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Zhu GS, Liao ZF, Chen CL, Luo CE, Li FW, Zhan WF, Luo SK. Three-Dimensional Computed Tomography Scanning Study of the Superior Labial Artery in Chinese Individuals for Assessing Filler Injection Safety. Aesthetic Plast Surg 2024:10.1007/s00266-024-04187-8. [PMID: 39048770 DOI: 10.1007/s00266-024-04187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Lip filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. The aim of this study was to investigate the anatomy of the superior labial artery (SLA) and provide precise topographic information for dermal filler injection into the lips. METHODS Computed tomography (CT) scans of 52 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3D images of the SLA described by a coordinate system based on the bilateral external auditory canal and the left orbit. This study aimed to classify the SLA in the Han Chinese population, measure its diameter at specific points, and determine the thickness of the lip at those points. Ultimately, we utilized a thermal imaging technique to illustrate the course and depth of the SLA within the lip. The objective of this study was to provide safe guidance for clinical injections. RESULTS In this study, the SLA was successfully identified in all cadavers. The mean overall diameter of the superior labial arteries was 1.36 ± 0.28 mm. The superior labial artery showed a general course from deep to shallow with an average depth of 5.68 ± 1.68 mm from the oral commissure to the midline. CONCLUSIONS There are anatomical differences in the superior labial arteries among Chinese people. Furthermore, 3D CT images can digitally elucidate the exact positions of the superior labial artery via a coordinate system, improving the safety of upper lip filler injections in clinical settings. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Guo-Sheng Zhu
- The Second School of Clinical Medicine, Southern Medical University, 253 Industry Avenue, Guangzhou City, Guangdong Province, People's Republic of China
| | - Zhi-Feng Liao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Chun-Lin Chen
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Fang-Wei Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China
| | - Wen-Feng Zhan
- Department of Radiology, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, Guangdong Province, People's Republic of China
| | - Sheng-Kang Luo
- The Second School of Clinical Medicine, Southern Medical University, 253 Industry Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, Guangdong Province, People's Republic of China.
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Meneses CCB, Freitas S, Knoedler L, Knoedler S, Davidovic K, Bravo C, Pappas A, Biesman BS, Alfertshofer M, Cotofana S. Increasing precision during neuromodulator injections for frontal rhytids-Using ultrasound imaging to identify the line of convergence. J Cosmet Dermatol 2024; 23:2373-2379. [PMID: 38757429 DOI: 10.1111/jocd.16368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Recent research introduced the concept of the "line of convergence" as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre-injection ultrasound scanning is employed to increase precision and reduce adverse events when searching for the line of convergence. OBJECTIVE To explore the feasibility and practicality of implementing pre-injection ultrasound scanning into aesthetic neuromodulator treatments of the forehead. METHODS The sample of this study consisted of n = 55 volunteers (42 females and 13 males), with a mean age of 42.24 (10.3) years and a mean BMI of 25.07 (4.0) kg/m2. High-frequency ultrasound imaging was utilized to measure the thickness, length, and contractility of the frontal soft tissue and to determine the precise location of the line of convergence during maximal frontalis muscle contraction. RESULTS The results revealed that the line of convergence was located at 58.43% (8.7) of the total forehead height above the superior border of the eyebrow cilia without a statistically significant difference between sex, age, or BMI. With frontalis muscle contraction, the forehead shortens in males by 25.90% (6.5), whereas in females it shortens only by 21.74% (5.1), with p < 0.001 for sex differences. CONCLUSION This study demonstrated the feasibility and practicality of pre-injection ultrasound scanning for facial aesthetic neuromodulator treatments. Knowing the location of the line of convergence, injectors can determine precisely and on an individual basis where to administer the neuromodulator deep or superficial or when the injection location is at risk to cause eyebrow ptosis.
