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Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol 2024; 23:3158-3172. [PMID: 38769652 DOI: 10.1111/jocd.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement. AIMS To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring. METHODS Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment. RESULTS Relevant case studies are presented. CONCLUSIONS Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.
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Affiliation(s)
| | - André Braz
- Dermatología Láser Cosmiatria Clinic, Rio de Janeiro, Brazil
| | | | - Carola de la Guardia
- Global Aesthetics Medical Affairs, Allergan Aesthetics, an AbbVie Company, Madrid, Spain
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2
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D'Andréa G, Poissonnet G, Camuzard O, Bronsard N, Baqué P. Cadaveric study on the arterial blood supply to the middle third nasal skin: implications for aesthetic and reconstructive surgery. Surg Radiol Anat 2024:10.1007/s00276-024-03481-z. [PMID: 39331142 DOI: 10.1007/s00276-024-03481-z] [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: 08/16/2024] [Accepted: 09/05/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To provide a detailed examination of the arterial blood supply to the middle third of the nasal skin through cadaveric dissections, identifying the primary arterial sources and their precise locations. METHODS Cadaveric dissections were performed on 14 hemifaces from fresh specimens. The main feeding arteries and their branches were carefully dissected under magnification. Morphometric characteristics of the specimens, along with the caliber of the arteries and their branches vascularizing the mid-third nasal skin were recorded, and statistically analyzed. RESULTS Four main arteries were identified as responsible for the blood supply to the mid-third of the nasal skin: the facial artery, the nasal branch of the infra-orbital artery (nbIOA), the dorsal nasal artery, and the upper branches of the columellar plexus. The lateral nasal artery (LNA) and the nbIOA were the main contributors, each providing significantly larger arterial branches than the other sources (1.8 ± 0.8 branches of 0.67 ± 0.2 mm for the LNA, p-value < 0.001-1 ± 0 branches of 0.55 ± 0.17 mm for the nbIOA, p-value < 0.01). The largest arterial branch consistently penetrated the lateral and inferior angle of the mid-third nasal skin, originated either from the LNA or nbIOA. CONCLUSION The LNA and nbIOA endorse crucial roles in the arterial blood supply to the mid-third nasal skin. Despite the variability in vascular anatomy, a consistent pattern of arterial supply with convergence in the depth of the alarfacial groove was observed. Understanding these patterns is vital for improving surgical precision and reducing the risk of complications in both aesthetic and reconstructive surgeries.
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Affiliation(s)
- Grégoire D'Andréa
- Department of Anatomy, School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France.
- Clinical Research Unit Côte d'Azur (UR2CA), School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France.
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS University Hospital of Nice - Antoine Lacassagne Centre, Côte d'Azur University, 31 Avenue de Valombrose, Nice, 06100, France.
| | - Gilles Poissonnet
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS University Hospital of Nice - Antoine Lacassagne Centre, Côte d'Azur University, 31 Avenue de Valombrose, Nice, 06100, France
| | - Olivier Camuzard
- Department of Anatomy, School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France
- Clinical Research Unit Côte d'Azur (UR2CA), School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France
- Reconstructive Surgery Department, University Institute of Locomotion and Sports (IULS), University Hospital of Nice, Pasteur 2 Hospital, 30 Voie Romaine, Nice, 06000, France
| | - Nicolas Bronsard
- Department of Anatomy, School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France
- Clinical Research Unit Côte d'Azur (UR2CA), School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France
- Department of Orthopedic and Traumatology Surgery & Spinal Surgery, University Institute of Locomotion and Sports (IULS), University Hospital of Nice, Pasteur 2 Hospital, 30 Voie Romaine, Nice, 06000, France
| | - Patrick Baqué
- Department of Anatomy, School of Medicine, Côte d'Azur University, 28 Avenue de Valombrose, Nice, 06100, France
- Digestive Department, University Hospital of Nice, CHU de Nice, Archet 2 Hospital, 151 Route de Ste Antoine de Ginestière, Nice, 06100, France
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3
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Harb A, Abdul-Razzak A. Nonsurgical Correction of Surgical Rhinoplasty Complications with Hyaluronic Acid Fillers: A Retrospective Review of 2088 Cases. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6126. [PMID: 39247575 PMCID: PMC11379477 DOI: 10.1097/gox.0000000000006126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/05/2024] [Indexed: 09/10/2024]
