A comprehensive examination of topographic thickness of skin in the human face.
BACKGROUND
Knowledge of topographic skin thickness is important to plastic surgery of the face as it may guide resection and restoration in oncologic, aesthetic, and reconstructive procedures.


OBJECTIVE
The purpose of this study is to report the relative thickness of the face throughout 39 distinct subunits.


METHODS
Full-thickness punch biopsy samples were obtained at 39 predetermined anatomic locations of the face from 10 human cadaveric heads. Tissue was fixed in paraffin-embedded slides and analyzed using triplicate measurement of dermis and epidermis using computerized measurements. Data were analyzed using univariate statistical analysis and expressed as mean thickness values and relative thickness (RT) values based on the thinnest portion of the face.


RESULTS
The area of the face with the thickest dermis was the lower nasal sidewall (1969.2 µm, dRT: 2.59), and the thinnest was the upper medial eyelid (758.9 µm, dRT: 1.00). The area with the thickest epidermis was the upper lip (62.6 µm, eRT: 2.12), and the thinnest was the posterior auricular skin (29.6 µm, eRT: 1.00). Our results confirm that eyelid skin is the thinnest in the face. The thickest portions of the skin appeared to be in the lower nasal sidewall, but the measurements are comparable to those in the ala and posterior auricular skin, which are novel findings.


CONCLUSIONS
The greatest epidermal, dermal and total skin thickness are found in the upper lip, right lower nasal sidewall, and left lower nasal sidewall respectively. The least epidermal skin thickness is in the posterior auricular skin. The least dermal skin thickness, and the least total skin thickness, are both in the upper medial eyelid.
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Karan
K
Chopra
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Daniel
D
Calva
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Michael
M
Sosin
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Kashyap Komarraju
KK
Tadisina
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Abhishake
A
Banda
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Carla
C
De La Cruz
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Muhammad R
MR
Chaudhry
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Teklu
T
Legesse
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Cinithia B
CB
Drachenberg
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Paul N
PN
Manson
Drs Chopra, Calva, and Banda are Residents and Dr Manson is a Professor, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD. Dr Sosin is a Resident, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, and the Department of Surgery, MedStar Georgetown University Hospital, Washington, DC. Mr Tadisina is a Medical Student, University of Illinois at Chicago College of Medicine, Chicago, IL. Ms De La Cruz is a Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Chaudhry is a Postdoctoral Research Fellow, Dr Legesse is a Resident, and Dr Drachenberg is a Professor, Department of Pathology, University of Maryland Medical Center, Baltimore, MD. Dr Christy is an Associate Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD, and Interim Chief, Section of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
Michael R
MR
Christy
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002102:Cadaver; D004817:Epidermis / Q000033:anatomy & histology*; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D012867:Skin / Q000033:anatomy & histology