Facial Anatomy: The Essential Map for Aesthetic Practice

Five-layered face

In modern aesthetic anatomy, the face is divided into five layers: (1) skin; (2) superficial fat pads (subcutaneous fat); (3) SMAS (Superficial Musculoaponeurotic System — mimic muscles and the fibrous layer covering them); (4) deep fat pads; (5) bone skeleton with periosteum. Each layer ages with its own timing.

While deep fat pads (e.g., deep medial cheek fat, Ristow's space) remain hidden in a young face, they slide or deplete with aging — this is the primary source of the hollowed appearance of the midface. Superficial fat, on the other hand, melts more slowly but tends to "sag downwards"; it deepens the nasolabial fold.

SMAS: the internal suspension system of the face

The SMAS layer is a fibrous network system underlying the skin, covering the facial muscles, and connecting them downwards to the bone with ligaments. The relaxation or displacement of this system is one of the most important external indicators of aging — with advancing age, the face "flows" downwards. HIFU, RF, and surgical facelift are procedures that intervene in this layer.

Vascular-nerve map

The face is vascularly supplied by two main arteries: the facial artery, a branch of the external carotid, and the ophthalmic artery, a branch of the internal carotid. The anastomosis (junction point) of these two systems is in the glabella region — an incorrect filler injection into the glabella can cause back pressure on the arteries supplying the eye, leading to blindness. Therefore, glabella anatomy is information that every aesthetic physician must memorize for their field.

Neurally, the seventh cranial nerve (facial nerve) innervates all mimic muscles. It runs superficially in areas close to Stensen's duct in front of the cheek — if the depth setting is incorrect at these points, there is a risk of temporary facial paralysis.