Anatomical Description of the Human Extratemporal Facial Nerve, Muscles and Wrinkles of the Face: Some Basics of the Facial Aging.

During the human life the face shows important changes. Transformation of the facial bones and fatty tissue occur, characteristic rids appear on the front, around the eyes, the mouth and elsewhere. Besides the extrinsic factors like the gravitation, the formation of the rids is strongly influenced by the underlying muscles of the subcutaneous musculoaponeurotic system. The muscular morphology is individual. The muscles are innervated by the branches of the facial nerve, showing a fan-like distribution, a highly complex network. Lesions of the extratemporal facial nerve lead to palsy or paresis with an important impact on function, aesthetics and the quality of life. Trauma to the nerve can be caused by aesthetic interventions, like facial lifting motivated by aging phenomena. To avoid iatrogenic damage of the nerve, precise knowledge of its anatomy and relationships with other structures like bones, cartilages and muscles is a must. This chapter describes the basic causes of the facial aging, the most important muscles, typical manifestation of the rids and focuses on the protection of the extratemporal facial nerve describing its anatomy and giving hints how to find them.

 

Aesthetic Problems Related to Wound Healing as Observed During Humanitarian Missions.

The human skin represents a protecting barrier of the body with an important surface exposed to traumas. Its characteristics like color, rids, collagen content and annexes are individualizing factors. The consequences of penetrating mechanical trauma /piercing, surgery../ are different, depending on the characteristics of the trauma, quality of the skin, extrinsic and intrinsic conditions, like smoking, diabetes, potential pathogens, ambient humidity and others. Normally, the cicatrisation goes through 3 basic phases: inflammation, proliferation and maturation. Keloids and hypertrophic scars are frequent disorders of scarring. While the hypertrophic scars respect the original site of the injury, keloids may develop extreme forms and besides the aesthetic consequences, pain, itching and ulceration may occur. Keloids are more frequent in the case of African, Asian and Latino ancestry, their incidence among the patients seeking for aesthetic treatments is higher in the corresponding continents and may represent an important issue during humanitarian missions. Ritual skin incisions, incisions related to traditional healing, surgery and trauma are the most important causes. Many of the patients demand removal. The therapeutic means are numerous, in this geographical areas steroid injections are the most widely used. Silicon compression, LASER and other means are far less available.