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Affiliation(s)
| | | | - Leonard Knoedler
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Knoedler
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | - Michael Alfertshofer
- Department of Oromaxillofacial Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
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Cotofana S, Hong WJ, Horne J, Harris S, Surek CC, Frank K, Alfertshofer M, Kattil PK, Sakuma T, Onishi EC, Bertucci V, Green JB, Smith MP, Khan A, Lowry N. Intralabial Lip Compartments and Their Potential Clinical Relevance. Plast Reconstr Surg 2024; 153:1293-1300. [PMID: 37314374 DOI: 10.1097/prs.0000000000010820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aesthetic soft-tissue filler injections for lip enhancement are popular and performed throughout the world. When injecting lips with a cannula, as the cannula is advanced, resistance is perceived in consistent locations, potentially indicating boundaries between intralabial compartments. OBJECTIVE We aimed to investigate whether intralabial compartments exist and, if so, to describe their volumes, location, boundaries, and dimensions. METHODS This cadaveric study investigated a total of 20 human body donors (13 male, seven female) with a mean (SD) age at death of 61.9 years (23.9) and body mass index of 24.3 kg/m 2 (3.7). The investigated cohort included 11 White donors, eight Asian donors, and one Black donor. Dye injections simulating minimally invasive lip treatments were conducted. RESULTS Independent of sex or race, six anterior and six posterior compartments in the upper and lower lip were identified, for a total of 24 lip compartments. Compartment boundaries were formed by vertically oriented septations that were found in consistent locations. The anterior compartments had volumes ranging from 0.30 to 0.39 cc; the posterior compartment volume ranged from 0.44 to 0.52 cc. The compartment volumes were larger centrally and decreased gradually toward the oral commissure. CONCLUSIONS The volume and size of each of 24 compartments contribute to the overall appearance and shape of the lips. To achieve a natural lip shape preserving aesthetic outcome it may be preferable to administer the volumizing product using a compartment-respecting injection approach.
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Affiliation(s)
- Sebastian Cotofana
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital
| | | | | | | | - Konstantin Frank
- Division of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich
| | - Michael Alfertshofer
- Division of Hand, Plastic, and Aesthetic Surgery, Ludwig-Maximilians-University Munich
| | - Punnose K Kattil
- From the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science
| | | | - Emy C Onishi
- Department of Dermatology, University of the Philippines, Philippine General Hospital
| | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute
| | - Michael P Smith
- Division of Anatomy, Department of Medical Education, Albany Medical College
| | - Amanda Khan
- Division of Anatomy, Department of Medical Education, Albany Medical College
| | - Natalia Lowry
- Division of Anatomy, Department of Medical Education, Albany Medical College
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Ozturk MK, Kibar Guzin AK. A Natural Flat Volumized Lips Filler Technique: Retrospective Analysis of 920 Patients. Dermatol Surg 2024; 50:453-458. [PMID: 38386847 DOI: 10.1097/dss.0000000000004128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. OBJECTIVE To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. METHODS AND MATERIALS Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. RESULTS The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. CONCLUSION The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.
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Ao YJ, Yi Y, Wu GH. Application of PLLA (Poly-L-Lactic acid) for rejuvenation and reproduction of facial cutaneous tissue in aesthetics: A review. Medicine (Baltimore) 2024; 103:e37506. [PMID: 38489708 PMCID: PMC10939544 DOI: 10.1097/md.0000000000037506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Poly-L-lactin acid (PLLA) has been widely used in the field of bio-medicine. In 2004, as an injectable material, PLLA was approved by the FDA to treat AIDS-related facial atrophy. Since then, several injectable stuffs containing PLLA have been approved for marketing in various countries and regions. Recently, PLLA has often been used to treat facial rejuvenation problems like cutaneous depressions and static wrinkles which always induce unsatisfactory facial expression. This review introduces the physicochemical properties, regeneration stimulating mechanism, applications in aesthetics and injectable comorbidity of PLLA.
