Anatomical study on the temporal fascial layers and their relationships with the facial nerve

The recent application of endoscopic techniques in facial rejuvenation has stimulated a new interest in the anatomy of this region. In endoscopic face lift, as in open techniques, one of the main steps is the conjunction of dissections of the upper and midface without damage to the frontal branch of the facial nerve. This article provides an accurate account of the organization of the temporal fascial layers and their relationship with the facial nerve. The authors' dissections confirm that the frontal branch, despite the variations in branching patterns, has an anatomical relationship with the surrounding fasciae that can be deemed constant and predictable: The frontal branch lies in the deep layer of the fatty tissue interposed between the suprazygomatic extension of the superficial musculoaponeurotic system (SMAS) and the superficial leaflet of the temporal aponeurosis. The arrangement of the temporal fasciae on the zygomatic arch is also discussed.