Abstract
Background Surgical rhinoplasty is a highly complex cosmetic procedure with significant revision rates. Unfortunately, surgical revision rhinoplasty is associated with many challenges. Nonsurgical correction of surgical rhinoplasty complications with injectable hyaluronic acid fillers is an alternative with less cost and downtime. In this article, we present the first author's experience with 2088 cases of nonsurgical revision rhinoplasty, including technical considerations, patient-reported outcomes, and adverse events. Methods A retrospective chart review was completed on patients 18 years and older who received nonsurgical rhinoplasty treatment between March 2018 and August 2022. Patient demographic data, and data on indications for treatment, volume of filler used, patient-reported satisfaction, and adverse events (including erythema, infection, vascular occlusion, and necrosis) were collected up to 1 year after the initial injection. Results A total of 2088 patient cases are included in this study. The most common indications for treatment included bridge collapse or asymmetry (49.0%), an under-projected tip (44.0%), and surface irregularity/scarring (35.4%). The mean volume of filler used at initial treatment was 0.49 mL (SD 0.19). Median patient satisfaction immediately after treatment was 9 (visual analog scale ranging from 1 to 10). The most common adverse event reported at the 2-week follow-up was erythema (36.4%). Three patients presented with skin necrosis (0.47%). All three of these were transient and self-resolving. Conclusions Nonsurgical correction of rhinoplasty complications with hyaluronic acid fillers can be a safe, minimally invasive option with high patient satisfaction and immediate and predictable results. This should be considered first line before surgical revision.
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Affiliation(s)
- Ayad Harb
- From the Private Practice, SRGN Clinics, London, United Kingdom
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Chaiyamoon A, Boontem P, Samrid R, Cardona JJ, Khanthiyong B, Yurasakpong L, Iwanaga J, Tubbs RS. An anatomical study of the nasal foramina. Surg Radiol Anat 2024; 46:1495-1500. [PMID: 39073592 DOI: 10.1007/s00276-024-03414-w] [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: 05/22/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The nasal foramen is located in the nasal bone and for vessels passage to supply the nasal area. This project aimed to establish reliable references for the nasal foramina for future clinical applications. METHODS The 72 dried skulls, 46 from the Division of Anatomy, University of Phayao, Thailand, and 26 from the Tulane University School of Medicine, USA, were collected and examined. The location, number, and sizes of nasal foramina were noted. The distances from each nasal foramen to the internasal suture, frontonasal suture, nasomaxillary suture, nasion, and rhinion were also recorded and used in the statistical analytical programs. RESULTS The most common type of nasal foramen in all skulls was type II (one external opening) at 65.97%, followed by type I (no foramen opening) at 20.83%, type III (two external openings) at 11.11% and type IV at 2.08% (three external openings). Nasal foramen subtypes in many of the Thai and American skulls were type IIb and type IIa. The diameter of a connecting nasal foramen was significantly larger than that of a non-connecting. Results from embalmed confirmed the passage of the external nasal artery through the nasal cavity. CONCLUSION The study shows no significant difference in nasal foramen morphometry between Thai and American. It illustrates recent data on type and subtype classifications and the location of a vascular passage through the nasal foramen. This is the first study of NF variations and their respective classifications.
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Affiliation(s)
- Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piyakarn Boontem
- Division of Anatomy School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Rarinthorn Samrid
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Juan J Cardona
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- University of Queensland, Brisbane, Australia
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Silikovich F, Kroumpouzos G. Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid. Aesthetic Plast Surg 2024:10.1007/s00266-024-04263-z. [PMID: 39060796 DOI: 10.1007/s00266-024-04263-z] [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: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization. OBJECTIVES Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique. METHODS This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]). RESULTS Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months. CONCLUSIONS The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety. 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)
- Fernando Silikovich
- Concepto 4 Puntos Clinic, Av Monroe 2270 1405, Belgrano, B1428, Buenos Aires, Argentina.
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
- GK Dermatology PC, 541 Main St, Suite 320, South Weymouth, MA, 02190, USA.
