Elevating a Subfascial-Subpericranial Flap. A, An elevated subfascial-subpericranial type of flap. The dissection lateral to the STL elevates the deep surface of the temporal fascia from the outer surface of the temporalis muscle in continuity with the frontal pericranium on the medial part of the STL. The temporalis muscle and the periosteum on its deep surface remain attached to the STL. B, The interrupted line shows the upper edge of the interfascial fat pad. The inset shows the incision parallel to the surface of the skull; the incision is used to separate the junction of the temporal fascia lateral to the STL (the superficial layer is edged in red, the deep layer in green, and the interfascial fat pad in purple) and the frontal pericranium (dark blue) medial to the STL while maintaining the continuity of these layers across the STL. C, The deep layer of temporal fascia has been opened from its deep side to expose the upper edge of the interfascial fat pad. There is no need to expose this fat pad in the subfascial-subpericranial approach. D, The temporalis muscle with the periosteum on its deep surface has been elevated and reflected posteriorly. A cuff composed of temporalis muscle and underlying periosteum remains attached along the STL for closure. (Images courtesy of AL Rhoton, Jr.)