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Kim SB, Hu H, Bae H, Yi KH. Anatomy of the temporal region to guide filler injections. Surg Radiol Anat 2024; 46:615-624. [PMID: 38480594 DOI: 10.1007/s00276-024-03340-x] [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: 09/25/2023] [Accepted: 03/01/2024] [Indexed: 05/07/2024]
Abstract
Hollow temples are not typically considered aesthetically pleasing, and hollowness worsens with the aging process. When filling this region with fillers, there are several anatomical considerations, with injection techniques varying depending on the layer targeted. Specifically, injections between the superficial temporal fascia and the superficial layer of the deep temporal fascia are performed using a cannula, while periosteal layer injections involve the use of a needle to reach the bone before inserting fillers. Detailed anatomical insights encompass the boundaries of the temporal fossa and cautionary notes regarding blood vessels, supported by specific studies on veins and arteries in the temporal region. Complications, including vessel injuries, are discussed alongside an exploration of various injection techniques. This review provides a comprehensive exploration of anatomical considerations and the specific methodologies employed in temple augmentation with fillers.
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Affiliation(s)
- Soo-Bin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyewon Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- Department of Oral Biology, Yonsei University College of Dentistry, Room 601, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- Maylin Clinic (Apgujeong), Seoul, 06005, Korea.
- Department of Oral Biology, Yonsei University College of Dentistry, Room 601, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Nikolis A, Enright KM, Nguyen Q, Cotofana S. The Suitability of a Large Particle Hyaluronic Acid Filler for the Treatment of Temporal Hollowing. Dermatol Surg 2023; 49:1145-1151. [PMID: 37712833 DOI: 10.1097/dss.0000000000003916] [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: 09/16/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) fillers may be manufactured to have distinctive physical properties that optimize their use for specific indications. Fillers manufactured with large gel calibration (particle size; HA-V) may be particularly suitable for volumizing large surface areas such as the temporal hollows. OBJECTIVE To investigate the safety and effectiveness of HA-V for the treatment of temporal hollows. MATERIALS AND METHODS A prospective, open-label, single-cohort, clinical trial was conducted. Twenty-six women who presented with bilateral temporal hollows at baseline were recruited. All subjects received treatment with HA-V and were observed at 4 to 5 in-person visits over 16 weeks. Subjective and objective measures of safety and efficacy parameters were collected through 2- and 3-dimensional imagery, questionnaires/scales (i.e., subject satisfaction, global aesthetic improvement, temporal hollowing severity), and adverse event diaries. RESULTS To achieve optimal correction, the investigator used an average of 1.70 syringes per subject, per side. All treatments were performed using a bolus injection technique to place the product on the periosteum (bone) of the temporal region. Following optimal correction, all subjects (100%) displayed improvement in their global aesthetic appearance, and 25 of 26 subjects (96.15%) displayed ≥1 grade improvement on the temporal volume scale. Subject satisfaction was high, with 91.3% of subjects being satisfied with the appearance of their temporal regions following optimal correction. CONCLUSION In this pivotal trial, HA-V was evidenced to have an excellent safety profile and proven efficacy up to 16 weeks, making it a suitable HA filler for volumization of the temporal region.