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Moellhoff N, Kuhlmann C, Frank K, Kim BS, Conte F, Cotofana S, Piccolo NS, Pallua N. Arterial Embolism After Facial Fat Grafting: A Systematic Literature Review. Aesthetic Plast Surg 2023; 47:2771-2787. [PMID: 37563433 PMCID: PMC10784353 DOI: 10.1007/s00266-023-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. OBJECTIVE To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation. MATERIALS AND METHODS Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology. RESULTS 61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms. CONCLUSIONS AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established. LEVEL OF EVIDENCE III 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)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany.
| | - Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Francesco Conte
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nelson S Piccolo
- Division of Plastic Surgery, Pronto Socorro para Queimaduras, Goiânia, Brazil
- International Society of Plastic Regenerative Surgeons, Arlington Heights, IL, USA
| | - Norbert Pallua
- Medical Faculty Rhenish, Westphalian Technical University, Aachen, Germany
- Pallua-Clinic Duesseldorf, Duesseldorf, Germany
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Hall SS, Kontis TC. Nonsurgical rhinoplasty. World J Otorhinolaryngol Head Neck Surg 2023; 9:212-219. [PMID: 37780677 PMCID: PMC10541163 DOI: 10.1002/wjo2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/20/2023] [Indexed: 10/03/2023] Open
Abstract
Interest in liquid, or nonsurgical rhinoplasty, has increased in demand as patients pursue less invasive techniques to achieve their aesthetic goals. Improved filler technology and refinement in injection techniques have made liquid rhinoplasty a reasonable choice for well-selected patients in both primary and revision rhinoplasty cases. This article reviews nasal anatomy, injection techniques, selected applications, and safety measures pertinent to performing nonsurgical rhinoplasty.
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Affiliation(s)
| | - Theda C. Kontis
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimoreMarylandUSA
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8
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Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts. Dermatol Surg 2022; 48:1328-1331. [PMID: 36449876 DOI: 10.1097/dss.0000000000003628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Within the aesthetic realm, the influence of social media is quite prominent, with a growing percentage of patients using this technology to seek out health care recommendations and education. OBJECTIVE To ascertain the most accurate representation of what our patients may encounter on social media, we sought to characterize the top posts on the most popular visually-based social media platform (Instagram). MATERIALS AND METHODS We queried Instagram with variations of hashtags related to filler to determine which hashtags had the greatest number of posts associated with them. We then reviewed the top 100 posts associated with the top 9 hashtags, making note of whether the poster was a physician or nonphysician and whether an off-label procedure was performed or discussed. RESULTS Most (85.6%) of the 900 reviewed posts were written by nonphysicians, and most (84.6%) of the posts focused on off-label procedures were posted by nonphysicians. Among the physician posters, the most common specialties were Plastic Surgery and Family Medicine, followed by Dermatology. CONCLUSION At a time when patients are increasingly turning to social media for health care recommendations and education, most "top" content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.
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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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Staglianò S, Tartaro G, Bertossi D, Pascali M, Finocchi V, Zerbinati N, Bove P, Cirillo P, Fragola R, Rauso R. An Italian Online Survey Regarding the Use of Hyaluronidase in Previously Hyaluronic Acid-Injected Noses Looking for Surgical Rhinoplasty. Aesthet Surg J Open Forum 2022; 4:ojac060. [PMID: 35903517 PMCID: PMC9317161 DOI: 10.1093/asjof/ojac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Nonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and is considered a valid alternative to surgical rhinoplasty in selected patients. Objectives The aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. Methods Between April and May 2021, an online survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding the types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase, an additional information was collected. Results In a range of time of 2 months (April and May 2021), a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was approximately 18%. The majority of respondents (61.5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinoplasty after a waiting time of 3 to 4 weeks. Conclusions Either direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However, a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase before surgery is mandatory, recommended, or not.
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Affiliation(s)
- Samuel Staglianò
- Corresponding Author: Dr Samuel Staglianò, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 6, 80138 Naples, Italy. E-mail:
| | - Gianpaolo Tartaro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Dario Bertossi
- Maxillofacial Surgery Department, Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | | | | | | | | | | | - Romolo Fragola
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Rauso
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
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11
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Cong LY, Liao ZF, Zhang YS, Li DN, Luo SK. Three-Dimensional Arterial Distribution Over the Midline of the Nasal Bone. Aesthet Surg J 2022; 42:784-790. [PMID: 34971367 DOI: 10.1093/asj/sjab432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A comprehensive understanding of arterial variations around the midline of the nose is of great importance for the safety of filler injection. OBJECTIVES The aim of the study was to clearly define the 3-dimensional location of the arteries along the midline of the nasal bone. METHODS The arterial structures overlapping the nasal bone along the midline were observed in 79 cadavers. RESULTS The present study found that 0 to 3 named arteries per nose segment could be identified. All the arterial structures were located in or above the superficial musculoaponeurotic system layer overlapping the nasal bone. The probability of encountering named arteries at 5 defined points, P1 to P5, was 5/79 (6.3%), 4/79 (5.1%), 1/79 (1.3%), 6/79 (7.6%), and 9/79 (11.4%), respectively. The depth of the main arterial trunk was 1.2 ± 0.4 mm, 1.6 ± 0.6 mm, 1.8 ± 0 mm, 1.0 ± 0.4 mm, and 0.9 ± 0.5 mm below the skin at P1 to P5, respectively. CONCLUSIONS The authors confirmed that sub-superficial musculoaponeurotic system injection along the midline through a needle is anatomically reliable and that a technique with 1 entry point through the rhinion via a cannula can easily keep the needle sufficiently deep for safe nasal filler injection.
