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Germani M, Miranda de Souza Almeida CC, Muñoz-Lora VRM. Comparison of 2 Fillers for Lip Injection-A Randomized-Controlled Clinical Trial Assessed by 3D Imaging. Aesthet Surg J Open Forum 2024; 6:ojae003. [PMID: 38938925 PMCID: PMC11210068 DOI: 10.1093/asjof/ojae003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Lip aging is a concern for many, and hyaluronic acid (HA) injections are a popular solution. Objectives This study compared 2 different HA gel technologies (OBT and NASHA) for lip augmentation in 20 volunteers. Methods Both groups received treatment from the same injector using the same method. Lip volume was measured with a 3D stereophotogrammetry device before, immediately after, and 30 days posttreatment. Patient satisfaction and adverse events were assessed through FACE-Q scales analysis. Results The NASHA group showed an immediate volume increase (P = .01), which decreased after 30 days. The OBT group did not show a significant immediate growth (P = .535) but did exhibit a significant increase after 30 days (P = .014). After 30 days, there were no significant volume differences between the groups (P = .802 and P = .999). FACE-Q analysis revealed no significant differences among groups after 30 days. Conclusions This study highlights that less cohesive gels may modify faster in dynamic lip areas, emphasizing the importance of selecting products based on their physicochemical and rheological properties. In the context of lip augmentation with HA, it is important not to consider immediate aesthetic changes as definitive results, as volume changes may persist and develop over time after the treatment. Level of Evidence 2
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Affiliation(s)
| | | | - Victor Ricardo Manuel Muñoz-Lora
- Corresponding Author: Dr Victor Ricardo Manuel Muñoz-Lora, Guarulhos University, Praça Tereza Cristina, 88—Centro, Guarulhos, São Paulo 07023-070, Brazil. E-mail: ; Instagram: @drvictormlora
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2
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Germani M, Almeida CCMS, Munoz-Lora VRM, Rogério V, Moelhoff N, Freytag DL, Green JB, Alfertshofer M, Davidovic K, Cotofana S. How to improve infraorbital hollows with neuromodulators-A clinical prospective interventional study about the application of facial biomechanics. J Cosmet Dermatol 2023; 22:2950-2956. [PMID: 37632259 DOI: 10.1111/jocd.15970] [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: 05/23/2023] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND A previous injection algorithm termed the "Toxin Lift" was recently introduced and described volume increases in the midface following neuromodulator treatments of the jawline. Increase in midfacial volume due to soft tissue repositioning could also affect the severity of infraorbital hollows. OBJECTIVE The objective is therefore to evaluate whether the severity of infraorbital hollows can be improved by injecting neuromodulators in the supra-mandibular segment of the platysma. MATERIALS AND METHODS A total of 35 volunteers (11 males/24 females) with a mean age of 39.8 (9.6) years and a mean BMI of 25.2 (5.2) kg/m2 were investigated. Bilateral infraorbital regions were evaluated via clinical assessment and semi-quantitative 3D imaging. The applied injection technique targeted the platysma via four injection points administering 5 I.U. per injection point resulting in a total of 20 I.U. per facial side. RESULTS Volume increase of the infraorbital region was 0.13 cc at 15 days (p = 0.001) and was 0.02 cc at 30 days (p = 0.452) whereas the skin displacement in cranial direction was 0.54 mm at 15 days (p < 0.001) and was 0.31 mm at 30 days (p < 0.001). Clinical evaluation revealed a highly statistically significant improvement of the tear trough, palpaebromalar groove, and of the lid-cheek junction when compared to baseline with all p < 0.001. CONCLUSION The results of this clinical prospective interventional analysis revealed that the "Toxin Lift" injection technique is capable to improve the clinical appearance of infraorbital hollows. The effects can be explained by the concepts of facial biomechanics.