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Affiliation(s)
- Andreas Nikolis
- Erevna Innovations Inc., Clinical Research Unit, Westmount, Quebec, Canada
- Department of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Kaitlyn M Enright
- Erevna Innovations Inc., Clinical Research Unit, Westmount, Quebec, Canada
| | - Quynh Nguyen
- Département d'ophtalmologie, Université de Montréal, Montréal, Quebec, Canada
| | - Sebastian Cotofana
- Department of Medical Education at Albany Medical College, Albany, New York
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Shin KJ, Lee SH, Gil YC, Shin HJ. Topography of the frontal branch of the facial nerve and its clinical implication for temporal direct browplasty. Sci Rep 2023; 13:14255. [PMID: 37652939 PMCID: PMC10471615 DOI: 10.1038/s41598-023-40206-5] [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: 02/19/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
Due to anatomic proximity to the surgical site, iatrogenic trauma to the frontal branch of the facial nerve (FbFN) with resultant brow paralysis is a recognized major complication of temporal direct browplasty. This study was aimed to elucidate the course of the FbFN in the area superolateral to the brow in order to facilitate safer temporal direct browplasty by preventing facial nerve injury. Forty-five hemifaces from 32 embalmed Korean cadavers were dissected. A horizontal line connecting the tragion to lateral canthus was established. Then, an oblique line passing through the lateral canthus and 45° to the horizontal line was used as reference line. The mean distance from the lateral canthus to the points where the FbFN cross the reference line was measured. The angle between the FbFN and reference line at the crossing points were also recorded. After crossing the zygomatic arch, FbFN continues in an anteriorly inclining curve across the temporal region, passing near the lateral end of the brow as it heads toward frontalis muscles. During the course, the FbFN laying in the innominate fascial layer was divided into 3 branches. The anterior and posterior branch of FbFN crossed the reference line superiorly and laterally at 3 and 4 cm from the lateral canthus, respectively. In conclusion, the oculofacial surgeon must bring the dissection plane of the forehead tissue more superficially around the 3 cm superolaterally to the lateral canthus in the direction of 45° from the horizontal line in order to avoid nerve injury.
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Affiliation(s)
- Kang-Jae Shin
- Department of Anatomy and Cell Biology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Shin-Hyo Lee
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Young-Chun Gil
- Department of Anatomy, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyun Jin Shin
- Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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The Middle Temporal Vein on Computed Tomographic Angiography: Implications for Filler Injection and Reconstructive Surgery. Plast Reconstr Surg 2023; 151:315-324. [PMID: 36696313 DOI: 10.1097/prs.0000000000009837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Detailed knowledge of middle temporal vein (MTV) anatomy would benefit health care professionals when performing filler injection and reconstructive surgery. The purpose of this study was to assess the variation and course of the MTV using computed tomographic angiography. METHODS Computed tomographic angiography images of 300 MTVs from 150 Asian patients were evaluated in this study. The course and branching pattern of the MTVs were evaluated, as well as the relationship between the location of the MTV and the frontal branch of the superficial temporal artery. The diameter of the MTV and the distances between anatomic landmarks and temporal vessels were measured. RESULTS The MTV was identified in all images, with an average diameter of 2.98 ± 0.80 mm. All MTVs had at least one major trunk; 12.3% had two major trunks. According to the landmarks, the MTV ran 16.3 ± 8.1 mm, 24.8 ± 4.5 mm, and 24.2 ± 4.6 mm above bony lateral canthus, jugale, and zygion point, respectively. Regarding the relationship between the MTV and the frontal branch of the superficial temporal artery, most of the superficial temporal arteries (81.7%) were located above the MTVs, whereas only 9.0% of the superficial temporal arteries crossed the MTVs. The superficial temporal artery was located 43.5 ± 9.6 mm, 44.3 ± 11.9 mm, and 37.0 ± 11.9 mm above the bony lateral canthus, jugale, and zygion point, respectively. CONCLUSION Detailed knowledge of MTV anatomy will provide a valuable reference for safe filler injection and reconstructive surgery in the temporal region. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Abstract
The surgical approach to the brow has changed perhaps more than any other facial esthetic procedure in the past 20 years. Understanding the functional anatomy of the upper face is the best means of maximizing results and minimizing untoward events in this region. The surgical and clinical correlation is addressed in detail in this article. Cadaver and intraoperative photographs are used to illustrate critical points. Armed with the details of this anatomy, the reader will best be able to best individualize surgical treatment.