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Affiliation(s)
- Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Zhi-Feng Liao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Yun-Song Zhang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Dong-Ni Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital , Guangzhou City, Guangdong Province , People’s Republic of China
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Lu Y, Hong WJ, Luo CE, Zhan WF, Luo SK. Vasculature of the Nasal Cartilage Region Related to Filler Injection. Aesthetic Plast Surg 2022; 46:2461-2468. [PMID: 35680708 DOI: 10.1007/s00266-022-02942-3] [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: 01/28/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A filler injection in the nose can be essential but is also dangerous, especially in the nasal cartilage region. To safely and accurately perform a filler injection, surgeons must have detailed knowledge of nasal anatomy. OBJECTIVES Associated the vessel branches and the characteristics of different nasal regions to provide suggestions for more suitable injection sites. METHODS Fifty specimens underwent computed tomography (CT) after contrast infusion. Qualified specimens were selected for 3D CT reconstruction. Dissection was performed to confirm the accuracy of the CT data. RESULTS The branches of arteries with large diameters, the dorsal nasal artery (DNA) and the lateral nasal artery (LNA) were distributed within the superficial musculoaponeurotic system layer. The DNA was seen in only 58% of specimens. The artery crossed the midline over the upper lateral cartilage in 16% of specimens. The LNA was a constant branch that traversed the nasal tip. The LNA crossed the midline to the contralateral side in 18% of patients. We divided the nasal cartilage dorsum into two regions for easy handling: the supratip region (STR) and the nasal tip region (NTR). The branches distributed in the STR mostly originated from the DNA (81.6%, 40/49), while those in the NTR mostly originated from the LNA. CONCLUSIONS The vasculature of the nasal cartilage region observed in this study is similar to that observed in previous studies. However, we found that the STR was an advantageous area for filler injection. At the same time, we provided suggestions for more suitable injection methods. 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)
- Yu Lu
- The Second School of Clinical Medicine, Southern Medical University, 253 Industry Avenue, Guangzhou City, Guangdong Province, People's Republic of China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 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, 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, Guangdong Province, People's Republic of China.
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Yu AY. Nose Tip Elongation and Elevation: A Novel Filler Injection Technique. Aesthet Surg J 2022; 42:660-676. [PMID: 35028658 DOI: 10.1093/asj/sjac006] [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: 11/14/2022] Open
Abstract
BACKGROUND Filler injection for nose tip improvement remains a difficult treatment due to efficacy and safety issues. OBJECTIVES The authors sought to better the techniques and safety for nose tip improvement with a filler. METHODS Patients seeking nose tip improvement were recruited regardless of their pretreatment conditions. A hyaluronic acid filler was injected through the skin behind the nose tip into the potential septal space. To achieve tip elevation, the filler was retro-injected from the anterior nasal spine, stopping at the mid-level of medial crura. To elongate the nose, the filler was deposited just in front of the caudal septal cartilage. The tip extended in the sagittal plane, causing the nose tip to move either caudally (tip elongation) or anteriorly (tip elevation), or both, as directed by the surgeon. RESULTS Depending on the patients, the nose could be elongated by 2 to 6 mm, and the tip could be elevated by 2 to 8 mm. Additionally, stronger columellar support, finer tip structures, and improved nasolabial angle were observed. Interestingly, the upper lip appeared shorter. The nostril shapes and the alar widths were also improved. A total of 1288 cases are reported. Only 2 patients expressed dissatisfaction. CONCLUSIONS This technique is easy and safe to perform, and the results are natural and comparable with those from rhinoplasty surgeries. Further, this report of filler nose lengthening may be the first large series in the world. Finally, this technique works well in all populations. LEVEL OF EVIDENCE: 4
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Jitaree B, Phumyoo T. The Columellar Arteries in the Asian Nose. Facial Plast Surg Clin North Am 2022; 30:143-148. [DOI: 10.1016/j.fsc.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Alfertshofer MG, Frank K, Ehrl D, Freytag DL, Moellhoff N, Gotkin RH, Mardini S, Beleznay K, Swift A, Cotofana S. The Layered Anatomy of the Nose: An Ultrasound-Based Investigation. Aesthet Surg J 2022; 42:349-357. [PMID: 34363459 DOI: 10.1093/asj/sjab310] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. OBJECTIVES The authors sought to describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. METHODS A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose utilizing ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. RESULTS In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n = 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% to 67.5% in relation to nasal length. The nasal arteries coursed superficially in 91.7% of all cases in the nasal radix, in 80% in the mid-nasal dorsum, and in 98.3% in the nasal tip. CONCLUSIONS Soft tissue filler administration in the nose carries the highest risk for irreversible vision loss compared with any other facial region. The safety of soft tissue filler rhinoplasty procedures is enhanced by knowledge of the layered anatomy of the nose, the location and depth of the major nasal vasculature, and employment of maneuvers to decrease the risk of blindness.
