Cranio-Facial Anatomy & Physiology

The head contains what makes us. Our thoughts, the processing, and the brain that controls everything
about our existence. Despite what we would think of as muscular areas the head has a surprising
amount of muscles to make it function. On top of that your head is unique in many ways
physiologically from it's skin down to unique bones. With both piercing and tattooing it is unnecessary
to know all the bones, but knowing which bone is where will help you identify what type of tissue
you're working with and will also help you to better guide your clients in making smart choices with
their modifications.

The Skull
The skull is made of 22 individual bones plus the mandible. Its purpose is to support the face and
protect the brain. Some parts of the brain also have their own names based on where they are located
even if they are made of more than one bone. The orbit of the eye, for example, is a collection of the
nasal bones, frontal bone, sphenoid, maxilla and more.
While understanding the bones of the skull is not a necessity for body modification procedures
understanding where certain bones lie will allow better understanding of how the superior structures
function. For example, knowing where the nerve foramen are located will help identify which nerve
may have been affected post procedure.

Facial Musculature
There are over 20 different muscles in the face. They're used for making expressions, chewing, and
more. Especially when it comes to piercing putting jewelry into the wrong muscle or the wrong place
can either seriously damage the ability of that muscle to function or it can end up causing the piercing
to be unable to heal. This is especially true of the cheeks. Many of the facial muscles work in groups to
make actions happen.
Occ
ipito frontalis or frontal fontalis
This runs from the occipital bone down to the brow ridge. It is responsible for raising your eyebrows
and causing your forehead to wrinkle. This is also where botox is delivered to smooth those lines.
Procerus
This muscle is between the eyebrows and pulls the brows downward. It also flares the nostrils when
contracted. This small muscle is part of the glabella complex which includes the supercillii and
orbicularis oculi which all work together to form a frown.
Corrigator Supercilli
This is located under the eyebrow and runs along the brow ridge. During an eyebrow piercing this must
be lifted out of the way and the piercing placed underneath. Without lifting or by piercing through this
the piercing will be tugged and pulled every time the muscle moves. It runs into the dermis and is very
superficial as it pulls the skin inward.
Depressor Supercilli or Levator Labii
This is part of the orbicularis occuli that nests into the corrigator supercilli under the eyebrow. This is
also important to not pierce into when doing a bridge piercing. It sits to the interior of the eye orbit and
can be felt if you pinch the bridge of the nose and lift your eyebrows.
Orbucularis Oculi
This is one of the most important facial muscles for both cosmetic tattooing and for piercing. It is a
round collection of muscle around the eye orbit. It is the most superficial of muscles around the eye and
sits on top of the corrigator supercilli and others. This muscle opens and closes your eyelids and
controls some eye movement such as narrowing or closing the eyes.
Temporalis
This forms the sides of the ocular orbit and is also used for chewing. It reaches all the way down the
face along the hairline and attaches to the zygomatic arch.
Zygomaticus Major
This is used for smiling by elevating the corners of the mouth. This is one of the muscles that is
affected with cheek piercings. It runs from the zygomatic arch to the corner of the lip across the outside
of the cheek. It is used for pulling up the cheeks
Zygomaticus Minor
It runs medial to the Major and is used to elevate the upper lip. It is used for lip movement and is where
a Monroe piercing sits between this and the lower edge of the Major.
Levator Labii Superioris Alaeque Nasi
This is the longest named muscle in the body. It's used to elevate the lip and for lip movement with
certain facial expressions, especially snarling. It runs along the side of the nose and also pulls on the
nose when crinkling the nose. It specifically pulls the lip line upward when contracting and is inferior
to the orbicularis oris.
Orbicularis Oris
A circular ring of 4 muscles surrounding the mouth that work together for lip movements. It contracts
both the upper and lower lips and the shape of the lips is created by the shape of this muscle group.
When you pout the upper ring of muscle contracts and the lower relaxes.
Depressor Angularis Orbis
This pulls down at the corners of the mouth. It originates at the chin and pulls down away towards the
jawline. It is the opposite of the Zygomaticus Major and the two work in tandem when pulling at the
lips.
Depressor Labii Orbis
This is medial and inferior to the Angularis and works to pull down on the lower lip. The strength of
this muscle determines whether the lower teeth are visible when smiling.
Mentalis
This is the central muscle of the chin, extending upwards to the lower lip. It is the deepest muscle
around the lip and sits underneath the depressors and the oris. The shape of this muscle determines
whether you have an indent in your chin or not.
Buccinator
This is the inside and deepest muscle of the cheek. It sits under the fat pad of the cheek and is the
strongest muscle a baby has since it's used for suckling.
Risoricus
This is superior to the fat pad on the cheek from the buccinator and is used for smiling. The outer
surface of the masseter muscle which is used for biting. It is used for forming many facial expressions,
especially smiling and laughing. This forms the underside of the cheek round.
Masseter
This is the muscle used for biting and is a thin sheet across the cheek.
Nasalis
This is the tip of the nose and extends across the front of the nose and up to the bridge. It covers the
cartilage of the nose and allows the nose to crinkle.
 Facial Fat Pads
The fat pads of the face serve to protect the various facial structures and also to provide support for the
skin. They are also used to help the muscles of the face move smoothly. The fat pads are divided into
superficial and deep. The exception to this is the Maylar fat pad which is both deep and superficial.
Superficial Fat Pads
There are 10 main superficial fat pads. These are found between the skin and the muscles
(subcutaneous). They are referred to as the SMAS or Superficial Muscular Aponeurotic System. This
connects the muscles and fascia to the tissue of the dermis. These fat pads are made of fatty tissue,
collagen, elastin, and muscle fiber.
There are 3 fat pads around the eye which form the eye shape and allow for movement – the lateral
orbital, superior orbital, and inferior orbital. All of these are within the area of the orbicularis occuli.
The nasolabial fat pad forms the lower cheek and is the closest fat pad to the nose. The nasolabial fat is
one of the few areas that does not decrease with age. Along with the medial and middle fat
compartments it forms the shape of the cheek.
For the purpose of body modification the superficial fat pads are often what helps give softer curves.
For those who are considering using PMU to add permanent contouring to the face these must be
carefully examined to determine where the superficial facial fat lies over the bone so that the bones can
be accentuated rather than the facial fat or the contouring may not appear natural and will not age well
with the face.
Deep Fat pads
These lie below the SMAS and are underneath muscle tissue. For the purpose of body modification it is
a rarity to have any need to interact with these. The exception would be cheek piercings. Of the 5 main
fat pads 3 of them surround and cushion the eye and ducts.

