Comment on Perforating Frontal Branch of the Superficial Temporal Artery

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To the Editor: We have read with great interest the article entitled “Perforating Frontal Branch of the Superficial Temporal Artery as Related to Subcutaneous Forehead Lift” by Jo et al.1 We congratulate the authors for this work.
Considering our surgical and scientific experience in this field, we would like to add a few comments.
There are 2 major types of perforating vessels: direct perforators and indirect perforators. All perforators perforate the deep fascia on their way to the skin.2
The vessels that do not fit this definition are considered as direct cutaneous vessels.
Concerning the frontal branch of the superficial temporal artery, the literature3,4 and all the dissections we performed (Fig. 1) point toward direct cutaneous branches.
Indeed, in every patient, the source vessel never had a submuscular location but was running in the subcutaneous tissue.
Nonetheless, the cluster of direct cutaneous vessels is important to take into account.
These last 2 points have a major impact when it comes to surgery of the frontal region or cosmetic medicine, such as injection or thread lift.
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