title: Where to fix in rejuvenation surgeries?: tensile strength of the periosteum.
abstract: The aim of this study is to elucidate the tensile strength of the periosteum relating to facial rejuvenation surgeries.Twelve hemifaces of 6 formalin-fixed Korean adult cadavers were used. Two horizontal incision lines were made 3 cm above the supraorbital rim and 1 cm below the infraorbital rim. Another 2 vertical incisions were on the medial orbital rim and 2 cm lateral to the lateral orbital rim. Elevated flaps were turned over, and the undersurfaces of the periosteum were exposed. A silk string was passed below the periosteum with a 3-mm bite and wound. A 3-cm loop was made, and this was pulled away using the tensiometer. The breaking strength was measured.The breaking strengths of the periosteum were different according to the location (P = 0.000, analysis of variation). The strongest point was 2 cm above the supraorbital rim at the medial one third of the orbit (14.05 [2.50] N) followed by 1 cm above the frontozygomatic suture (13.35 [4.70] N). The weakest point was the infraorbital rim at the lateral one third of the orbit (6.93 [3.76] N) followed by the lateral orbital rim at the level of the lateral canthus (7.60 [3.49] N). Breaking strengths of the periosteum of the medial side (11.44 [3.83] N) were significantly greater (P = 0.021, t-test) than the lateral side (9.32 [3.76] N). In the supraorbital area, the breaking strengths of the periosteum of the upper points (12.91 [3.00] N) were significantly greater (P = 0.000, t-test) than the lower points (9.36 [2.76] N).The results of this study can be of use when choosing a fixation point in rejuvenation surgeries.
authors.affiliation: From the *Department of Plastic Surgery, Inha University School of Medicine, Incheon; and †Department of Anatomy, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Kun
authors.initials: K
authors.lastname: Hwang
authors.forename: Han Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Han
authors.forename: Kyung Yong
authors.initials: KY
authors.lastname: Kim
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Park
authors.forename: Seong Kee
authors.initials: SK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D003357:Cosmetic Techniques; D005143:Eyelids / Q000033:anatomy & histology; D005145:Face / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000033:anatomy & histology; D010521:Periosteum / Q000033:anatomy & histology / Q000502:physiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012060:Rejuvenation; D047011:Silk; D013524:Surgical Flaps / Q000601:surgery; D013537:Sutures; D013718:Tensile Strength; D015050:Zygoma / Q000033:anatomy & histology
chemical_list: D047011:Silk