Knowledge of facial anatomy critical

LaJolla, Calif. - As surgical abilities expand in dermatology, so too has the need for a thorough understanding of the surgical anatomy of the face by dermatologists, Hugh Greenway, M.D., says.

Twenty-three years ago, Dr. Greenway founded his superficial anatomy and cutaneous surgery course through the Scripps Clinic and the University of California. His aim was to help dermatologists, dermatologic surgeons and other physicians stay on the forefront of cutaneous surgery.

In addition to the steady rise in cosmetic and dermatologic surgeries, non-invasive procedures such as Botox (Allergan) injections and fillers have raised demand for the award-winning, week-long course. It fills to capacity each year.

Facial road maps

Critical areas of importance to dermatologists include the facial muscles around the eyes, nose, mouth, cheeks and ears and how they interact with each other, Dr. Greenway tells Dermatology Times.

With the potential of injecting a filler or other substance into a significant vessel, dermatologists also need to have a full understanding of the vascular supply to the face, including the fact that some vessels come from the internal carotid system, whereas others come from the external system.

A comprehensive knowledge of nerves is needed to give dermatologists a map to the branches of nerves and potential danger zones. For instance, the facial motor nerve is protected by the parotid gland in the pre-lobular cheek area. But as its branches exit the gland moving toward the muscles that they innervate, they are exposed in a "danger zone" of the cheek and temple, and for several centimeters they are at risk, Dr. Greenway says.

"To cut one of those would cause a loss of function in that muscle and could cause an asymmetrical appearance on the face," he says.

An understanding of sensory nerves is also needed in dermatology, especially because those areas are important in doing local nerve blocks that provide sensory anesthesia over regions of the face.

Other specialized areas

Where the neck is concerned, among the many things clinicians should know is that over time, the anatomic structure tends to droop, due to gravity and aging.

"One branch of facial nerves actually tends to drop down into the upper neck a bit in older patients, and doctors need to be aware of that," Dr. Greenway says.

Other specialized areas, ranging from the tear duct system in the eyes to the nose and its function as an air exchange and the bones' supporting structure in the nose all need to be considered in certain dermatological surgeries.

"To achieve the best outcome in any surgery and limit any inherent risk, you really need to know the anatomy," Dr. Greenway concludes.

Disclosure: Dr. Greenway reports no conflicts of interest regarding companies and products mentioned in this article.

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