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.