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Affiliation(s)
- Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Anatomical Study of the Dorsal Nasal Artery to Prevent Visual Complications during Dorsal Nasal Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3924. [PMID: 34796083 PMCID: PMC8594662 DOI: 10.1097/gox.0000000000003924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Dorsal nasal augmentation is a common injection associated with ocular complications. Digital compressions on both sides of the nose are recommended during injection. Considering the reported incidences of visual complications, this preventive technique may need an adjustment for more effectiveness to prevent blindness. Therefore, the dorsal nasal arteries (DNAs) were studied by conventional dissections in the subcutaneous and fibromuscular tissues of the nasal dorsum in 60 embalmed cadavers. The results showed that among the 60 faces, 32 faces had bilateral DNAs (53.3%), 23 had dorsal nasal plexus with minute arteries (38.3%), and five had a single dominant DNA (8.3%). The DNA originated from one of the four arterial sources, which influenced the location and course of the artery. These sources included the ophthalmic angular arteries in 21 faces (56.8%), terminal ophthalmic arteries in two faces (5.4%), lateral nasal arteries in 11 faces (29.7%) and facial angular arteries in three faces (8.1%). Consequently, the dominant dorsal nasal artery running close to the midline found in 8% of the cases could make side compressions during nasal dorsum augmentation less effective from preventing ocular complications. However, an adjustment of digital compressions which combines pinching and side compressions is suggested to improve the safety.
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Cai B, Yuan R, Zhu GZ, Zhan WF, Luo CE, Kong XX, Luo SK. Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones. Aesthet Surg J 2021; 41:NP1975-NP1985. [PMID: 33421060 DOI: 10.1093/asj/sjab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nasal filler placement is associated with a high risk of blindness. The arterial supply to the upper nose overlaying the nasal bones is poorly understood. OBJECTIVES The aim of this study was to visualize and analyze the deployment of the ophthalmic and facial angiosomes in the upper nose to help prevent blindness following nasal filler injections. METHODS The arterial systems of 62 cadaveric heads were filled with lead oxide contrast agent, and computed tomography (CT) images were acquired and reconstructed in 3 dimensions. RESULTS Twenty-six of the cadaveric noses examined demonstrated clear CT images of the facial and ophthalmic angiosomes in the upper nose. The Type 1 upper nose (15.4%) is supplied by 2 independent ophthalmic angiosomes that communicate indirectly through a choke anastomosis. The Type 2 upper nose (38.5%) is supplied by 2 ophthalmic angiosomes with a true anastomosis between them. The Type 3 upper nose (46.1%) is supplied by both ophthalmic and facial angiosomes with true anastomoses across the dorsal midline. These true anastomoses are mediated by the radix arcade in 46% of the noses and involve the dorsal nasal artery in 65% of the cases. The anastomoses all cross the upper dorsal midline and are directly linked to the ophthalmic angiosome. CONCLUSIONS The deployment and anastomosis of the facial and ophthalmic angiosomes in the upper nose fall into 3 major patterns. About 85% of the noses have true anastomotic arteries that cross the upper dorsal midline and are directly linked to the ophthalmic circulation. Dorsum filler injection poses a significant risk of blindness.
