dr. David Sharp, MBBS, FRACS (Plast)

Exploring Facial Anatomy: What Lies Beneath?

Understanding the intricate anatomy and physiology of the face might feel somewhat overwhelming for those of us without a medical degree. But when it comes to cosmetic surgery and cosmetic treatments, knowledge is power – and knowing some basic information about your facial anatomy will help you during the important patient education process that is undertaken before any procedures are performed. This period, prior to your surgery or treatment, is called the ‘informed consent’ period because it ensures that you make a confident, well informed decision about your body. But in order to do so, you need to know the parts of your body that may be involved with your treatment plan.

Skin

Starting from the top, our skin consists of three layers: epidermis, dermis, and subcutaneous fat.

The major structural component of the dermis is collagen, of which Type I and Type III are the most common. Type I accounts for about 80% of the total collagen in human skin. Elastic fibres (elastin) makes up about 3% of the dry weight of the dermis. Both deplete as we age, starting in our 30s.

Fat pads

Subcutaneous fat lies beneath the dermis. The cheeks, temples, and neck have the thickest subcutaneous fat pads, and the size of these varies between patients. Connective tissue septa divide the subcutaneous fat into lobules.

The superficial musculoaponeurotic system (SMAS) is a thin layer of fascia that connects facial muscle contractions to the skin. Facial expression results from the contraction of the mimetic muscles. These muscle actions are then transmitted to the skin by ligamentous attachments located between the SMAS and the dermis. Over time, the effects of gravity and age cause relaxation and laxity of facial soft tissues.

Major vessels and nerves are deep to the SMAS, and their smaller branches perforate it. In the lower face, the facial nerve branches are underneath the SMAS, as are sensory nerves. It’s important to understand how these nerves may respond if they are injured or severed during a procedure.

Facial Musculature

The facial muscles serve as the engine behind facial expressions and movements, categorised into superficial and deeper layers:

Superficial Muscles:

Frontalis: Elevates the eyebrows and forms horizontal forehead wrinkles.

Orbicularis oculi: Encircles the eye, facilitating eye closure and contributing to the formation of crow’s feet (lines either side of your eyes).

Orbicularis oris: Encircles the mouth, enabling lip puckering, smiling and involved in the formation of mouth lines. The Depressor Anguli Oris (DAO) pulls down the corners of the mouth.

Deeper Muscles:

Masseter: Located in the jaw, facilitates chewing and grinding, and can become enlarged or painful due to teeth clenching.

Platysma: Situated in the neck, responsible for downward mouth movement, visible neck ‘bands’ or ‘strings’ and neck wrinkles.

Anatomical Landmarks and Structures

In addition to muscles, your face has a number of important anatomical landmarks and structures that impact how you age:

Blood Vessels: Positioned just beneath the skin, including facial arteries, veins and capillaries. As we age, our circulation system is weaker, reducing the amount of oxygenated blood that gets to our tissues and skin. Hence many cosmetic therapies such as massage, ultrasound, LED and aim to improve facial blood flow.

Nerves: Such as the facial nerve and trigeminal nerve enable our muscles to move and facial expressions, as well as chewing and swallowing.
Bone Structure: The skull, mandible, and zygomatic bone provide the framework or ‘scaffolding’ for muscles, fat pads and skin. As we age, these deplete, reducing volume and support for the overlying structure.

Why Your Clinician’s Anatomy Knowledge Matters

The face contains complex anatomical structures and a thorough understanding of key anatomical landmarks, as well as anomalies, is integral to safe practice.

About Dr. David Sharp:

Dr. David Sharp is an experienced specialist plastic surgeon in Brisbane, with a special interest in breast, body and facial cosmetic surgery.

With over two decades of experience in medicine, Dr. Sharp has performed over 20,000 surgical procedures in Australia and has an established surgical and non surgical practice in Brisbane.

For more information and to schedule an appointment with Dr. David Sharp, please contact our patient support team at 3202 4744 or visit our online booking request form here.

This information is intended for general knowledge and should not replace personalised advice from your surgeon. Always consult with your surgeon for individual care.