Invited Discussion on: Classification and Morphological Variation of the Frontalis Muscle and Implications on the Clinic
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Classification and Morphological Variation of the Frontalis Muscle and Implications on the Clinical Practice Luis O. Vasconez1,2
Received: 24 September 2020 / Accepted: 26 September 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Invited Discussion. Plastic surgery is an anatomically based specialty. Anything that delineates more accurately our anatomical knowledge is likely to have clinical value. The frontalis muscle, constantly activated in every face, has not received the detailed anatomical and functional study it deserves, particularly now that we can modify it by surgery or chemical paralysis. We welcome the authors study [1] of the frontalis muscle, although, I should say, I wish the dissections would have been done in fresh cadavers. The salient points of the study are as follows: 1.
2.
The paired muscles are not joined at the midline. They decussate at different levels. Not much different from the paired platysmal muscles well studied by Cardozo de Castro [2] The frontalis muscle does not insert along the entire length of the eyebrow. In fact in 6 out 24 specimens, there was no insertion in the distal third of the eyebrow (more so in Caucasians). This is of clinical importance as the authors emphasize.
3.
On average, the width of the muscle at the base was narrower in males than in females, even though the skull base is larger. (It would have been of interest to our readers to have the authors’ perspective for this finding.)
I was surprised that the authors discussed little or nothing in regard to gender or ethnic differences, even though, they set up this study with these differences in mind. Now, please allow me a personal perspective. What we know about facial muscles in general and facial wrinkles in particular.
Facial Muscles They are unique. They are not enveloped in a thick facia; they insert into the dermis and one can activate segments of the muscle, rather than the entire muscle. It is this unique ability which permits us to have the multitude of facial expressions. In contradistinction, skeletal muscles have a bony origin and insertions are encased by a thick fascia and thus contract in an ‘‘all or none fashion.’’
Facial Wrinkles & Luis O. Vasconez [email protected] 1
University Alabama- Birmingham, Birmingham, Al, US
2
Emory University, Atlanta, GA, US
They are present and visible on everyone. As a facial muscle contracts its dermal insertion produces a skin wrinkle. When we are young, the skin is very elastic and thus the wrinkles immediately disappear, after the muscle
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stops contracting. As we age, the skin has lost its elasticity, and the wrinkles remain.
As It
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