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Affiliation(s)
- Bing Cai
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Rong Yuan
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Guo-Zhang Zhu
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Wen-Feng Zhan
- Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Xiang-Xue Kong
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China
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Tansatit T, Phumyoo T, Jitaree B, Rungsawang C, Uruwan S. Commentary on: Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones. Aesthet Surg J 2021; 41:NP1986-NP1988. [PMID: 33765110 DOI: 10.1093/asj/sjaa397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tanvaa Tansatit
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thirawass Phumyoo
- Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Benrita Jitaree
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | | | - Sukanya Uruwan
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Mespreuve M, Waked K, Collard B, De Ranter J, Vanneste F, Hendrickx B. The Usefulness of Magnetic Resonance Angiography to Analyze the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualization Through an Augmented Reality Application. Aesthet Surg J Open Forum 2021; 3:ojab018. [PMID: 34169278 PMCID: PMC8218598 DOI: 10.1093/asjof/ojab018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The use of soft tissue fillers for facial rejuvenation is increasing rapidly and the complications, unfortunately, follow the same path. Blindness caused by intravascular filler injections is a rare but devastating complication. Knowledge of the individual arterial anatomy may aid the injector in avoiding injecting into an artery and thus to prevent blindness. OBJECTIVES To evaluate if the use of magnetic resonance angiography (MRA) may visualize the arterial facial anatomy in a contrast- and radiation-free way and study the individual arterial variations using an augmented reality (AR) image. METHODS The individual arterial anatomy of the 3 terminal branches of the ophthalmic artery (supraorbital [SO]; supratrochlear [STr]; and dorsal nasal [DN] arteries) of 20 volunteers was studied by a 3-Tesla MRI, combining infrared (IR) facial warming and 3-dimensional time-of-flight multiple overlapping thin slab acquisition MRA. The resulting visualization of the facial arteries was shown on the patient's face through AR technology. RESULTS The MRA was able to visualize the SO in 90.0%, STr in 92.5%, and DN arteries in 75% of the examined patients, as well as numerous variations in both vessel localization and path. Furthermore, a proof-of-concept of the AR visualization of the individual arterial anatomy was successfully implemented. CONCLUSIONS Dermal filler injectors should be aware of the risk of filler-induced blindness and familiarize themselves with the visualization of the variable facial vascular anatomy. The implementation of a one-time MRA and subsequent AR visualization may be useful in the accurate planning of minimally invasive facial rejuvenation procedures.
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Affiliation(s)
- Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Ghent, Belgium
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussel, Belgium
| | | | - Joris De Ranter
- Department of Plastic and Reconstructive Surgery, Universitair Ziekenhuis Leuven Campus Gasthuisberg, Leuven, Belgium
| | - Francis Vanneste
- Department of Medical Imaging, AZ Zeno Hospital, Knokke, Belgium
| | - Benoit Hendrickx
- Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussel, Belgium
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Ramos HHA, Freire L, Cavallieri F, Frota AE, Ragazzo R, Jurado JRP. Management of Patients Seeking Surgical Rhinoplasty with Previous Nasal Injections of Hyaluronic Acid. Aesthetic Plast Surg 2021; 45:1675-1682. [PMID: 33616714 DOI: 10.1007/s00266-021-02136-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients are looking for procedures which are minimally invasive and consequently incur minimal downtime. However, these procedures are not usually long lasting and have limited outcomes both esthetically and functionally. For these reasons, the number of patients seeking surgical rhinoplasty and who have previous nasally injected hyaluronic acid is increasing. METHODS The aim of this article is to provide the surgeon with information for both the identification and surgical approach for those patients who seek nasal cosmetic surgery, and who have previously been treated with nasal injections of hyaluronic acid filler. RESULTS We present cases that illustrate the use of this approach and suggest three possible patient management. CONCLUSIONS There are three possible approaches: wait HA to be naturally reabsorbed; apply hyaluronidase before the surgery or proceed to rhinoplasty with no prior application of hyaluronidase. The physician must be aware of this progression and know how to manage each case to optimize the surgical outcome. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Helena Hotz Arroyo Ramos
- ENT and Facial Plastic Surgeon, Private Practice, Av. Saturnino de Brito, 256, Vitoria, ES, Brazil.