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Affiliation(s)
- Yin-Jie Ao
- Zhengxing Stomatological Hospital, Yichun City, Jiangxi Province, P.R. China
| | - Yan Yi
- Zhengxing Stomatological Hospital, Yichun City, Jiangxi Province, P.R. China
| | - Guo-Hui Wu
- Ophthalmology Hospital Affiliated to Nanchang University, Nanchang City, Jiangxi Province, P.R. China
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Nguyen VH, Cheng-Kuan L, Nguyen TA, Cai THNT. Facial artery: anatomical variations in the perioral region in cadavers. Arch Craniofac Surg 2023; 24:266-272. [PMID: 38176760 PMCID: PMC10766500 DOI: 10.7181/acfs.2023.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In recent years, there has been an increase in reports of perioral vascular complications resulting from filler injections, such as necrosis of the lip or alar rim, occlusion, and in severe cases, blindness. Conversely, the use of perioral arterial flaps is becoming more prevalent in the treatment of cleft lips, cancer, and trauma. A thorough understanding of perioral arteries is essential to minimize complications and maximize the success of these flaps. However, the course of the facial artery (FA) in the perioral region remains incompletely understood. The aim of this study was to describe the variations of the FA in the perioral region. METHODS We dissected 52 embalmed and formaldehyde-fixed Vietnamese cadavers. We then studied the size and distribution of perioral arteries in 102 specimens. RESULTS The superior labial artery (SLA) was the most common branch, occurring in 87.25% of cadavers, followed by the inferior labial artery (ILA) at 78.43%. The SLA primarily originated above the mouth corner (cheilion), accounting for 91.01% of cases, and predominantly exhibited a tortuous course within the submucosa (78.65%). The ILA's branching pattern varied, but it was primarily located below the cheilion (91.25%). The ILA also followed a twisted path, generally within the submucosa. The ILA exhibited two patterns: the typical pattern, distributed at the vermilion border of the lower lip (8.82%), and the horizontal labiomental artery pattern, which ran horizontally in the middle of the lower lip area (69.61%). At their origin, the SLA and ILA had average external diameters of 1.29 mm and 1.28 mm, respectively. CONCLUSION Numerous anatomical variations in the FA in the perioral region were found. A detailed anatomic description, suggested landmarks, and angiography before the procedure will be useful to help doctors avoid complications.
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Affiliation(s)
- Vu Hoang Nguyen
- Department of Anatomy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lin Cheng-Kuan
- Department of Environmental Health, Harvard Chan School of Public Health, Boston, MA, USA
| | - Tuan Anh Nguyen
- Department of Plastic and Cosmetic Surgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Trang Huu Ngoc Thao Cai
- Department of Plastic and Cosmetic Surgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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Isaac J, Walker L, Ali SR, Whitaker IS. An illustrated anatomical approach to reducing vascular risk during facial soft tissue filler administration – a review. JPRAS Open 2022; 36:27-45. [PMID: 37064503 PMCID: PMC10102405 DOI: 10.1016/j.jpra.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular complications from soft tissue fillers can have catastrophic consequences for patients. Adverse events are rare, but they are increasing, and their appearance may be the result of intravascular injection. A comprehensive understanding of the 2-dimensional anatomy (distribution) and 3-dimensional anatomy (depth) of the facial vasculature is fundamental for the safe delivery of nonsurgical cosmetic procedures. The purpose of this review is to provide an illustrated approach to examine surgical anatomy specific to the facial vascular system and the anatomical considerations clinicians need to give in specific danger during injectable cosmetic procedures. A grounding in safety and anatomy will help the new injector to mitigate the risk of vascular complications.
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Affiliation(s)
| | - Lee Walker
- B City Clinic, Liverpool, United Kingdom
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre. Institute of Life Sciences, Swansea University Medical School. Swansea, United Kingdom
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
- Corresponding author: Professor Iain S. Whitaker MA Cantab PhD FRCS Plast FAcadTM, Reconstructive Surgery & Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea SA2 8PP, United Kingdom, Tel: 01792205678.
