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Hong GW, Hu H, Park Y, Park HJ, Yi KH. Safe Zones for Facial Fillers: Anatomical Study of SubSMAS Spaces in Asians. Diagnostics (Basel) 2024; 14:1452. [PMID: 39001342 PMCID: PMC11241601 DOI: 10.3390/diagnostics14131452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
The study "Spaces of the Face for Filler Procedures: Identification of subSMAS Spaces Based on Anatomical Study" explores the anatomy of facial spaces crucial for safe and effective filler injections. By delineating the subSMAS (sub-superficial musculoaponeurotic system) spaces, this research highlights how these virtual compartments, bordered by fat, muscles, fascia, and ligaments, facilitate independent muscle movement and reduce the risk of damaging critical structures. The thicker and more robust skin of East Asians necessitates deeper filler injections, emphasizing the significance of accurately identifying these spaces. A cadaver study with dyed gelatin validated the existence and characteristics of these subSMAS spaces, confirming their safety for filler procedures. Key spaces, such as the subgalea-frontalis, interfascial and temporalis, and prezygomatic spaces, were examined, illustrating safe zones for injections. The findings underscore the importance of anatomical knowledge for enhancing facial aesthetics while minimizing complications. This study serves as a guide for clinicians to perform precise and safe filler injections, providing a foundation for further research on the dynamic interactions of these spaces and long-term outcomes.
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Affiliation(s)
- Gi-Woong Hong
- Sam Skin Plastic Surgery Clinic, Seoul 06577, Republic of 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, Republic of Korea
| | | | - Hyun Jin Park
- Department of Anatomy, Daegu Catholic University School of Medicine, Daegu 42472, Republic of 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, Republic of Korea
- Maylin Clinic (Apgujeong), Seoul 06005, Republic of Korea
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Zhuang J, Yuan L, Chai H, Hu J, Wang Y. Response to: Demystifying the Forehead Using Ultrasonography. Aesthet Surg J 2024; 44:NP525-NP526. [PMID: 38629494 DOI: 10.1093/asj/sjae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
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Ahn HS, Kim HM, Oh W, Yi KH, Kim J, Kim HJ. Singular entry point technique for forehead and temple filler augmentation: Anatomical and clinical perspectives. J Cosmet Dermatol 2024. [PMID: 38837504 DOI: 10.1111/jocd.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. METHODS Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three-dimensional (3D) scanning. RESULTS Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. CONCLUSIONS This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians.
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Affiliation(s)
- Hyo-Sang Ahn
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 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, Seoul, Korea
- Maylin Clinic, Apgujeong Seoul, Korea
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Department of Electric and Electronical Engineering, College of Engineering, Yonsei University, Seoul, Korea
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Hong G, Kim S, Park SY, Wan J, Yi K. SMAS repositioning technique utilizing cog thread: Anatomical perspectives. Skin Res Technol 2024; 30:e13650. [PMID: 38497380 PMCID: PMC10945592 DOI: 10.1111/srt.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Face-lifting surgeries were once common among individuals over 60 years old due to skin laxity, but recent trends favor thread lifting in this age group. Understanding dynamic changes in facial anatomy during postural shifts is essential. METHOD Fresh cadaver studies have demonstrated the passage of threads through the superficial musculoaponeurotic system (SMAS) layer, confirming the efficacy of the technique. Proper insertion depth targeting SMAS repositioning, rather than superficial skin layers, is crucial. RESULT The natural movement of tissues secured by thread (N-Cog and N-Fix, N-Finders Inc., Korea) insertion results in lifting effects. However, complications may arise if threads affect deeper facial muscles, leading to discomfort. Fibrous septa play a significant role in guiding thread placement, with different densities influencing thread maneuverability and tissue response during lifting. CONCLUSION Procedures targeting SMAS repositioning using threads aim to maintain the new position of relocated tissues. Understanding structural variations in facial regions informs thread selection and placement. Aligning threads with tissue movement and the intended SMAS layer positioning is vital to prevent complications. Balancing thread insertion depth and tissue traction is critical for successful outcomes. Modern thread lifting techniques prioritize SMAS repositioning, enhancing lifting effects while ensuring procedure safety and efficacy.