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Affiliation(s)
- James E Zins
- Section of Cosmetic Surgery, Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jacob Grow
- Southern Indiana Aesthetic and Plastic Surgery, 2450 NorthPark, Suite B, Columbus, Indiana 47203, USA
| | - Cagri Cakmakoglu
- Cleveland Clinic Department of Plastic Surgery, 9500 Eucllid Avenue, Cleveland Ohio 44195, USA
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Chen CL, Cong LY, Kong XX, Zhao WR, Hong WJ, Luo CE, Luo SK. Three-Dimensional Computed Tomography Scanning of Temporal Vessels to Assess the Safety of Filler Injections. Aesthet Surg J 2021; 41:1306-1313. [PMID: 33647932 DOI: 10.1093/asj/sjaa371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. OBJECTIVES This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection. METHODS Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus. RESULTS In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries. CONCLUSIONS 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.
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Affiliation(s)
- Chun-Lin Chen
- Jinan University, The First Affiliated Hospital, Guangzhou, China
| | - Li-Yao Cong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Xiang-Xue Kong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wei-Rui Zhao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Cheng-En Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
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Huang PPH. Commentary on: Three-Dimensional Computed Tomography Scanning of Temporal Vessels to Assess the Safety of Filler Injections. Aesthet Surg J 2021; 41:1314-1315. [PMID: 33629725 DOI: 10.1093/asj/sjab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cotofana S, Gaete A, Hernandez CA, Casabona G, Bay S, Pavicic T, Coimbra D, Suwanchinda A, Swift A, Green JB, Nikolis A, Frank K. The six different injection techniques for the temple relevant for soft tissue filler augmentation procedures – Clinical anatomy and danger zones. J Cosmet Dermatol 2020; 19:1570-1579. [DOI: 10.1111/jocd.13491] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA
| | | | | | | | - Shino Bay
- Shino Bay Cosmetic Dermatology & Laser Institute in Fort Lauderdale Fort Lauderdale FL USA
- Department of Dermatology at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale Fort Lauderdale FL USA
| | - Tatjana Pavicic
- Private Practice for Dermatology & Aesthetics Munich Germany
| | - Daniel Coimbra
- Department of Cosmetic Dermatology at Santa Casa de Misericórdia Rio de Janeiro Brazil
| | - Atchima Suwanchinda
- Department of Dermatology School of Anti‐Aging and Regenerative Medicine Mae Fah Luang University Bangkok Thailand
- Ramathibodi University Hospital Mahidol University Bangkok Thailand
| | - Arthur Swift
- Westmount Institute of Plastic Surgery Montreal QC Canada
| | - Jeremy B. Green
- Skin Associates of South Florida and Skin Research Institute Coral Gables FL USA
| | - Andreas Nikolis
- Clinical Research Unit Erevna Innovations Inc Montreal QC Canada
- Division of Plastic Surgery McGill University Montreal QC Canada
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery Ludwig – Maximilian University Munich Munich Germany
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Cotofana S, Lachman N. Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie. J Dtsch Dermatol Ges 2019; 17:399-415. [PMID: 30958928 DOI: 10.1111/ddg.13737_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, New York, USA
| | - Nirusha Lachman
- Department of Anatomy and Department of Surgery, Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
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Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures. Plast Reconstr Surg 2019; 143:416-426. [DOI: 10.1097/prs.0000000000005201] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cotofana S, Lachman N. Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery. J Dtsch Dermatol Ges 2019; 17:399-413. [DOI: 10.1111/ddg.13737] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical EducationAlbany Medical College Albany New York USA
| | - Nirusha Lachman
- Department of Anatomy and Department of SurgeryDivision of Plastic SurgeryMayo Clinic College of Medicine and ScienceMayo Clinic Rochester Minnesota USA
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Suwanchinda A, Webb KL, Rudolph C, Hladik C, Custozzo A, Muste J, Schalet G, Hamade H, Smith MP, Frank K, Patel A, Cotofana S. The posterior temporal supraSMAS minimally invasive lifting technique using soft-tissue fillers. J Cosmet Dermatol 2018; 17:617-624. [DOI: 10.1111/jocd.12722] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Atchima Suwanchinda
- Department of Dermatology, School of Anti Aging and Regenerative Medicine; Mae Fah Luang University; Bangkok Thailand