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Wu WT, Chang KV, Chang HC, Kuan CH, Chen LR, Mezian K, Ricci V, Özçakar L. Ultrasound Imaging of Facial Vascular Neural Structures and Relevance to Aesthetic Injections: A Pictorial Essay. Diagnostics (Basel) 2022; 12:diagnostics12071766. [PMID: 35885669 PMCID: PMC9317469 DOI: 10.3390/diagnostics12071766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
The facial and submental regions are supplied by complicated neurovascular networks; therefore, facial aesthetic injections may be associated with serious adverse events such as skin necrosis and blindness. Pre-injection localization of neurovascular structures using high-resolution ultrasound can theoretically prevent unexpected complications. Therefore, a systematic protocol that focuses on these facial neurovascular structures is warranted. In this pictorial essay, we discuss the sonoanatomy of facial and submental neurovascular structures and its relevance to aesthetic injections. Moreover, we have highlighted the mechanisms underlying potential neurovascular injuries during aesthetic injections.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-2-2371-7101-5309
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Chen-Hsiang Kuan
- Department of Surgery, Division of Plastic Surgery, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.)
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, 12800 Prague, Czech Republic;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Guo Y, Wei W, Li Q, Tao C, Li X, Zhang A, Jin P. Efficacy and safety of hyaluronic acid fillers for lip augmentation in a Chinese population. J Cosmet Dermatol 2022; 21:1959-1966. [PMID: 35132743 DOI: 10.1111/jocd.14757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients. METHODS From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the "three-point" injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications. RESULTS All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients. CONCLUSIONS Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The "three-point" technique is simple, safe, and effective and does not cause serious complications.
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Affiliation(s)
- Yanping Guo
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Wuhan Wei
- School of Clinical Medicine, Xuzhou Medical University, Jiangsu, China
| | - Qiang Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Changbo Tao
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Xueyang Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Aijun Zhang
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Peisheng Jin
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
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Lopes de Resende Serratine P, de Moraes PH. A Novel approach to lip filling following labial subcision. Br J Oral Maxillofac Surg 2021; 60:661-663. [DOI: 10.1016/j.bjoms.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
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Yamamoto M, Chen HK, Hidetomo H, Watanabe A, Sakiyama K, Kim HJ, Murakami G, Rodríguez-Vázquez JF, Abe S. Superior labial artery and vein anastomosis configuration to be considered in lip augmentation. Ann Anat 2021; 239:151808. [PMID: 34324994 DOI: 10.1016/j.aanat.2021.151808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022]
Abstract
The treatment of cleft lip and palate is performed over a long period, starting immediately after birth. However, esthetic problems remain after lip augmentation. Endothelial cells of new capillaries are important for wound healing. Thus, the reconstruction of vascular networks is key to postoperative wound healing during lip augmentation. However, studies describing the superior labial artery (SLA) and superior labial vein (SLV) are rare, and their mutual positional relationship thus remains unclear. We procured 29 adult cadavers and ten fetuses. Macroscopic and histological examinations were performed on adult cadavers. We extracted soft tissues and blood vessels after micro-computed tomography (CT) and 3D tissue reconstruction. We performed histological investigations of vascular networks within the cleft lip in fetal samples. In adults, the SLV was distributed throughout the cutaneous side of the orbicularis oris muscle and the SLA, throughout the mucosal side. The SLV and SLA were separated by this muscle. Micro-CT images revealed that the SLA on the mucosal side transversed the orbicularis oris muscle to the SLV (55%). Histological analysis of fetuses revealed that the SLA was on the mucosal side, similar to that in adults, and traversed the orbicularis oris muscle in continuity with the SLV of the cutaneous side (100%). In lip augmentation, the reconstruction of the vascular structure, which involves the anastomosis of SLA and SLV passing through the orbicularis oris muscle, is an important factor when considering esthetic repair.
