Anchor Tethers – mentolabial fold, chest and spine
Anchor tethers clearly overlap functionally and aesthetically with border tethers. These anchors are typically dense, tight tethers attached to the relatively inflexible deep fascia around muscles or bones. They separate visible planes, and in some cases, they serve as a mooring point or semi-rigid endpoint during rotation, flexion and extension. Forming a fixed skin crease, anchor tethers support the contours of the soft tissues above and below them.
Mentolabial Fold
The mentolabial fold or mental crease is perhaps the best example of anchoring tethers. These attachments track from the dermis all the way to the mandibular periosteum. The mentolabial fold adds contour to the lower lip and chin by separating the vertical convex chin plane from the horizontal sulcus beneath the vermillion or red margin of the lip. Look in the mirror. Put your finger below the halfmoon crease between your lower lip and chin, in the Kirk Douglas dimple. No matter how hard you pull, you can’t pull down the lower lip, because the tethers between the skin and the jaw bone serve as anchors. If not for them, your lower lip would pull down and you would drool every time you extend your neck or look up at the sky.
Dermal tethers deeply anchor the skin of the mentolabial fold to the periosteum of the mandible protecting the lower lip from pull when the neck is extended.
The anchored mental crease protects the central lip from distortion. The less rigid lateral submandibular tethers are subject to contracture from skin graft and platysma muscle shortening after a burn.
Feel the tethers between the skin and the lower edge of the jawbone in the jowl area. They are much looser and more flexible than those at the mental crease. For this reason, distortion of your lower lip from scar shortening after injury or surgery tends to occur laterally more than centrally. In the case of deep neck burns, the central anchoring tethers at the mental crease protect against the pull of the subcutaneous muscle (platysma) that extends from the chest onto the face. With aging, the lateral boundary between the face and neck is blurred, forming jowls as these tethers loosen and attenuate from gravity, loss of elasticity and the repetitive motion of chewing and talking.
So-called “ligaments of the face” have been known to aesthetic and reconstructive head and neck surgeons for many years and serve to protect the soft tissues of your face from distortion. What we are discovering is that when these anchoring attachments are preserved, their aesthetic and functional design remains intact. If they are injured by surgery or trauma or attenuated by aging, attempts can be made to normalize them by thoughtful orientation of incisions and/or skin graft seams and regenerative anti-aging techniques.
Artists draw or sculpt the nose as a complex of planes, shadows and light reflexes. The underlying structural and functional endoskeleton demonstrates once again how function and form rely on each other. As we move downward on the nose toward the tip, there are anchoring tethers between the cartilage, the external skin and the intranasal lining that contribute to the three-dimensional shape and orientation of our nose. If you inhale deeply, these connections between the underlying cartilage, muscles and skin facilitate flaring of the nostrils, which in turn, keeps the nasal airway from collapsing.
Chest
Chest and abdominal contours are determined to a large degree by The Cinderella Layer. The inframammary fold (crease beneath the breast) is formed by very thick, tight tethers anchored to the deep fascia over the ribs. This coalescence of tethers forms a supportive base shaping the inferior pole of each breast and separates the anterior chest from the abdomen. Artists and therapists undoubtedly already appreciate these separate aesthetic and functional domains. Cancer and burn reconstructive surgeons must observe the importance of these tethers in shaping the torso and breasts. Above the inframammary fold, longer, less dense tethers septate the breast extending from the pectoralis muscle fascia to the breast skin. These well-known suspensory ligaments form a soft tissue endoskeleton that shapes and projects the breast mound especially in females. One of our first anchoring tethers in-utero forms from our fetal-maternal nutritional attachment, the umbilical cord. The umbilicus (belly button) is a very important dermal-fascial tether contributing to the shape of our anterior trunk.
Dense, short tethers form the inframammary fold which runs along the bottom of the breast cupping and supporting it to shape the inferior pole and facilitate projection.
Dense, short tethers form the inframammary fold.
Sparser, longer tethers run from the pectoralis fascia to the dermis (suspensory ligaments of the breast) to help shape the breast.
Fasciocutaneous tethers (suspensory ligaments) support and shape the breast.
Spine
Tight, anchoring tethers between the dermis and the fascia of the paraspinous muscles on your back serve as a mooring point for trunk rotation. They also help with flexion and extension of the back by storing some transverse skin laxity between them. These lateral, rigid anchors run parallel to the spine neutralizing tension on looser, filmy tethers located directly over the vertebral spinous processes. The loose tethers centrally allow skin to move freely over the bony spine preventing injury from prolonged pressure while lying on hard surfaces or from friction forces. If we lose these boundary anchors, through surgery or injury, it may lead to scar-induced limitation of rotation, flexion and extension of the back.
Paraspinal rigid tethers on the back serve as mooring points for rotation. Filmy, central tethers are directly over the vertebral spinous processes.
Tight lateral tethers between the skin and the paraspinous muscle fascia.
By bridging dynamic rotational planes across the midline with skin grafts that will inevitably shorten and tighten, a tourniquet-type of contracture forms that limits mobility.