こんな文献がでました

以前の記事で、顔の加齢変化を改善するのに皮膚の下のスペースを扁平化する発想もあるのでは・・ということを書きましたが、先日調べものをしていてこのコンセプトについて書かれている文献をみつけました。

Aesthetic Plastic Surgeryの最新号からです。

この文献、というかメンデルソンの文献はたくさんあるのですが、文中のイラストがカラーでとてもわかりやすいのが特徴です。

残念ながらここでイラストは紹介できませんが、興味のある人はＳpringerLink社からログインすると見れると思います。

イラストをみながら、文献を読むととても理解しやすいです。

以下にabstractを載せます。興味のある人はどうぞ・・

Aesth Plast Surg
DOI 10.1007/s00266-007-9060-3

Surgical Anatomy of the Lower Face: The PremasseterSpace,
the Jowl, and the Labiomandibular Fold
Bryan C. Mendelson Mark E. Freeman
Woffles Wu Richard J. Huggins

Abstract The anatomic basis for the jowl has not been fullydescribed. A formal analysis was performed of the sub-superficialmusculoaponeurotic system (SMAS) areolar tissue layer, whichoverlies the lower part of the masseter. For this research,facial dissections were performed on 16 fresh cadavers ages 12 to89 years, and detailed anatomic observations were made during the course ofseveral hundred rhytidectomy procedures. Tissuesamples from varying age groups were examined histologically. Theareolar cleavage plane overlying the lower masseter has specificboundaries and is a true space named the ‘‘premasseter space.’’This space is rhomboidal in shape, lined by membrane, andreinforced by retaining ligaments. The masseter fascia lines thefloor, and branches of the facial nerve pass under its deepsurface. Histologically, the floor is formed by a thin layer ofdense connective tissue, which undergoes minor deterioration inarchitectural arrangement with age. The roof, lined by a thin transparent and adherent membrane on the underside of theplatysma, has a less dense collagen network and contains more elastin. With age, there is a significant reductionin the collagen density of the roof. Expansion of the space with aging, secondary to weakness of the anterior andinferior boundaries, results in formation of the jowl. Medial tothe premasseter space is the buccal fat in the masticator space,which descends with aging and contributes to the labiomandibularfold and jowl. Application of the premasseter space in surgeryprovides significant benefits. The SMAS incision should beforward of the traditional preauricular location to be over thespace, not behind. Because the space is a naturally occurringcleavage plane, dissection is bloodless and safe, as all facialnerve branches are outside. The premasseter space should beconsidered as the preferred dissection plane forlower(cervicofacial) facelifts.