The forehead cutaneo-musculo-aponeurotic unit and aging of the forehead. Anatomo-physiological considerations and surgical implications

The occipitofrontalis muscle, as it is described in classical anatomy text books, does not exist. The epicranial aponeurosis or galea aponeurotica receives the occipitalis muscle on its deep surface and the frontalis muscle on its superficial surface. The frontalis muscle plays a fundamental role not only in forehead expression, but also in the support and elevation of the eyelids. This revised and corrected anatomy gives rise to the concept of the forehead cutaneomusculoaponeurotic unit, composed of skin, galea and frontalis muscle (forehead CMAU), resulting in a new forehead facelift which corrects forehead ageing, essentially related to recession of the forehead and relaxation of the galea.