| | - Leila Freire
- ENT and Facial Plastic Surgeon, Jurado Institute of Education and Research, São Paulo, Brazil
| | | | | | - Reinaldo Ragazzo
- ENT and Facial Plastic Surgeon, Jurado Institute of Education and Research, São Paulo, Brazil
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Bertossi D, Malchiodi L, Albanese M, Nocini R, Nocini P. Nonsurgical Rhinoplasty With the Novel Hyaluronic Acid Filler VYC-25L: Results Using a Nasal Grid Approach. Aesthet Surg J 2021; 41:NP512-NP520. [PMID: 32628267 DOI: 10.1093/asj/sjaa196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonsurgical aesthetic treatment of the nose is becoming increasingly popular. VYC-25L is a novel hyaluronic acid product with the high G' and cohesivity required of a nasal filler. OBJECTIVES The authors sought to assess the safety and efficacy of VYC-25L for treatment of the nose utilizing a previously published, grid-based protocol. METHODS This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the nose with VYC-25L between February and April 2019 utilizing the grid system as the reference for injection quantity and sequencing. Specific procedures included correction of inadequate projection, deep glabella treatment, correction of a nasal hump, and adjustment of the nasolabial angle and columella. Patients were followed-up for 6 to 9 months. RESULTS A total of 61 patients were included in the analysis (mean age, 32 ± 3 years; n = 45 females [74%]). At 2 weeks posttreatment, a high degree of defect correction was confirmed based on independent evaluation, with all patients scoring 9 or 10 on a 10-point visual analog scale. Fifty-nine of 61 patients (97%) self-assessed the degree of correction as "adequate." Results were stable at 3- and 6-month follow-up visits. Complications recorded were bruising (n = 15, 25%), asymmetry (n = 2, 3%), and hematoma (n = 1, 2%). All resolved rapidly. There were no cases of infection, bumps, or skin necrosis. CONCLUSIONS VYC-25L is safe and efficacious for treatment of the nose, with high levels of patient satisfaction. It has potential to be a valuable tool in nonsurgical rhinoplasty. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Dario Bertossi
- Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Luciano Malchiodi
- Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Massimo Albanese
- Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Pierfrancesco Nocini
- Department of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
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Rhinoplasty With Hyaluronic Acid: A Standard 5-step Injection Procedure Using Sharp Needle. Ann Plast Surg 2021; 85:595-600. [PMID: 32756257 DOI: 10.1097/sap.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the clinical effect of rhinoplasty with a standard 5-step injection procedure of hyaluronic acid using sharp needle in correction of deficient features of the Chinese nose. METHODS Between January 2016 and December 2018, hyaluronic acid was injected with the sharp needle by a standard procedure in the anterior nasal spine, nasal columella, nasal tip, nasal root, and dorsum, as well as the junction region of nasal root and brow in 198 Chinese patients. The postoperative curative effect was analyzed, and the adverse reactions were observed. RESULTS The nasal shape in all patients was significantly improved, obtaining the stereoscopic appearance, and satisfactory results. During a 6-month follow-up, 4 patients developed local subcutaneous congestion and bruising in the nasal dorsum after treatment, which disappeared within 2 weeks. No patients suffered from complications such as infection, embolism, necrosis, transparent nasal dorsum, and widened nasal roots. CONCLUSIONS Injection of hyaluronic acid with the sharp needle by a standard 5-step procedure is a safe technique that can effectively correct the deficient features of the Chinese nose.
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Invited Discussion on: The Role of Skin Thickness in the Choice of a Rhinoplasty Technique for Thin-Skinned Patients: Analysis of Long-Term Results and Patient Satisfaction. Aesthetic Plast Surg 2020; 44:1751-1758. [PMID: 32524196 DOI: 10.1007/s00266-020-01804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
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Abstract
Abstract
Nowadays, minimally invasive and non-invasive approaches in aesthetic medicine are increasingly popular and non-surgical rhinoplasty is one of the procedures with rising demand worldwide. In Bulgaria, this procedure seems to be uncommonly performed, since there are no reports in the local scientific literature. The aim of this preliminary study was to briefly explore the possibilities of hyaluronic acid (HA) fillers for correcting three of the most common nasal deformities – dorsal hump, under-projected and under-rotated nasal tip in primary cases. In order to accomplish this objective, a retrospective clinical study was conducted encompassing 11 cases of the authors’ practices with the above mentioned nasal irregularities and no previous surgical/non-surgical treatment. The analysis of patient-reported outcomes suggested a high satisfaction rate, with no major complication in the series. The HA filler has shown to be safe, relatively easily applicable and highly effective for camouflaging nasal deformities. A special emphasis was put on the patient safety and ten golden rules for staying out of trouble were given.
