Where to fix in rejuvenation surgeries? Tensile strength of the periosteum

The aim of this study is to elucidate the tensile strength of the periosteum relating to facial rejuvenation surgeries. Twelve hemifaces of 6 formalin-fixed Korean adult cadavers were used. Two horizontal incision lines were made 3 cm above the supraorbital rim and 1 cm below the infraorbital rim. Another 2 vertical incisions were on the medial orbital rim and 2 cm lateral to the lateral orbital rim. Elevated flaps were turned over, and the undersurfaces of the periosteum were exposed. A silk string was passed below the periosteum with a 3-mm bite and wound. A 3-cm loop was made, and this was pulled away using the tensiometer. The breaking strength was measured. The breaking strengths of the periosteum were different according to the location (P = 0.000, analysis of variation). The strongest point was 2 cm above the supraorbital rim at the medial one third of the orbit (14.05 [2.50] N) followed by 1 cm above the frontozygomatic suture (13.35 [4.70] N). The weakest point was the infraorbital rim at the lateral one third of the orbit (6.93 [3.76] N) followed by the lateral orbital rim at the level of the lateral canthus (7.60 [3.49] N). Breaking strengths of the periosteum of the medial side (11.44 [3.83] N) were significantly greater (P = 0.021, t-test) than the lateral side (9.32 [3.76] N). In the supraorbital area, the breaking strengths of the periosteum of the upper points (12.91 [3.00] N) were significantly greater (P = 0.000, t-test) than the lower points (9.36 [2.76] N). The results of this study can be of use when choosing a fixation point in rejuvenation surgeries.