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Zhou LC, Dong YX, Cao MB, Li JY, Peng T, Zhang SY, Zhou YW, Shu HN, Luo SK. The Safety of Injections in the Infraorbital Region. Aesthetic Plast Surg 2024; 48:2231-2238. [PMID: 38528128 DOI: 10.1007/s00266-024-03976-5] [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: 01/27/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Infraorbital filler injection is a commonly used minimally invasive cosmetic procedure on the face, which can cause vascular complications. OBJECTIVE In this study, we aimed to explore the anatomical structure of the infraorbital vasculature and to establish an accurate protocol for infraorbital filler injection. METHODS The vascular structure of the infraorbital region was evaluated in 84 hemifacial specimens using computed tomography. Four segments (P1-P4) and five sections (C1-C5) were considered. We recorded the number of identified arteries in each slice and at each location and the number of deep arteries. Furthermore, we also measured the infraorbital artery (IOA) distribution. RESULTS At P1-P4, the lowest number of arteries was detected in segment P4, with a 317/1727 (18.4%) and 65/338 (2.3%) probability of total and deep arterial identification, respectively. The probabilities of encountering an identified artery at the five designated locations (C1-C5) were 277/1727 (16%), 318/1727 (18.4%), 410/1727 (23.7%), 397/1727 (23%), and 325/1727 (18.8%), respectively. The probability of an IOA being identified at C2 was 68/84 (81%). CONCLUSION We described an effective filler injection technique in the infraorbital region to minimize the associated risks. 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)
- Ling-Cong Zhou
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yun-Xian Dong
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Mi-Bu Cao
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Jun-Yu Li
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Tong Peng
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Si-Yi Zhang
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Yang-Wu Zhou
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Hai-Ning Shu
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
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Li Z, Xia Z, Qiu Z, Ting W, Dong R, Wang X, Jin L, Zeng A, Liu Z, Wang X, Yu N, Long X. Studying Dynamics of Mid-face Lifting During Hyaluronic Acid Filler Injection Using Ultrasound Imaging. Aesthetic Plast Surg 2023; 47:2661-2676. [PMID: 36536094 DOI: 10.1007/s00266-022-03221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The ageing in the mid-face involves volume deficiency in multiple anatomical units, including the zygomatic arch, infraorbital region, medial and lateral cheek and nasolabial fold (NLF). Hyaluronic acid (HA) is extensively used in the minimally invasive procedures of mid-face rejuvenation. OBJECTIVES MD CodesTM is proposed to perform combined treatment of multiple sites to reduce treatment variability and increase clinician success rates. Although the detailed procedure of this technique, aesthetic effects and complications have been disclosed, its anatomical information has yet to be discussed. This paper elaborated on the static and dynamic anatomical characteristics of MD CodesTM through cadaveric dissection and ultrasound imaging. METHODS Anatomical dissection and ultrasound imaging help us look back on the injection methods and anatomical principles of MD CodesTM. RESULTS The treatment is threefold: (1) the bolus injections, for lifting purposes, are performed at the most depressing point along the zygomatic arch, zygomatic eminence, the prominent optimal point in the zygomatic region, the most depressed point of upper NLF with 0.2-0.3 ml HA. (2) The linear injections, featuring facial contouring refinement, are performed at the deep fat pad of the medial cheek and infraorbital region with 0.4 ml HA. (3) The linear injections, featuring volume replacement, are performed at the subcutaneous fat layer of lateral cheek and NLF with 0.8 and 0.4 ml HA. CONCLUSIONS MD CodeTM is led by the principle of "less dosage and better effect", and a special injection sequence is formulated based on the anatomical characteristics. Ultrasound is a useful tool to make for a dynamic anatomical understanding of MD CodeTM and visualize the anatomical information such as layers and thicknesses. 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)
- Zhijin Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zenan Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zikai Qiu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Wenyun Ting
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ruijia Dong
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xue Wang
- Department of Anatomy, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jin
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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Wu WT, Chang KV, Chang HC, Chen LR, Kuan CH, Kao JT, Wei LY, Chen YJ, Han DS, Özçakar L. Ultrasound Imaging of the Facial Muscles and Relevance with Botulinum Toxin Injections: A Pictorial Essay and Narrative Review. Toxins (Basel) 2022; 14:toxins14020101. [PMID: 35202129 PMCID: PMC8878462 DOI: 10.3390/toxins14020101] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
High-resolution ultrasound is preferred as the first-line imaging modality for evaluation of superficial soft tissues, such as the facial muscles. In contrast to magnetic resonance imaging and computed tomography, which require specifically designated planes (axial, coronal and sagittal) for imaging, the ultrasound transducer can be navigated based on the alignment of facial muscles. Botulinum toxin injections are widely used in facial cosmetic procedures in recent times. Ultrasonography is recognized as a useful tool for pre-procedure localization of target muscles. In this pictorial review, we discuss the detailed sonoanatomy of facial muscles and their clinical relevance, particularly with regard to botulinum toxin injections. Furthermore, we have summarized the findings of clinical studies that report ultrasonographic imaging of facial muscles.
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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.); (D.-S.H.)
- 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.); (D.-S.H.)
- 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;
| | - 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.); (D.-S.H.)
| | - Chen-Hsiang Kuan
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Jung-Ting Kao
- Department of Dermatology, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Ling-Ying Wei
- Department of Dentistry, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Yunn-Jy Chen
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Medical School, Hacettepe University, Ankara 06100, Turkey;
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