title: Anatomy of Forehead, Glabellar, Nasal and Orbital Muscles, and Their Correlation with Distinctive Patterns of Skin Lines on the Upper Third of the Face: Reviewing Concepts.
abstract: BACKGROUND
  The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients.
  
  
  METHODS
  Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles. Subgaleal dissection identified the cutaneous insertions of the muscles. They were correlated with skin lines on the upper third of the face of the cadavers that represent the muscle activity in life. Voluntary contraction was performed by 20 voluntary patients, 13 females and 7 males, with ages ranging from 35 to 62 years. Distinct patterns of skin lines on the forehead, glabellar and orbital areas, and eyebrow displacement were identified.
  
  
  RESULTS
  The frontalis exhibited four anatomical shapes with four different patterns of horizontal parallel lines on the forehead skin. The corrugator supercilii showed three shapes of muscles creating six patterns of vertical glabellar lines, three symmetrical and three asymmetrical. The orbicularis oculi and procerus had single patterns. The skin lines exhibited in voluntary contraction of the upper third of the face in patients showed the same patterns of the skin lines achieved in cadavers.
  
  
  CONCLUSIONS
  Skin lines in cadavers, which are the expression of the muscle activity in life, were similar to those achieved in the voluntary contraction of patients, allowing us to assert that the muscle patterns of patients were similar to those identified in cadavers.
  
  
  METHODS
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authors.affiliation: Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil. acabramo@abramo.com.br.
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Abramo
authors.affiliation: Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
authors.forename: Thiago Paoliello Alves
authors.initials: TP
authors.lastname: Do Amaral
authors.affiliation: Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
authors.forename: Bruno Pierotti
authors.initials: BP
authors.lastname: Lessio
authors.affiliation: Division of Plastic Surgery at the General Hospital São Luiz, ACA - Institute of Assistance in Plastic Surgery of São Paulo, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
authors.forename: Germano Andrighetto
authors.initials: GA
authors.lastname: De Lima
mesh_terms: D000368:Aged; D002102:Cadaver; D004210:Dissection / Q000379:methods*; D005152:Facial Muscles / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D005546:Forehead / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000033:anatomy & histology* / Q000601:surgery; D015361:Rhytidoplasty / Q000379:methods; D012680:Sensitivity and Specificity
keywords: Anatomical dissection; Corrugator supercilii; Frontalis; Orbicularis oculi; Procerus; Voluntary contraction