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Affiliation(s)
- Masahito Yamamoto
- Department of Anatomy, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan; Tokyo Dental College Research Branding Project, 2-9-18 Kanda-misakicho, Tokyo, 101-0061, Japan.
| | - Hsiu-Kuo Chen
- Department of Anatomy, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan
| | - Hirouchi Hidetomo
- Department of Anatomy, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan
| | - Akira Watanabe
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-misakicho, Tokyo, 101-0061, Japan; Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan
| | - Koji Sakiyama
- Division of Anatomy, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283, Japan
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Gen Murakami
- Department of Anatomy, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan; Division of Internal Medicine, Jikou-kai Clinic of Home Visits, 4-4-18, Bieicho-Minamimachi, 071-0202 Kamikawa, Japan
| | | | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, 101-0061 Tokyo, Japan; Tokyo Dental College Research Branding Project, 2-9-18 Kanda-misakicho, Tokyo, 101-0061, Japan
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A Safe and Effective Lip Augmentation Method: The Step-by-Step Φ (Phi) Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3332. [PMID: 33680634 PMCID: PMC7928943 DOI: 10.1097/gox.0000000000003332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
The shape and fullness of the lips are essential in facial aesthetics. We describe a safe injection technique of hyaluronic acid (HA), based on the well-known golden number Φ (phi), for lip augmentation.
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Cotofana S, Alfertshofer M, Schenck TL, Bertucci V, Beleznay K, Ascher B, Lachmann N, Green JB, Swift A, Frank K. Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization. Aesthet Surg J 2020; 40:1327-1335. [PMID: 32469050 DOI: 10.1093/asj/sjaa137] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lips are considered a key element of facial attractiveness due to their central position in the face and their elemental role in verbal and nonverbal communication. OBJECTIVES The authors sought to provide clinically relevant information on the 3-dimensional pathway of the superior and inferior labial arteries within the lips to increase safety during labial soft tissue filler injections. METHODS The study enrolled 41 healthy volunteers with a mean age of 26.17 ± 9.6 years and a mean body mass index of 23.09 ± 2.3 kg/m2. Ultrasound imaging was performed at 6 different locations. The position of the labial arteries within the lips, depth of the arteries, cranio-caudal location of each artery in relation to the vermilion border, and diameter of the superior/inferior labial arteries were recorded. RESULTS The most frequent location of both the superior and inferior labial arteries was the submucosal plane (58.5%) followed by intramuscular (36.2%) and subcutaneous (5.3%) planes. The depth of the superior labial artery in the upper lip was 5.6 ± 0.13 mm, whereas the depth of the inferior labial artery in the lower lip was 5.2 ± 0.14 mm. Both arteries were more frequently located within the red lip: upper lip (83% vs 18.7%) and lower lip (86.2% vs 13.8%). In the midline, the artery coursed within the red lip in all investigated volunteers. CONCLUSIONS Clinically, results of this study favor a superficial injection plane for lip volumization procedures. A perpendicular approach to the lip (coming from the cutaneous lip) might increase safety because the artery is located most frequently within the red lip.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | | | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nirusha Lachmann
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
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Papadopoulos T. Commentary on: Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization. Aesthet Surg J 2020; 40:1336-1340. [PMID: 33165602 DOI: 10.1093/asj/sjaa248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Tim Papadopoulos
- Department of Plastic and Reconstructive Surgery, Westmead Private Hospital, Westmead NSW, Australia
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15
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Peng J, Peng HP. Classifications and injection strategy for lip reshaping in Asians. J Cosmet Dermatol 2020; 19:2519-2528. [DOI: 10.1111/jocd.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jui‐Hui Peng
- Kaohsiung Chang‐Gung Memorial Hospital Kaohsiung Taiwan
| | - Hsien‐Li Peter Peng
- P‐Skin Professional Clinic Kaohsiung Taiwan
- Department of Dermatology Tri‐Service General Hospital National Defense Medical Center Taipei Taiwan
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16
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Wollina U, Goldman A. Lip enhancement and mouth corner lift with fillers and botulinum toxin A. Dermatol Ther 2020; 33:e14231. [PMID: 32852076 DOI: 10.1111/dth.14231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