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Affiliation(s)
| | | | | | | | - Nicholas Moelhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Gemeinschaftsklinikum Havelhöhe, Berlin, Germany
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute, Coral Gables, Florida, USA
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Kristina Davidovic
- Department of Radiology & Medical School, University of Belgrade, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
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Frank K, Ehrl D, Bernardini F, Walbrun A, Moellhoff N, Alfertshofer M, Davidovic K, Mardini S, Gotkin RH, Cotofana S. How We Look At Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:115-122. [PMID: 36099471 DOI: 10.1093/asj/sjac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is still unclear which facial region contributes most to the perception of an aged face when evaluated by eye-tracking analyses. OBJECTIVES The authors sought to apply eye-tracking technology to identify whether mature faces require longer fixation durations than young faces and which facial region contributes most to the perception of a mature face. METHODS Eye-tracking analyses were conducted in 74 volunteers (37 males, 37 females; 43 ≤ 40 years, 31 > 40 years) evaluating their gaze pattern and the fixation durations for the entire face and 9 facial subregions. Frontal facial images of 16 younger (<40 years) and older (>40 years) gender-matched individuals were presented in a standardized setting. RESULTS Independent of age or gender of the observer, a younger stimulus image was viewed shorter than an older stimulus image with 0.82 (0.63) seconds vs 1.06 (0.73) seconds with P < 0.001. There was no statistically significant difference in their duration of a stable eye fixation when observers inspected a male vs a female stimulus image [0.94 (0.70) seconds vs 0.94 (0.68) seconds; P = 0.657] independent of the observer's age or gender. The facial image that captured the most attention of the observer (rank 9) was the perioral region with 1.61 (0.73) seconds for younger observers and 1.57 (0.73) seconds for older observers. CONCLUSIONS It was revealed that the perioral region attracts the most attention of observers and contributes most to an aged facial appearance. Practitioners should be mindful of the importance of the perioral region when designing an aesthetic treatment plan.
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Affiliation(s)
- Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Alina Walbrun
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kristina Davidovic
- Department of Radiology and Medical School, University of Belgrade, Belgrade, Serbia
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Fabi SG, Hernandez C, Montes JR, Cotofana S, Dayan S. Aesthetic considerations when treating the Latin American patient: Thriving in diversity international roundtable series. J Cosmet Dermatol 2023; 22:593-602. [PMID: 36468194 DOI: 10.1111/jocd.15516] [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: 09/13/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The Hispanic/Latin American population is the fastest growing non-Caucasian group in the United States. Within this group, demand for aesthetic procedures is on the rise. High ethnic variability among these patients influences treatment approaches and patient priorities. Understanding these ethnic differences is central to providing optimal care. AIMS To discuss similarities and differences in anatomy and treatment preferences of Hispanic/Latin American patients both within the United States and internationally and explore how these differences may influence or inform aesthetic practices. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. In this roundtable, held in Medellin, Columbia, expert clinicians from across Latin America and the United States were invited to contribute and share best practices. RESULTS The results of the second roundtable in the series, the Latin American Patient, are described here. A special emphasis is placed on procedures that address the most commonly encountered concerns in these patients. CONCLUSIONS Hispanic and Latino patients represent a broad demographic with unique anatomical features, aesthetic preferences, and treatment priorities. Clinicians should consider these differences when treating this patient population.
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Affiliation(s)
| | | | - José Raúl Montes
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Jose Raul Montes Eyes & Facial Rejuvenation, San Juan, Puerto Rico
| | | | - Steve Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
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Hernandez CA, Zapata DEU, Bermudez MP, Frank K, Moellhoff N, Alfertshofer M, Gotkin RH, Davidovic K, Cotofana S. Clinical validation of the upper face first principle-A clinical, prospective, interventional split-face study. J Cosmet Dermatol 2023; 22:418-425. [PMID: 36573471 DOI: 10.1111/jocd.15563] [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: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. OBJECTIVE To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. METHODS This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. RESULTS Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. CONCLUSION Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.
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Affiliation(s)
| | | | | | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | | | - Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Few JW. Editor’s Note from Cosmetic Medicine Section Editor Julius W. Few, Jr., MD. Aesthet Surg J 2022; 42:1107-1108. [DOI: 10.1093/asj/sjac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julius W Few
- School of Medicine, University of Chicago Pritzker School of Medicine , Chicago, IL , USA
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Labadie JG, Dover JS. Commentary On: Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics. Aesthet Surg J 2022; 42:1172-1174. [PMID: 35576932 DOI: 10.1093/asj/sjac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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