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An Update on the Anatomy of the Forehead Compartments

Cotofana, Sebastian M.D., Ph.D.; Mian, Asima; Sykes, Jonathan M. M.D.; Redka-Swoboda, Wolfgang M.D.; Ladinger, Andrea; Pavicic, Tatjana M.D.; Schenck, Thilo L. M.D., Ph.D.; Benslimane, Fahd M.D.; Ingallina, Fabio M.D.; Schlattau, Alexander M.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 864e–872e
doi: 10.1097/PRS.0000000000003174
Cosmetic: Original Articles

Background: The forehead is one of the most frequent locations for neuromodulator and soft tissue filler applications; however, the underlying anatomy is still poorly understood. Thus far, the presence of deep forehead compartments has not been confirmed.

Methods: Twenty Caucasian cephalic specimens, 15 fresh frozen (six female and nine male) and five with formalin-phenol embalmment (three female and two male) were investigated using contrast-enhanced computed tomographic scans, dye injections, and anatomical dissections.

Results: Three superficial (one central and two lateral) and three deep (one central and two lateral) forehead compartments were identified. The superficial fat compartments were found within the subcutaneous fat tissue (layer 2) and measured 2.1 × 4.6 mm for the superficial central forehead compartments and the right superficial lateral forehead compartments and 2.6 × 3.2 cm for the left superficial lateral forehead compartments, with a mean volume of 2.5, 3.1, and 3.4 cc, respectively. The deep fat compartments were identified deep to the frontalis muscle but superficial to the periosteum with an extent of 6.4 × 5.9 cm for the deep central forehead compartments, 2.6 × 5.8 cm for the right deep lateral forehead compartments, and 2.7 × 5.8 cm for the left deep lateral forehead compartments, and a mean volume of 9.1, 1.6, and 1.4 cc, respectively.

Conclusions: The results presented in this study increase the understanding of the forehead anatomy. Understanding the presence of the superficial and the deep forehead compartments allows one to change the signs of frontal aging. The deep forehead compartments are in general avascular planes and permit blunt dissection for access to the supraorbital region.

Roseau, Commonwealth of Dominica, West Indies; Salzburg, Austria; Sacramento, Calif.; Munich, Germany; Casablanca, Morocco; and Catania, Italy

From the Department of Anatomy, Ross University School of Medicine; the Institute of Anatomy and the Department of Radiology, Paracelsus Medical University Salzburg & Nuremberg; Facial Plastic and Reconstructive Surgery, University of California Davis Medical Center; FaceSthetics, private practice, and the Department of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians University; Clinique Benslimane; and Clinica Di Stefano Velona.

Received for publication August 10, 2016; accepted October 18, 2016.

Disclosure: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with the results presented or methods applied in this study.

Sebastian Cotofana, M.D., Ph.D., Department of Anatomy, Ross University School of Medicine, P.O. Box 266, Roseau, Commonwealth of Dominica, West Indies,

©2017American Society of Plastic Surgeons