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HISTOLOGY
(APPLICABLE FOR ESTHETIC TREATMENTS)
Christian Dumontier, Pierre Dumas
Plastic Surgery, Nice
ANATOMY ?
Arteries
Tendons
OSTEO-ARTICULAR AGEING
RATIO P1/PIP
NEURO-MUSCULAR AGEING
> 60 years
TENDON AGEING
Does not participate
SUPERFICIAL LAYERS
Nerve ageing
has no
influence
Nerves
Veins
Skin
VEINS
dilatation, microthrombosis,...)
Dr LEFEBVRE-VILARDEBO
HOWEVER
THE SKIN
Modification of both
volume and aspect
Glanz S et al. Aesthetic surgery of the arm. Part I. Aest Plast Surg 1981;5:1-17.
SKIN AGEING
Kuhne U, Imhof M. Treatment of the Ageing Hand with Dermal Fillers. J Cutan Aesthet Surg. 2012 Jul-Sep; 5(3): 163169
SKIN AGEING
THE SKIN
THE SKIN
THE SKIN
DORSAL SKIN
2 mm thick
Dermis 1 mm (no
meissner corpuscles),
DORSAL SKIN
150 cm2
Large surface
190 cm2
ANATOMICAL LAYERS ?
Kanavel (1939) found two layers: above muscles (deep) and above
tendon (superficial) where infection can spread
THREE LAMINAE ?
Fig. 2. reported
Histologic slideof
demonstrating
dorsal superficial
(DSL), dorsal
superficial fascia (DSF),
Bidic
three distinct
fattylamina
laminae
(superficial,
and dorsal intermediate lamina (DIL).
intermediate and deep) divided by thin fascia on the dorsum of
the hand.
THREE LAMINAE ?
Fig. 2. Histologic slide demonstrating dorsal superficial lamina (DSL), dorsal superficial fascia (DSF),
and dorsal intermediate lamina (DIL).
Fig. 3. Intraoperative photograph demonstrating dorsal intermediate fascia overlying the dorsal deep lamina where the extensor tendons run.
WHERE TO INJECT ?
WHERE TO INJECT ?
Volume 126, Number 1 Dorsal Hand Anatomy
It is technically impossible to
inject into the superficial lamina
without puncturing the veins !.
So where to inject ?