Anatomy of the aging face

The traditional approach to assessing the face is to consider the face in thirds (upper, middle, and lower thirds). While useful, this approach limits conceptualization, as it is not based on the function of the face. From a functional perspec­ tive, the face has an anterior aspect and a lateral aspect. The anterior face is highly evolved beyond the basic survival needs, specifically, for communication and facial expression. In contrast, the lateral face predominantly covers the struc­ tures of mastication. A vertical line descending from the lateral orbital rim is the approximate division between the anterior and lateral zones of the face. Internally, a series of facial retaining ligaments are strategically located along this line to demarcate the anterior from the lateral face (Fig. 6.1). The mimetic muscles of the face are located in the superficial fascia of the anterior face, mostly around the eyes and the mouth. This highly mobile area of the face is designed to allow fine movement and is prone to develop laxity with aging. In contrast, the lateral face is relatively immobile as it overlies the structures to do with mastication, the temporalis, masseter, the parotid gland and its duct, all located deep to the deep fascia. The only superficial muscle in the lateral face is the platysma in the lower third, which extends to the level of the oral commissure. Importantly, the soft tissues of the anterior face are subdi­ vided into two parts; that which overlies the skeleton and the larger part that comprises the highly specialized sphincters overlying the bony cavities. Where the soft tissues overlie the orbital and oral cavities they are modified, as there is no deep SYNOPS I S