Beautiful lips are responsible for facial attractiveness and a youthful appearance. During aging process, lips become thinner and the red lips borders get poor defined. Downturn of the corners of the mouth suggests negative emotions. Lip surgery and underlying pathology may result in asymmetries and lip incontinence. Minor invasive procedures with hyaluronic acid fillers and botulinum toxin A are versatile tools to improve appearance of the lips, restore function and improve psycho-social well-being. In this review, we discuss anatomy, safety concerns, injections techniques as well as esthetic and medical indications.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Alberto Goldman
- Department of Plastic Surgery at Hospital São Lucas da PUCS, Porto Alegre, Brazil
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17
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Jiang L, Yin N, Wang Y, Song T, Wu D, Li H. Three-dimensional visualization of blood supply of the upper lip using micro-CT and implications for plastic surgery. Clin Anat 2020; 34:191-198. [PMID: 32285488 DOI: 10.1002/ca.23606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The anatomy of the arterial branches in the upper lip and their relationships to soft tissue are not well described in the literature. The purpose of this study was to explore a method for visualizing the microvessels and soft tissue three-dimensionally to gain better understanding of the upper lip blood supply. MATERIALS AND METHODS Seventeen stillborn fetuses were injected with lead oxide-gelatin and stained with iodine. Thirty-four half upper lip specimens were obtained and scanned by micro-computed tomography. The images were then examined and Inveon analysis software was used for three-dimensional reconstructions. RESULTS The main supplies to the upper lip were from the superior labial and inferior alar arteries. In some cases, the infraorbital and lateral nasal arteries also branched off to the upper lip. The anatomical variations were classified into six types on the basis of the observed vascular composition patterns. The skin was supplied by the subcutaneous vascular network, formed by the superficial ascending branches of the superior labial and inferior alar arteries. The mucosa was supplied by the submucosal vascular network, formed by the deep ascending branches of the superior labial artery and the labial branches of the infraorbital artery. The muscles were supplied by small vertical branches from the subcutaneous and submucosal vascular networks. CONCLUSION This study provides new anatomical insight into the upper lip by describing the microvessels and the relationship between the arteries and the soft tissue involved. This is important information for clinical applications in upper lip plastic surgery.
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Affiliation(s)
- Liya Jiang
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ningbei Yin
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongqian Wang
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Song
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wu
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haidong Li
- Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tansatit T, Phumyoo T, MCCabe H, Jitaree B. Translucent and Ultrasonographic Studies of the Inferior Labial Artery for Improvement of Filler Injection Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2399. [PMID: 31942380 PMCID: PMC6908380 DOI: 10.1097/gox.0000000000002399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
Lower lip augmentation by filler injection is an aesthetic procedure essential for achieving a feminine look and to enhance attractiveness. Complications as a result of injury to the inferior labial artery can result in undesirable outcomes. METHODS The translucent technique was used to study the origin of the inferior labial artery in 11 cadavers. Ultrasonography of the inferior labial artery was also performed in 20 volunteers, which provided supplemental data to this study, in relation to establishing recommendations for filler injection. RESULTS Five different types of inferior labial artery were described. These types were found in various combination patterns. Types 2, 4, and 5 are more vulnerable to arterial injury during filler injection. Ultrasonography revealed a depth of 6 mm and an arterial position at the vermillion border as the dangerous injection plane. CONCLUSION The origins and courses of the inferior labial artery are classified into 5 types. These types are often found in combination with each other in different faces, resulting in large anatomical variation between people. Types of combination influence severity of lower lip necrosis when arterial injury occurs. The physician should be aware of these anatomical variations during aesthetic treatments and reconstructive procedures to avoid the dangers of accidental arterial injury.
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Affiliation(s)
- Tanvaa Tansatit
- From the Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thirawass Phumyoo
- From the Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Hannah MCCabe
- Anatomy and Human Biology, University of Birmingham, Birmingham, United Kingdom
| | - Benrita Jitaree
- From the Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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