Facial/Ear Nerves
There are both sensory, parasympathetic and motor nerves on the head and ears. The main nerves of the
face for piercings and tattooing are Cranial Nerve V and VII. The greater auricular nerve (CN III) and
the lesser occipital nerve (CNII) are also active in the outer ear as well as the Vagus nerve (CNX).

Trigeminal Nerve (Cranial Nerve V)

This is a sensory, motor and parasympathetic nerve. It innervates the skin and mucous membranes of
the face and ear. This is the largest cranial nerve. There are 3 foramen on the skull for the Trigeminal
nerve to exit from the brain:
• Supraorbital Foramen,
• Infraorbital Foramen
• Mental Foramen
The location of these is essential for both piercing and permanent makeup as this is an area that must be
treated carefully. Bruising or pressure can cause unnecessary damage. The Supraorbital foramen
(located above the eyebrow) is usually the location of any numbness post procedure.
The trigeminal nerve is split into 3 divisions:
• Opthalmic (V1)
• Maxilliary (V2)
• Mandibular (V3)
On top of this there is also a Cervical Plexus branch which extends to the back of the head and ears. It
runs along the jawline back to the occipital bone where it connects to the main Trigeminal at the crown.
The mandibular V3 division is the only one to have motor function and is also one of the nerves of the
ear.
V1 – Frontal Nerve Branch
The Opthalmic branch of the CNV exits here from the supraorbital foramen and follows the brow ridge
across the forehead. It connects at the bridge of the nose to the supertrochlear nerve branch. This is the
main nerve that needs to be avoided when piercing an eyebrow and when tattooing. This branch also
has parasympathetic function with the lacrimal gland which creates tears. One of the reasons your
client is apt to cry during a nose piercing is that this runs from the tip of the nose up the side of the
cartilege to the bridge and is usually affected during piercing. It is possible with piercing in the wrong
location to sever this branch and cut off feeling to the tip of the nose. While it is possible that the nerve
can regrow it is not guaranteed.
V2 – Infraorbital Nerve Branch
This is the Maxilliary division and exits the skull from the Infraorbital Foramen. It is also the beginning
of the Zygomatico temporal and the external nasal nerves. The nerve runs across the ear, nose, cheek,
and the forehead. This nerve runs from the edge of the lip along the cheek and joins the main trigeminal
branch at the tip of the eyebrow.
V3 – Mandibular Nerve Branch
This splits into the auriculotemporal, mental, and buccal branches. The auriculotemporal branch also
wraps around the meningio artery which is why the ear can occasionally bleed excessively. It is both
the motor and the sensory nerve for the ears. The mental branch serves the teeth and chin area. The
buccal branch serves the cheek.
Cervical Plexus Branches
These run along the jawline, up through the tragus and back to the occcipital bone. It connects to the
Trigeminal nerve at the crown. '

The Facial Nerve (Cranial Nerve VII)

This is the main nerve for facial movement. It is very complex with 5 different branches across the
face. The 5 branches are the Frontal/Temporarl, Zygomatic, Buccal, Marginal Mandibular, and
Cervical. They are all responsible for facial expression and many sub branches intersect or overlap.
Damage to any section of the frontal nerve can cause various problems in facial movement.