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Abstract
BACKGROUND Nonsurgical rhinoplasty using injectable fillers improved skin quality and texture, cost-effectiveness, and quick recovery. The aim of this study was to provide a valid and customized protocol for injecting the nose with the aid of a nasal grid. METHODS From January of 2016 to October of 2017, 150 consecutive patients entered the trial. The mean patient age was 36 years (range, 16 to 60 years). The patients were divided into two arms: primary nasal defects (no previous surgery, n = 109) and secondary nasal defects (previous surgery, n = 41). The primary defect group included 43 male patients and 66 female patients, and the secondary nasal defect group included 14 male patients and 27 female patients. Within each arm, patients were stratified into three age group tiers: younger than 30 years, 30 to 45 years, and older than 45 years. RESULTS The grid became the reference for quantity and sequence of injection records. The overall complication rate was 1.82 percent, and a visual analogue scale ranging from 1 to 10 was implemented (with 10 being the most accurate correction). Of the patients evaluated, 98.350 percent scored 8 to 10, 0.825 percent scored 6 to 8, and 0.825 percent scored below 6. CONCLUSIONS Fillers can be either alternatives or complementary to plastic surgery. Nonsurgical rhinoplasty, with its avoidance of general anesthesia, splints, swelling, and bruising, represents a distinct advantage, allowing the patient to return to work as quickly as the same or the next day. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Vascular Complication in Aesthetic Medicine Treated with Hyperbaric Oxygenation. POLISH HYPERBARIC RESEARCH 2018. [DOI: 10.2478/phr-2018-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed
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Abstract
BACKGROUND During periorbital noninvasive and surgical procedures, there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomical information that would help them to avoid associated complications. METHODS Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and seven Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system. RESULTS The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8 ± 1.0 mm medially, and the vertical distance was 14.0 ± 2.9 mm superiorly. The transverse distance from the midline was 16.5 ± 1.7 mm to the emerging point of the ophthalmic artery and 20.0 ± 2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8 ± 1.7 mm by means of three-dimensional scanning and 4.5 ± 1.1 mm using ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3 ± 1.4 mm. CONCLUSION These data inform clinicians about the anatomical three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures.
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Tansatit T, Phumyoo T, Jitaree B, Sawatwong W, Rungsawang C, Jiirasutat N, Sahraoui YME, Lee JH. Ultrasound evaluation of arterial anastomosis of the forehead. J Cosmet Dermatol 2018; 17:1031-1036. [DOI: 10.1111/jocd.12755] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tanvaa Tansatit
- Department of Anatomy, Faculty of Medicine, The Chula Soft Cadaver Surgical Training CenterChulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Thirawass Phumyoo
- Department of Anatomy, Faculty of Medicine, The Chula Soft Cadaver Surgical Training CenterChulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand
- Department of Basic Medical Science Faculty of Medicine Vajira Hospital, Navamindradhiraj University Bangkok Thailand
| | - Benrita Jitaree
- Department of Anatomy, Faculty of Medicine, The Chula Soft Cadaver Surgical Training CenterChulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Worapat Sawatwong
- Department of Anatomy, Faculty of Medicine, The Chula Soft Cadaver Surgical Training CenterChulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand
| | - Chalermquan Rungsawang
- Department of Anatomy, Faculty of Medicine, The Chula Soft Cadaver Surgical Training CenterChulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand
| | | | - Yasmina M. E. Sahraoui
- Division of Cellular and Molecular Physiology, Institute of Translational MedicineUniversity of Liverpool Liverpool UK
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Sahan A, Tamer F. Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018; 26:101-103. [PMID: 29264900 DOI: 10.15570/actaapa.2017.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Rhinoplasty is one of the most common aesthetic procedures performed by plastic surgeons all over the world. In recent years, a non-surgical nose job has become the preferred option for most patients and specialists. Minimally invasive techniques already result in high satisfaction rates. Moreover, patients do not need anesthesia and there is no post-operative recovery period. METHODS Between January 2016 and January 2017, 35 patients (33 female, 2 male) that had undergone nonsurgical rhinoplasty with dermal fillers were included in the study. Clinical and demographic features of the patients, our technique, satisfaction rates, and complications were discussed. RESULTS We recorded an extremely high satisfaction rate and did not observe any complications. All of the patients returned to their normal daily activities immediately after the procedure. CONCLUSIONS Non-surgical nose augmentation with dermal fillers is an easy, safe, and comfortable technique. It appears that dermatologists need to assume a more active role in rhinoplasty.
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Affiliation(s)
- Ali Sahan
- Doctor Al-Sa Aesthetic & Cosmetic Dermatology Clinic, Ankara, Turkey
| | - Funda Tamer
- Department of Dermatology, School of Medicine, Ufuk University, Ankara, Turkey
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