Reply: The Fascial Planes of the Temporal Region Related to the Frontal Branch of the Facial Nerve

Sir: In response to the Letter to the Editor, the authors of the referenced article “The Frontal Branch of the Facial Nerve across the Zygomatic Arch: Anatomical Relevance of the High-SMAS Technique” appreciate the comments about the article and agree that this area in the temporal region is confusing. This was one of our major inspirations for performing the anatomical study. We feel that the recommendations in the letter may continue to add layers within this area rather than formally define them. The parotid temporal fascia as described in our article is a defined fascial plane below the transition between it and the temporal parietal fascia. From our anatomical dissections with histologic evaluation and the senior author's vast clinical experience, it appears that there is a fusion plane between the parotid temporal fascia and the temporal parietal fascia where the frontal branch transitions from a deep to a more superficial depth. This point was captured on histologic evaluation and contains an anterior branch of the superficial temporal artery. This fascial plane can be separated easily in anatomical and clinical dissection, thus explaining the conclusion of our article that the division of the superficial musculoaponeurotic system can be performed safely above the zygomatic arch. Above this fusion point, it is very difficult to define two distinct fascial planes between the temporal skin and deep temporal fascia. Therefore, we would simplify rather than complicate this area and keep the temporal parietal fascia as the intermediate fascial plane and not name an additional intermediate temporal fascia. Andrew P. Trussler, M.D. Department of Plastic Surgery University of Texas Southwestern Medical Center 1801 Inwood Road Dallas, Texas 75490