1. Frontal – Paralysis of the forehead, inability to move the eyebrow

2. Zygomatic – difficulty with eye closure
3. Buccal – difficulty with speech and mouth motion, especially B and P sounds some difficulty
moving the nostrils and potential difficulty blinking.
4. Marginal Mandibular – Affects the downward motion of the mouth and may cause an
asymmetric smile.
5. Cervical – an injury to this causes paralysis of the platysma muscle which affects lip symmetry.
These are subdivided into two divisions – the temporal and the cervicofacial divisions. The buccal
branches can be found in both divisions.
It is also responsible for some of the tongues ability to taste (cortatimpany nerve) and the production of
tears. The nerve travels on the underside of the skull and exits at the Stylomastoid foramen at the base
of the ear. It is found between the tragus and the edge of the lobe and extends across the face from the
chin to the forehead. It also controls the Parotid gland which is on the zygomatic arch which controls
the salivary glands.

The posterior auricular nerve has mostly atrophied due to evolution but some people can still use this to
move or wiggle their ears.
 Nerves of the Ear

The Vagus Nerve (Cranial Nerve X)

This is the main nerve of the parasympathetic nervous system. It controls involuntary actions such as
heart rate and breathing. This nerve can also affect your mood, salivary production, speech and taste. It
is also the longest cranial nerve and runs from your brain to your large intestine. There are left and right
vagus nerves. There are three branches of the vagus nerve:
• Inferior ganglion branch
• Superior Ganglion Branch
• Vagus Nerve Branch
The superior ganglion branch supplies nerves to your ear and spine. The vagus nerve is also one of the
reasons your client may faint. The overreaction of this nerve to anxiety or stress causes the blood
pressure to drop which will make your client feel faint and dizzy. Part of the “science” that is quoted
for the daith piercing affecting headaches is based on the location of the vagus nerve in the ear since
there is a connection between this nerve and certain types of headaches.

Additional Facial Structure Anatomy

The Nose
The nose is made up of three types of tissue – bone, cartilage and fibro-fatty tissue. The nasal cavity
plays a large part in most nasal piercings. The nose is made of Hyaline cartilage but it does not fuse
into bone with age.]' Too deep and you'll be in a sinus, too shallow and the piercing will irritate the
cartilage that makes up the nose. The inside sinus cavity is split by the Vomer bone. This is a unique
bone in the body in terms of shape and unique in that it also is one of the few bones of the skull that
isn't part of a pair.
Lip Anatomy
The anatomy of the lip is essential for aesthetic reasons for both piercing and PMU needs. The
vermillion border is a key marking point for most lip piercings and its defined edge makes for a
beautiful lip. The surface of the lip area has 4 zones – hairy skin, the vermillion border, and the
vermillion and oral mucosa. The shape of the lips will vary with age and is also heavily dependent on
ethnicity.
Vermillion
The vermillion is the red part of the lips. It is covered in special stratified squamous epithelial cells
which continue from the oral mucosa inside.
The Vermillion Border
This is the rim of the lip and should have a defined edge. With PMU techniques an edge that has faded
or become uneven can be replaced and realigned to make the lips fuller. When choosing to pierce it is
essential to examine the lips closely and also ask clients about PMU procedures if they have been
performed. It is entirely likely that the piercing will outlast the ink in this situation. When performing
PMU on a client with lip piercings it is advisable for them to change their jewelry to longer bars before
starting to account for the initial swelling from the PMU procedure.
Cupid's Bow
This is the top contour of the upper lip and resembles an archer's bow.
Oral Mucosa
The stratified squamous epithelium cells on the lip become non-keratinized as they transition to the
inner mouth cavity.
Ear Anatomy
The anatomical name for the outer ear is the Pinna or Auricle. Each ear is unique to the point that it is
as distinctive as a fingerprint. The outer ear is made of both skin and auricular cartilage and is divided
into three sections:
• Lobule
• Tragus
• Helix
Cartilage helps the ear to maintain its shape but is flexible enough to move. Before evolution the ear
could move and turn much like a dogs. Piercing the ear can cause issues with the inner ear as well as
the inflammation can spread to the connective tissue and potentially spread. In a worst case scenario an
untreated infection that has spread to the inner ear can cause permanent disfigurement and potential
hearing loss.
The purpose of the pinna is the direct soundwaves into the ear canal. By piercing or altering the ear
cartilage we can affect how well a person hears as well as their ability to detect the vibrations of
speech. Especially larger or punched holes in the upper pinna allow soundwaves to pass through the
outer ear rather than being reflected into the ear canal. The outer ear also contains the glands that
secrete earwax and damaging these may lead to ear infections. The skin of the ear is susceptible to
keloids, sebaceous cysts, tumors (including melanoma) and growths.