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Dr Tim Pearce
As aesthetic clinicians and injectors, it is vital that you keep up to date with your facial anatomy knowledge so you can minimise risk when performing procedures.
In this blog, Dr Tim Pearce has compiled a round-up of his top 5 anatomy lessons to include the lips, chin, platysmal bands, facial ligaments, and the anatomy of the lower face.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.
Understanding lip anatomy
The first focus with lips is on the likely position of the superior labial artery. Clinical papers routinely describe the artery as usually running slightly above or within the vermillion border, found beneath orbicularis oris (60% of the time), but sometimes within the muscle (35%), and occasionally above (5%). This could vary within the same patient along the course of the artery, and anomalies do occur, such as a calibre persistent labial artery, which can present as a pulsating artery at the wet-dry border of the lip, seen in around 2-3% of the population.
When it comes to injecting fillers, whether using a horizontal or vertical technique, you are aiming for the anterior surface in front of the muscle to avoid the likely location of the artery.
Understanding chin anatomy
The anatomy of the chin can be tricky, and it may not be as safe to treat as you might think.
These are two main vessels to be aware of when injecting the chin for an augmentation procedure, the mental artery, and the submental artery, however, you should also be mindful of the inferior labial artery when approaching this area. Nevertheless, your primary focus will be on the submental artery.
The submental artery originates as a branch of the facial artery, running underneath the mandible and curving around to supply blood to the anterior part of the chin. Be that as it may, it is not as simple as it first appears. The submental artery supplies some very important structures in the neck as it traverses, passing under several muscles that stabilise the floor of the mouth upon swallowing, including the digastric muscle, geniohyoid, mylohyoid, and stylohyoid muscles which can all be affected by a compromise to the submental artery. In some people there is also an anastomosis between the sublingual artery and the submental artery. It is important to be aware of this aspect of the anatomy because if you are injecting with high volumes of filler product, as can be commonplace with chin augmentation, in theory, you could affect the blood supply to the tongue if you occlude or compromise the submental artery.
Read our recent blog which includes 6 tips for safe practice when performing chin augmentation.
Why does facial anatomy differ from the rest of the body?
When injecting the face with dermal filler, anatomy and physiology are your primary components of consideration. The anatomy is the physical structures and layers within which you are injecting your cosmetic product, so you must consider how the anatomy is going to change how your product behaves over time in a structure that has movement and requires function that must also not be compromised, unlike a static sculpture of a face where only the aesthetic matters. Educate yourself well on all the tissue structures – ligaments, connective tissue, SMAS, muscles, arteries and veins, superficial and deep fat pads, nerves, glands, etc.
Anatomy is dynamic, thus when you inject, you must remember to think in a 3D, dynamic way, rather than simply focusing on the 2D of static before and after photographs.
The purpose of the face is to communicate and is precisely why it has different musculature and anatomy compared to anywhere else in the body. Muscles elsewhere in the body run from bone to bone and move those bones to give us the ability to be mobile and move around. With the face, the muscles primarily run from bone to the surface of the skin and their only purpose is to move the skin so that we can communicate non-verbally, as an evolutionary survival skill.
Aesthetic injectors must understand the rules, ratios, and functions of the face to control dynamic beauty, as well as the static beauty, to maintain the aesthetics and function of the face and only affect movement in a good way – harmonising movement that may be unattractive and avoiding cessation of necessary movement.
What is the structure and function of the lower face muscles?
As discussed, there are interesting differences in the muscles in the face compared with other muscles in the body, in that they are either connected to each other or originate from bone to skin due to the requirement for facial movement. Focusing on the lower face, we find a considerable collection of muscles that control the mouth, elevate the lip, and move the chin, all of which are bone-to-skin muscles. However, masseter muscles for chewing and mastication are classic bone-to-bone muscles.
With this knowledge, we come to question, how are these muscles holding and supporting the structures? Dr Tim explains that the mid-face (mouth, nose, and chin) can be pictured as ‘hanging off’ the zygoma and the maxilla, supported by muscles running from those bony attachments, some in the role of elevator and some as depressor, alongside the facial ligaments.
Learn more about how to manage and avoid Botox complications with Dr Tim’s eLearning courses on botulinum toxin complications mastery.
Where are the facial ligaments located?
Dr Tim advises that you focus on the distribution of facial ligaments rather than on individual ligaments themselves, as most fall on an angle between the lateral and anterior face. The change in the function of the face is overlaid by the anatomy; as the focus moves from communication to mastication, the line of ligaments comes into play, forming a boundary line.
The ligament line that holds the anterior face in place starts in the upper face, at the temple with the superior temporal septum, moving down to the orbicularis retaining ligament around the eye, and the lateral orbital thickening which falls on that line, moving on to the zygomatic cutaneous ligaments, by far the strongest aspect of which is on the angle of the zygoma. Continuing downwards, we find the upper masseteric cutaneous ligaments, the masseteric cutaneous ligaments, and the mandibular septum along the line of the mandible, culminating in the mandibular cutaneous ligament.
Why you should not rely on a textbook to understand the platysmal bands
The platysma is a very superficial muscle, like a sheet. It collects into bands that can be relaxed (with botulinum toxin) if they become too prominent. The platysma is connected to the SMAS (superficial musculoaponeurotic system) thus relaxation can also have an overall aesthetic effect improving the jawline, the combined smoothing of the neck and jawline in this way is often referred to as the Nefertiti lift.
There is a risk of asymmetry in the lower mouth from this treatment because the platysma is often not as neatly defined as it appears in textbooks, but is instead woven in with depressor muscles, like the depressor anguli oris, which can become affected by injections of botulinum toxin higher up in the platysma, leading to a mouth droop.
If you’re looking to update your anatomy knowledge, then why not join Dr Tim Pearce on one of SkinViva Training’s Cadaveric Masterclasses where you will get an aesthetics-related deep understanding of anatomical structures and vascular complications.
Dr Tim would love to hear your thoughts on top anatomy tips, why not drop him a comment on social media, you can find Dr Tim Pearce on Instagram.
Aesthetics Mastery Show
Top Aesthetics Anatomy Lessons
This episode of the Aesthetics Mastery Show on YouTube is a compilation of Dr Tim’s top 6 anatomy lessons; including lips, chin, muscles, ligaments and platysmal bands.
The channel has over 37k subscribers – visit our YouTube channel to join.
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Foundation eLearning Courses
If you want to ensure you have the right building blocks in place for your medical aesthetics techniques, Dr Tim Pearce offers two foundation courses that are highly rated by our delegates:
Both give CPD and certificates on completion.
In addition, browse our FREE downloadable resources on complications.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.