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Affiliation(s)
| | - Soo‐Bin Kim
- Division in Anatomy and Developmental BiologyDepartment of Oral BiologyHuman Identification Research InstituteBK21 FOUR ProjectYonsei University College of DentistrySeoulSouth Korea
| | | | - Jovian Wan
- Asia Pacific Aesthetic AcademyHong KongHong Kong
| | - Kyu‐Ho Yi
- Division in Anatomy and Developmental BiologyDepartment of Oral BiologyHuman Identification Research InstituteBK21 FOUR ProjectYonsei University College of DentistrySeoulSouth Korea
- Maylin Clinic (Apgujeong)SeoulSouth Korea
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Pak I, Askarov M, Kissamedenov N, Klyuyev D, Kamyshanskiy Y. Experimental study on clinical and morphological determination of the optimal cannula diameter for lipoaspirate harvest from rabbit inguinal fat pad. J Appl Biomed 2023; 21:99-105. [PMID: 37376884 DOI: 10.32725/jab.2023.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023] Open
Abstract
Determining the most appropriate cannula diameter for lipoaspirate harvesting is important, both in terms of the quality and composition of the material obtained, and the ease of practical use of the cannula. The size of the cannula is one of the main factors affecting the qualitative characteristics of the obtained lipoaspirate sample for further use of adipose tissue. The purpose of the investigation was to clinically and histomorphometrically determine the optimal cannula diameter for lipoaspirate samples collection from rabbit inguinal fat pad in an experimental study. The methods of Animal models, Surgical procedures, Macroscopic examination, Histological examination, and Morphometric study were applied. There is a direct correlation between the percentage of connective tissue fibres in the lipoaspirate and the diameter of the cannula. The lack of clear criteria for selecting a lipoaspiration cannula is one of the limitations to obtaining generally accepted lipoaspiration protocols with subsequent use of adipose tissue. In this study, the animal experiment determined the most ideal cannula diameter suitable for collecting the largest amount of lipoaspirate for subsequent use.
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Affiliation(s)
- Ilona Pak
- Karaganda Medical University, Research Center, Karaganda, Republic of Kazakhstan
| | - Meirambek Askarov
- Karaganda Medical University, Department of Surgical Diseases, Karaganda, Republic of Kazakhstan
| | - Nurlan Kissamedenov
- National Center for Neurosurgery, Department of Reception and Diagnosis, Astana, Republic of Kazakhstan
| | - Dmitriy Klyuyev
- Karaganda Medical University, Research Center, Karaganda, Republic of Kazakhstan
| | - Yevgeniy Kamyshanskiy
- Clinic of Karaganda Medical University, Department of Pathology, Karaganda, Republic of Kazakhstan
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Desyatnikova S. Understanding the Anatomic Layers of the Forehead Seen on Ultrasound: A Guide for Injectable Fillers and Chemodenervation. Facial Plast Surg Aesthet Med 2023; 25:179-181. [PMID: 36099185 DOI: 10.1089/fpsam.2022.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Analysis of facial ultrasonography images based on deep learning. Sci Rep 2022; 12:16480. [PMID: 36182939 PMCID: PMC9526737 DOI: 10.1038/s41598-022-20969-z] [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: 01/22/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Transfer learning using a pre-trained model with the ImageNet database is frequently used when obtaining large datasets in the medical imaging field is challenging. We tried to estimate the value of deep learning for facial US images by assessing the classification performance for facial US images through transfer learning using current representative deep learning models and analyzing the classification criteria. For this clinical study, we recruited 86 individuals from whom we acquired ultrasound images of nine facial regions. To classify these facial regions, 15 deep learning models were trained using augmented or non-augmented datasets and their performance was evaluated. The F-measure scores average of all models was about 93% regardless of augmentation in the dataset, and the best performing model was the classic model VGGs. The models regarded the contours of skin and bones, rather than muscles and blood vessels, as distinct features for distinguishing regions in the facial US images. The results of this study can be used as reference data for future deep learning research on facial US images and content development.
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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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