| | - Katherine L. Webb
- Department of Medical Education; Albany Medical College; Albany New York
| | - Christina Rudolph
- Department of Medical Education; Albany Medical College; Albany New York
| | - Casey Hladik
- Department of Medical Education; Albany Medical College; Albany New York
| | - Amanda Custozzo
- Department of Medical Education; Albany Medical College; Albany New York
| | - Justin Muste
- Department of Medical Education; Albany Medical College; Albany New York
| | - Grant Schalet
- Department of Medical Education; Albany Medical College; Albany New York
| | - Hassan Hamade
- Department of Medical Education; Albany Medical College; Albany New York
| | - Michael P. Smith
- Department of Medical Education; Albany Medical College; Albany New York
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery; Ludwig - Maximilian University Munich; Germany
| | - Ashit Patel
- Division of Plastic Surgery; Albany Medical Center; Albany New York
| | - Sebastian Cotofana
- Department of Medical Education; Albany Medical College; Albany New York
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Novel Anatomic Description of the Course of the Inferior Palpebral Vein for Minimally Invasive Aesthetic Treatments. Dermatol Surg 2017; 42:618-23. [PMID: 27054444 DOI: 10.1097/dss.0000000000000700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The inferior palpebral vein (IPV) receives tributaries from the inferior palpebral part of the orbicularis oculi muscle (OOc). The aim of this study was to elucidate the venous distribution pattern of the IPV for dermal filler injection. MATERIAL AND METHODS Fifty hemifaces from 34 cadavers were used in this study. The various distribution patterns of the IPV were classified according to its relationship with the angular vein (AV) and facial veins. RESULTS The IPV can be classified into the following 4 types: Type I (58.0%), in which the origin of the IPV is located beneath the lateral part of the OOc; Type II (12.0%), in which the origin of the IPV is located beneath the inferior part of the OOc; Type III (8.0%), in which the origin of the IPV is located beneath both the lateral and inferior parts of the OOc; and Type IV (22.0%), in which the IPV is undeveloped. CONCLUSION The course of the IPV can be approximated by connecting the lateral orbital rim to the C point (the meeting point between the IPV and the AV). The lateral rim can be palpated and the location of the C point is suggested as a columnar area inferior to the pupil.
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An Anatomical Study of the Middle Temporal Vein and the Drainage Vascular Networks to Assess the Potential Complications and the Preventive Maneuver During Temporal Augmentation Using Both Anterograde and Retrograde Injections. Aesthetic Plast Surg 2015; 39:791-9. [PMID: 26174139 DOI: 10.1007/s00266-015-0529-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Non-thrombotic pulmonary embolism has recently been reported as a remote complication of filler injections to correct hollowing in the temporal region. The middle temporal vein (MTV) has been identified as being highly susceptible to accidental injection. METHODS The anatomy and tributaries of the MTV were investigated in six soft embalmed cadavers. The MTV was cannulated and injected in both anterograde and retrograde directions in ten additional cadavers using saline and black filler, respectively. RESULTS The course and tributaries of the MTV were described. Regarding the infusion experiment, manual injection of saline was easily infused into the MTV toward the internal jugular vein, resulting in continuous flow of saline drainage. This revealed a direct channel from the MTV to the internal jugular vein. Assessment of a preventive maneuver during filler injections was effectively performed by pressing at the preauricular venous confluent point against the zygomatic process. Sudden retardation of saline flow from the drainage tube situated in the internal jugular vein was observed when the preauricular confluent point was compressed. Injection of black gel filler into the MTV and the tributaries through the cannulated tube directed toward the eye proved difficult. CONCLUSION The mechanism of venous filler emboli in a clinical setting occurs when the MTV is accidentally cannulated. The filler emboli follow the anterograde venous blood stream to the pulmonary artery causing non-thrombotic pulmonary embolism. Pressing of the pretragal confluent point is strongly recommended during temporal injection to help prevent filler complications, but does not totally eliminate complication occurrence. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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